COPD

Question 1

COPD overview

Answer 1

Preventable and treatable disease characterised by persistent, progressive airflow limitation
Enhanced chronic inflammation
Hospital admissions and economic burden
Rising prevalence due to ageing population

Question 2

Effects on Airways

Answer 2

Chronic inflammation
Increased number of goblet
Mucus cell hyperplasia
Fibrosis
Narrowing and reduction in the number of small airways
Airway collapse due to alveolar wall destruction in emphysema

Question 3

Different types of symptoms

Answer 3

Chronic Bronchitis (large airways): chronic productive cough for 3 months in 2 successive years.
Emphysema (alveolar): abnormal and permanent enlargement of airspaces due to destruction of the alveolar airspace walls - effects gas exchange.
Small airways disease: wheeze

Question 4

Risk Factors

Answer 4

Cigarette smoke - smoking history: age started, pack per year history, times stopped.
Occupational dust and chemicals
Environmental tobacco smoke
Indoor and outdoor air pollution
Genes
Infections
Socio-economic stauts
Ageing population

Question 5

Pathophysiology

Answer 5

Airways narrowing due to chronic irritation of the bronchi causing inflammation and changes to the mucocilliary escalator, often results in chronic cough.
Airways narrowing due to bronchoconstriction and inflammation; duration and severity are risk factors for development of airway remodelling and COPD.
Airways collapse due to destruction of alveolar walls - may be bullae.
- Large airway inflammation, small airways, emphysema

Question 6

Diagnosis

Answer 6

Symptoms + Risk Factors (10pkpy smoking history and age >35 years) + Spirometry (FEV1/FVC < 0.7)

Question 7

Physical Signs

Answer 7

Barrel shaped chest
Hyperresonant on percussion
Accessory Muscles & prolonged expiration
Pursed lip breathing
Tripod Position
Low BMI
Nicotine-staining
- Increased work of breathing
- Reduced exercise tolerance
- Inpaired gas exchange: hypoxia, hypercapnia, raised pul artery pressure, RV dilation, cor pulmonale, loss of fat free mass

Question 8

Chronic Disease Management

Answer 8

Stop smoking
If symptomatic LABA/LAMA combined inhaler
Flu vaccination
Educate and empower
Treat exacerbations
Pulmonary rehabilitation
Think about the whole patient (bones, nutrition, mental health)

Question 9

Rehabilitation and Treatment

Answer 9

2x supervised sessions for 6 weeks - supervised exercise/education/psychosocial support and group work.
Theophylline (oral phosphodiesterase inhibitor)
Azithromyocin 3x/week (anti-inflammatory antibiotic prophylaxis)
Lung volume reduction surgery (valves/bullectomy)
Lung Transplantation

Question 10

Acute and Severe Exacerbation

Answer 10

Acute:
Mild (SABA)
Moderate (SABA +/- steroids +/- antibiotics)
Severe (hospital admission) or ED attendance
Severe:
Antibiotics if signs of infection
Oral steroids
Target saturations 88-92%
Nebuliserfs (bronchodilate)
Consider diruetics
Nicotine replacement therapy

Question 11

Treatment Failure

Answer 11

Decompensated hypercapnic respiratory failure despite controlled oxygen and nebulised treatments –> non invasive ventilation.
Respiratory failure despite nebulised therapy and controlled oxygen and patient unable to tolerate –> consider invasive mechanical ventilation.
Respiratory failure on background of significant progressive decline over several months/years with no evidence of reversible event –> palliate

Question 12

Symptom control of COPD

Answer 12

Oromorph
Lorazepam
Fan therapy
Oxygen therapy
Cognitive behavioural therapy
Pacing/breathing strategies
Hospice input