COPD

Question 1

Examination signs of COPD

Answer 1

GA:

• purse lipped breathing
• use of accesory muscles
• drowsiness
• cyanosis
• ?sputum cup, on oxygen?

VITALS

• low O2 sats, afebrile, normal BP, normal HR

HANDS

• tar staining
• flapping - CO2 retention
• CLUBBING DOES NOT OCCUR IN COPD

EYES

• subconjunctival haemorrages from coughing

MOUTH

• cyanosis

PALPATION

• reduced chest expansion
• hyperinflated chest
• Hoover’s sign
• tracheal tug

PERCUSSION

• hyperresonant with decreased liver dullness

AUSCULTATION

• decreased breath sounds
• early inspiratory crackles
• wheeze is often absent
• signs of right heart failure in late disease

Question 2

Investigations for COPD

Answer 2

• spirometry - low FEV1/FVC <70%
• pulse oximetry - low O2 sats
• ABG - respiratory acidosis
• CXR - to rule out pneumonia and pneumothorax
• FBC - polycythemia? leucocytosis
• ECG - signs of right ventricular hypertrophy, arrhythmia, ischaemia

______________________________

• pulmonary function test - decreased DLCO
• sputum culture
• chest CT

Question 3

What is COPD X?

Answer 3

• Confirm diagnosis
  
  • spirometry, CXR, ECG, FBC etg
• Optimise lung function
  
  • SABA/LABA/ICS/SAMA/LAMA
  • theophylline
  • oxygen
  • STOP SMOKING !!!!!
  • lifestyle
    
    • smoking cessation
    • encouragement of physical activity
    • pulmonary rehabilitation
    • Immunisation
• Prevent deterioration
  
  • STOP SMOKING !!!!
• Develop a plan of care
• manage eXacerbations

Question 4

What are some comorbidities/complications of COPD?

Answer 4

• cardiovascular disease
• anxiety + depression
• osteoporosis
• diabetes
• cor pulmonale + pulmonary HTN