COPD

Question 1

What are the TWO CONDITIONS that COPD encompasses?

Answer 1

Emphysema

Chronic Bronchitis

Question 2

What are the MAIN CHARACTERISTICS of COPD?

Answer 2

Slowly Progressive Disorder

Airflow Obstruction, due to Small Airway Narrowing

Lung Impairment is, usually, Fixed.

Question 3

Describe the EPIDEMIOLOGY of COPD:

Answer 3

1) 5th and 6th Most Common Cause of Death in the World and the UK, respectively
2) UK Prevalence = approx. 1.5-2 million
3) Highest Incidence Rate = Low Educational and Socioeconomic Classes
4) By 2030, will be 3rd Leading Cause of Death

Question 4

What are some of the SYMPTOMS of COPD?

Answer 4

Insidious Onset

1) Dyspnoea
2) Chronic Cough (Chronic Bronchitis)
3) Sputum Production (Chronic Bronchitis)
4) Wheeze - on Exertion
5) Recurrent Chest Infection
6) Weight Loss
7) Peripheral Oedema - Cor Pulmonale

Question 5

How is CHRONIC BRONCHITIS defined?

Answer 5

‘Clinically’ as:

Cough Productive of Sputum for

1) Most Days
2) At Least 3 Consecutive Months
3) 2 or More Years

Question 6

What are some of the SIGNS of COPD?

Answer 6

1) Pursed-Lip Breathing
2) Tachypnoea
3) Use of Accessory Muscles of Respiration
4) Flapping Tremor
5) Cyanosis
6) Hyperexpanded (Barrel) Chest
7) < Breath Sounds
8) > Resonance/Hyper Resonance to Percussion
9) < Cricosternal Distance - < 3cm
10) Palpable Liver

Question 7

What is the ESSENTIAL INVESTIGATION for COPD and what would be the EXPECTED FINDINGS?

Answer 7

Spirometry

Obstructive Pattern (+ Gas Trapping + < Gas Transfer, in Emphysema)

1) FEV1 < 80% of the Predicted Normal
2) FEV1:FVC < 70%
3) > Total Lung Capacity (TLC)
4) > Residual Volume (RV)
5) < Carbon Monoxide Diffusing Capacity (DLCO)

Question 8

What other USEFUL INVESTIGATIONS can be carried out for COPD?

Answer 8

1) CXR
2) Arterial Blood Gases
3) FBCs - Secondary Polcythaemia due to Chronic Hypoxia
4) ECG - Right Atrial Enlargement (P Pulmonale)
5) Sputum Microscopy and Culture - LRTI Pathogens
6) Bronchodilator Trial - Minimal Reversibility
7) BMI - Low due to Weight Loss

Question 9

How is EMPHYSEMA defined?

Answer 9

‘Histologically’ as:

1) Enlarged Spaces, Distal to the Terminal Bronchioles
2) Destruction of the Alveolar Walls

Question 10

What would be the expected FINDINGS from a CXR of a COPD patient?

Answer 10

1) Hyperinflated Lung Fields ( > 10 Posterior Ribs)
2) Flattened Hemidiaphragms
3) Lucent Lung Fields
4) Bullae

Question 11

What would be the expected FINDINGS from ABGs of a COPD patient?

Answer 11

Low PaO2 (Type I Respiratory Failure) + or - Hypercapnia (Type II Respiratory Failure)

Question 12

What are the CAUSES of COPD?

Answer 12

1) Smoking (85%)
2) Chronic Asthma
3) Maternal Smoking
4) Air Pollution
5) Occupational Exposure to Noxious Chemicals, Gases and Materials
6) Genetics - Alpha 1-Antitrypsin Deficiency

Question 13

What are the AIMS in the MANAGEMENT of COPD?

Answer 13

1) Prevention of Disease Progression
2) Relieve Breathlessness
3) Prevention of Exacerbations
4) Management of Complications

Question 14

How can COPD symptoms be MANAGED in a NON-PHARMACOLOGICAL

manner?

Answer 14

1) Smoking Cessation
2) Annual Flu Vaccination
3) Pulmonary Rehabilitation
4) Nutritional Assessment
5) Psychological Support

Question 15

What PHARMACOLOGICAL TREATMENTS are utilised in the MANAGEMENT of COPD?

Answer 15

Long-Term O2 Therapy

Inhaled Therapy:

1) Short Acting Bronchodilators
- SABA, i.e. Salbutamol
- SAMA, i.e. Ipratropium

2) Long Acting Bronchodilators
- LAMA, i.e. Tioptropium
- LABA, i.e. Salmeterol

3) Inhaled Corticosteroids (ICS) and LABA

Question 16

What is the STEPWISE APPROACH to TREATING WORSENING SYMPTOMS/EXACERBATIONS of COPD?

Answer 16

1) Few Symptoms + Low Risk of Exacerbations = As Required SABA
2) More Symptoms + Low Risk of Exacerbations = Single Agent LABA or LAMA commenced
3) Few Symptoms + High Risk of Exacerbations = Combined LAMA and LABA Inhaler
4) More Symptoms + High Risk of Exacerbations = Triple Therapy (Combined ICS and LABA + Single Agent LAMA)

Question 17

What are some of the CAUSES of ACUTE EXACERBATIONS of COPD (AECOPD)?

Answer 17

1) Viral/Bacterial Infection
2) Sedative Drug Use
3) Pneumothorax
4) Trauma

Question 18

What are the SYMPTOMS of AECOPD?

Answer 18

1) > Cough
2) > Sputum Volume and Purulence
3) > Dyspnoea
4) > Wheeze
5) > Oedema
6) Sleep Disturbance
7) Confusion

Question 19

What are the ESSENTIAL INVESTIGATIONS for a patient admitted with AECOPD?

Answer 19

1) CXR
2) FBCs and Serum Biochemistry (LFTs; U and Es)
3) ABGs
4) Sputum Microscopy and Culture
5) ECG

Question 20

How would a patient admitted with AECOPD by MANAGED?

Answer 20

1) Nebulised Bronchodilators
2) O2 Therapy (Target Sats = 88-92%)
3) IV Corticosteroids
4) Antibiotics
5) Diuretic IV Aminophylline
6) Non-Invasive Ventilation (if Acute Respiratory Failure)