COPD

Question 1

Define COPD

Answer 1

a common progressive disorder characterized by airway obstruction with little or no reversibility

It includes chronic bronchitis and emphysema

Usually patients have either COPD or asthma, not both

Question 2

Define chronic bronchitis

Answer 2

It is a daily cough for about 3 months in 2 consecutive years

Question 3

When do symptoms improve in chronic bronchitis

Answer 3

When smoking is stopped

Question 4

Define emphysema

Answer 4

Histologically defined as enlarged air spaces distal to terminal bronchioles with alveolar wall destruction

Question 5

Risk factors of COPD

Answer 5

Age

Smoking

Exposure to toxic fumes

Genetic (A1 antitrypsin deficiency)

Question 6

Epidemiology of COPD

Answer 6

10-20% of over 40s

Question 7

Symptoms of COPD

Answer 7

persistent cough/sputum/SOB/wheeze

Question 8

Signs of COPD

Answer 8

Tachypnoea - use of accessory muscles

hyperinflation

Reduced expansion

Hyperesonant percussion note

Quite breath sounds

Wheeze

Question 9

Complications of COPD

Answer 9

Acute exacerbation +- infection

respiratory failure

Cor pulmonalae

Pneumothorax (ruptured bullae)

Lung carcinoma

Question 10

How to investigate COPD

Answer 10

FBC

PCV?

CXR - Hyperinflation, flat diaphragms

ABG - hypercapnia(increased CO2)

lung function tests - spirometry

Question 11

Conservative management of COPD

Answer 11

Smoking cessation

Pulmonary rehabilitation:

Encourage exercise

Nutritional counseling

all these reduce symptoms improves health and boosts confidence

Question 12

Medicine management of COPD

Answer 12

Broncholdiators: short and long B2 agonists

Inhaled corticosteroids

Oral corticosteroids - useful in exacerbation

Oxygen

influenza vaccination and pneumococcal vaccination

Treat depression and cachexia which may occur because of disabling disease

Question 13

Surgical management of COPD

Answer 13

In highly selected patinets, lung volume reduction therapy may be beneficial

Bullectomy - if large bullae compressing surrounding lung tissue

Question 14

What is cachexia

Answer 14

Wasting and weakness of body because of chronic disease

Question 15

Management of acute COPD

Answer 15

In order

Look for cause

Nebulized bronchodilators (salbutamol/ipratioprum)

Investigate - CXR ABG

O2 Therapy aim sats 88-92%

Steroids - IV hydrocortison and oral predinisolone

Antibiotics - if infection is suspected

Physiotherapy for aid in sputum expectoration

If no response to nebulizers and steroids consider aminophyline (theophline)

If still no response consider non invasive positive pressure ventilation (NIPPV)

Consider intubation and ventilation

Call S/V

Question 16

COPD ladder

Answer 16

Give all Pts SABA or SAAM

FEV1>50%
LABA add ICS add step 3
or
LAAM seeda to step 3

FEV1<50 LABA and ICS then ICS.
.
step3 –> icS, lama, laba