COPD

Question 1

What is COPD?

Answer 1

Irreversible airway obstruction from lung damage.

Question 2

Red flags for COPD?

Answer 2

Significant smoking history, wheeze, productive cough (sputum) + recurrent respiratory infection.

Question 3

Diagnosis of COPD?

Answer 3

1) History + Respiratory Examination
2) Spirometry = 1st line
3) FeV1 : FVC <0.7
4) Not entirely reversible by SABA

Question 4

Assessing Severity of COPD?

Answer 4

FeV1 % vs normal values
Stage 1) >80%
Stage 2) <80%
Stage 3) <50%
Stage 4) <30%

Question 5

Additional Investigations for COPD?

Answer 5

CXR - hyperinflated lungs
FBC - Anaemia OR Compensatory Hypoxic Polycythaemia (raised Hb due to increase RBC production)
Pulmonary Function Tests - low KCO (rule out asthma)

Question 6

Lifestyle management of COPD?

Answer 6

1) Smoking cessation
2) Single combined annual flu AND pneumococcal vaccine
3) Encourage exercise

Question 7

Long term drug management for COPD?

Answer 7

1) Inhaled SABA OR SAMA (e.g. ipratropium)
2) Are they steroid responsive/asthmatic?
2. 5) Yes = Combined LABA + ICS inhaler
3) No = Combined LABA + LAMA inhaler

Question 8

What are Steroid responsive features?

Answer 8

Inflammation e.g. atopy, eosinophils in blood
Day to day variation in PEFR >20%
FeV1 variation >400ml

Question 9

Signs of acute COPD exacerbation?

Answer 9

1) Worsening Dyspnoea + Productive Cough (more sputum/changed colour)
2) May = worse wheeze + chest tightness
3) Severe can = respiratory distress/fail (cyanosis, confusion etc.)

Question 10

Assess acute COPD exacerbation?

Answer 10

1) ABCDE
2) Obs + patient background
3) ABG - partially compensated resp acidosis (CO2 retention)
4) Bloods (raised WCC)
5) CXR + Blood/sputum culture

Question 11

O2 therapy for acute COPD exacerbation?

Answer 11

1)15L/min Non-breathable before ABG
2)If CO2 retention = Venturi (88-92% aim)
No retention = Aim >94%

Question 12

Medical Therapy for acute COPD Exacerbation?

Answer 12

Home: Prednisolone 30mg OD 7-14 days, SABA inhaler + Antibiotics (if bacterial)
Hospital: Neb Salbutamol (5mg/4hrs) + Ipratropium (500mcg/6hrs), Antibiotics
Severe: IV Xanthine bronchodilation (e.g. theophyline), ventilation on ICU