COPD

Question 1

Two common types of COPD

Answer 1

chronic bronchitis

emphysema

Question 2

emphysema

Answer 2

hyperinflation

Question 3

chronic bronchitis

Answer 3

airflow obstruction

not fully reversible

Question 4

What is COPD?

Answer 4

airflow obstruction, progressive disease that is not fully reversible

Question 5

What happens to the airways in COPD?

Answer 5

mucus build up

airway muscles tighten

airway lining swells (inflammation)

Question 6

Main three symptoms of COPD

Answer 6

Breathlessness

Cough

Recurrent chest infections

Question 7

Developing symptoms of COPD

Answer 7

Weight loss
loss of muscle mass
cardiac disease
depression, anxiety

Question 8

Things to look for in order to diagnose COPD

Answer 8

age 35 or more

current or former smoker

Chronic cough

exertional SOB

sputum production

Frequent ‘winter’ bronchitis

Wheeze/ chest tightness

Question 9

On examination, COPD symptoms

Answer 9

reduced chest expansion

prolonged expiration/ wheeze

hyper inflated chest

respiratory failure

Question 10

respiratory failure in COPD symptoms

Answer 10

tachypnoea

cyanosis

use of accessory muscles

pursed lip breathing

reduced breath sounds

peripheral oedema

Question 11

Tachypnoea

Answer 11

abnormally fast breathing

Question 12

Cyanosis

Answer 12

blue colour to the skin and mucus membranes

Question 13

Peripheral Oedema

Answer 13

Fluid accumulation in the peripheral vascular system

usually in the lower limbs

Question 14

Spirometry

Answer 14

Will confirm diagnosis and assess severity

Question 15

COPD severity

FEV1/FVC is less than…

Answer 15

0.7

post-bronchodilator

Question 16

FEV1 in COPD

80%

Answer 16

mild

Question 17

FEV1 in COPD

50-79%

Answer 17

moderate

Question 18

FEV1 in COPD

30-49%

Answer 18

severe

Question 19

FEV1 in COPD

less than 30%

Answer 19

very severe

Question 20

COPD baseline tests

Answer 20

CXR

ECG

Spirometry (recorded absolute and % predicted value)

Full blood count (looking for anaemia etc)

BMI

Blood gases

Question 21

COPD intervention

non-pharmalogical

Answer 21

Smoking cessation

Long term oxygen therapy

Pulmonary Rehabilitation

Vaccines

physiological support

Question 22

Short acting bronchodilators

Answer 22

SABA (eg salbutamol)

SAMA (eg ipratropium)

Question 23

Long acting bronchodilators

Answer 23

LAMA (long acting muscarinic agents) (eg umeclidinium, tioptropium)

LABA (long acting Beta 2 agonist) (eg salmeterol)

Question 24

High dose inhaled corticosteroids (ICS) and LABA

Answer 24

relvar

fostair MDI

Question 25

COPD - long term oxygen is needed is PaO2 is less than

Answer 25

7.3 kPa

Question 26

Polycythaemia

Answer 26

abnormally high haemoglobin in the blood

Question 27

Exacerbated COPD management

Answer 27

Short acting bronchodilators (salbutamol etc) Steroids (prednisone 40mg pre day 5-7days) Antibiotics (if evidence of infection) Consider hospital admission if unwell (tachypnoea, low oxygen saturation of 90-92%, hypotension)

Question 28

Causes of COPD

Answer 28

chronic asthma passive smoking maternal smoking air pollution occupation

Question 29

Stethoscope reading for COPD

Answer 29

reduced breath sounds

Question 30

Significant bronchodilator/steroid response suggest asthma/asthmatic component. No significant response would suggest

Answer 30

COPD

Question 31

Useful Investigations: Chest X-Ray in COPD would show you

Answer 31

hyper inflated lung fields flattened diaphragms Lucent lung fields bullae (blister/fluid build up)

Question 32

All symptoms of COPD

Answer 32

``` Cough increased sputum sputum purulence SOB Wheeze drowsiness unable to sleep oedema ```

Question 33

Other COPD symptoms

Answer 33

``` Confusion cyanosis breathless flapping tremor pyrexial ```

Question 34

Pyrexial

Answer 34

fever

Question 35

What to do?

Answer 35

Chest radiograph blood gases FBC Sputum culture