[Resp] COPD and Pulmonary Hypertension

Question 1

what is COPD?

Answer 1

a combination of chronic bronchitis (clinical) and emphysema (histological) defined by an obstructive defect on spirometry: FEV1/FVC <0.7

Question 2

what is COPD severity determined by?

Answer 2

FEV1 (as a % of predicted)

Question 3

what is mild COPD?

Answer 3

FEV1 ≥80%

Question 4

what is moderate COPD?

Answer 4

FEV1 50-79%

Question 5

what is severe COPD?

Answer 5

FEV1 30-49%

Question 6

what is very severe COPD?

Answer 6

FEV1 <30%

Question 7

what is the mx of COPD once diagnosed?

Answer 7

• smoking cessation
• SABA or SAMA PRN

SABA = short-acting beta2 agonist
SAMA = short-acting muscarinic antagonist

Question 8

what if the pt with COPD has asthmatic features or features suggestive of steroid responsiveness? what do you give the pt now?

Answer 8

LABA + ICS

LABA = long-acting beta2 agonist
ICS = inhaled corticosteroid therapy

Question 9

what does ‘asthmatic features or features suggestive of steroid responsiveness’ mean?

Answer 9

• previous dx of asthma or atopy
• high eosinophil count
• variation in FEV1 (at least 400ml)
• diurnal variation in peak flow (at least 20%)

Question 10

what if the pt with COPD does not have asthmatic features or features suggestive of steroid responsiveness? what would you give the pt?

Answer 10

LABA + LAMA

LAMA = long-acting muscarinic antagonist

Question 11

what would you initiate if the COPD pt has severe exacerbation (hospitalisation) or 2 moderate exacerbations in one year?

Answer 11

triple therapy: LABA + LAMA + ICS

Question 12

what is cor pulmonale?

Answer 12

right heart failure caused by chronic pulmonary arterial HTN

Question 13

what is pulmonary HTN (pHTN)?

Answer 13

pulmonary artery pressure ≥20mmHg

Question 14

what is 1˚ pHTN?

Answer 14

pulmonary artery pressure not related to underlying cause e.g. underlying lung disease

Question 15

what are the clinical features of pHTN?

Answer 15

• progressive exertional dyspnoea with lethargy

- R sided heart failure: raised JVP, peripheral oedema, loud P2 (pulmonary 2nd heart sound) +/- tricuspid regurgitation

Question 16

how do you investigate for pHTN?

Answer 16

ECHO + pulmonary artery pressure

Question 17

what is the mx for pHTN?

Answer 17

• CCB, Endothelin antagonists e.g. bosentan

- ultimately require heart-lung transplant

Question 18

how do you make a clinical dx of cor pulmonale in COPD?

Answer 18

• peripheral oedema
• raised venous pressure
• loud pulmonary 2nd heart sound
• systolic parasternal heave

Question 19

how do you manage cor pulmonale in COPD pts?

Answer 19

• smoking cessation
• optimise COPD medications
• ABG

Question 20

what would you do for COPD pts with ABG showing pO2 <8.0 + features of cor pulmonale?

Answer 20

mortality benefit: long term oxygen therapy (LTOT)

**pts cannot start LTOT if they are current smokers

Question 21

what would you do for COPD pts with ABG showing pO2 >8.0 + features of cor pulmonale?

Answer 21

symptomatic benefit: diuretics

Question 22

FEV1/FVC >0.8 with reduced FVC. dx?

Answer 22

restrictive lung defect

Question 23

COPD exacerbation, pH <7.30 despite back-to-back nebulisers. what to do next?

Answer 23

commence NIV (BiPAP)

Question 24

how do you diagnose cor pulmonale?

Answer 24

clinical dx, ECHO to confirm

Question 25

P450 inhibitor, nausea and refractory hypokalaemia with pt on theophylline. dx?

Answer 25

theophylline toxicity