COPD ☺️

Question 1

Description

Answer 1

Chronic obstructive disease of the lungs

• chronic bronchitis - chronic productive cough
• emphysema - enlargement of air spaces in alveoli leading to inefficient gas exchange

Question 2

Epidemiology

Answer 2

Relatively common, affecting 16% of 40+

-found in smokers, construction workers

Question 3

Aetiology

Answer 3

Smoking
Age - 35+
FHx
Pollution
a1antitrypsin deficiency

Question 4

Pathophysiology

Answer 4

Bronchi get inflammed and release mucus => narrow airways
Alveoli lose their elasticity and collapse => narrow airways

Both lead to reduced gas exchange and poor oxygenation

Question 5

Symptoms

Answer 5

SOB, worse on exertion
Wheeze
Productive cough (white sputum)

Exacerbation

• worsening of symptoms
• sputum changes colour
• fever
• tight chest

Question 6

Signs

Answer 6

Hyperinflated, barrel chest
Tripod position
Pursed lips
Cachexic

CV/resp exam findings

• tar stained fingers, clubbing
• asterixis
• hyperresonant chest
• bilateral lung crackes from cor pulmonale
• elevated JVP, peripheral edema
• wheeze

Question 7

Differential diagnoses

Answer 7

Vascular
-congestive heart failure => generally no productive cough

Iatrogenic/idiopathic
-ACEi induced chronic cough

Infective/inflammatory

• pneumonia => no barrel chest
• bronchiolitis => younger patients
• TB => systemic symptoms, recent travel

Neoplastic
-lung cancer => systemic symptoms

Congenital
-asthma => no productive cough

Degenerative
-bronchiectasis (from CF, recurrent chest infections)

Question 8

Other investigations

Answer 8

FBC - infective
Serum a1antitryptin - for young patients
BMI - cachexia
TLCO - severity of COPD

Sputum culture - infective

CXR - rule out pneumonia, malignancy
ECG/echo - cor pulmonale
CT chest - rule out malignancy, bronchiectasis

Question 9

Diagnostic criteria

Answer 9

Spirometry

• FEV1 < 80% of expected
• FER < 70%, severity judged by GOLD criteria
• no change with SABA

GOLD criteria for FEV1 % of expected
Stage 1 = 80+
Stage 2 = 50-79
Stage 3  = 30-49
Stage 4 = U30

Question 10

Management - pharmacological (NICE)

Answer 10

SABA or SAMA

If not enough and has no asthmatic features => LABA+LAMA combination and consider triple therapy

If not enough and has asthmatic features => LABA+ICS combination and consider triple therapy

Question 11

Management - lifestyle

Answer 11

Healthy diet, physical activity, smoking cessation
Pneumococcal, flu vaccines
Pulmonary rehab

Question 12

Prognosis

Answer 12

Chronic progressive condition with gradual decline in lung function and increasing symptoms over time

• significant relationship between lower FEV1 and risk of exacerbation and death
• smoking cessation can reduce the rate of decline in lung function and exacerbations in COPD