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Flashcards in Stable COPD Deck (18)
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Define COPD

  • Airflow obstruction
  • Not fully reversible
  • Usually progressive deterioration
  • Predominantly caused by smoking (90%)


How would COPD present on spirometry?

  • Obstructive pattern
    • FEV1 reduced
    • FVC reduced (>0.8)
    • FEV1/FVC <0.7
  • Limited bronchodilator reversibility
  • Progressive deterioration in subsequent spirometry


Outline the NICE classification of airflow obstruction severity

FEV1/FVC must be <0.7 for obstructive disease

Post-bronchodilator FEV1% predicted:

  • Mild: 50-79%
  • Moderate: 30-49%
  • Severe: <30%


Suggest three risk factors for COPD

  • Smoking
  • Occupational exposure: dust; fumes; chemicals
  • Air pollution
  • Alpha-1-antitrypsin deficiency


When should alpha-1-antitrypsin deficiency be considered in COPD?

  • Early onset
  • Minimal smoking history
  • FHx of alpha-1-antitrypsin deficiency


List four symptoms of COPD

Suspect COPD in >35 with any risk factor and 1+ symptoms:

  • Exertional breathlessness
  • Chronic/recurrent cough
  • Regular sputum production
  • Frequent LRTIs
  • Wheeze
  • Weight loss; anorexia; fatigue
  • PND; ankle odema: suggestive of cor pulmonale
  • Reduced exercise tolerance


Give four signs of COPD

May be normal

  • Cyanosis
  • Raised JVP and/or peripheral oedema
  • Cachexia
  • Hyperinflated chest
  • Use of accessory muscles and/or pursed lip breathing
  • Wheeze and/or crepitations
  • Hypercapnia: Bounding pulse, CO2 retention flap, confusion


Differentiate between the clinical features of COPD and asthma


Outline the MRC dyspnoea scale

  1. Only on strenuous exercise
  2. Hurrying or walking up a slight hill
  3. Either:
    • Walks slower than peers on level ground
    • Stops for breath when walking at own pace
  4. Either:
    • Stops for breath after walking about 100m
    • Stops after a few minutes on level ground
  5. Unable to leave house; SOB when dressing or undressing


Request three investigations for suspected COPD

  • Spirometry
    • Post-bronchodilator spiratory to confirm COPD
  • CXR: exclude other pathology
  • FBC: anaemia or polycythaemia (chronic hypoxia)
  • BMI
  • Sputum culture
  • Serial peak flow: exclude asthma
  • ECG; BNP; Echo: suspected cor pulmonale
  • Serum alpha-1-trypsin


Suggest four lifestyle modifications for COPD

  • Smoking cessation
  • Dietary advice: BMI is a prognostic factor
  • Pulmonary rehabilitation: offer to MRC score 3+
  • Vaccinations:
    • One-time pneumococal
    • Annual influenza


Suggest three non-pharmacological management of COPD

  • Chest physio
  • Management of anxiety and depression
  • Dietitian
  • Occupational therapy
  • Palliative: end-stage COPD
  • LTOT or lung volume reduction if appropriate


Outline the medical management of stable COPD

COPD care bundle

  • Consider
    • Mucolytics: if chronic productive cough of sputum
    • Prophylactic antibiotics eg. azithromycin
    • Oral theophylline if either:
      • Uncontrolled by short- and long-acting bronchodilators
      • Unable to use inhaled therapy


What is meant by 'asthmatic feautres or features suggesting steroid responsiveness' in regards to COPD?

  • Any previous diagnosis of asthma or atopy
  • Elevated serum eosinophils
  • Substantial variation in FEV1 over time (at least 400ml)
  • Substantial diurnal variation in PEFR (at least 20%)


Provide three indications for long-term oxygen therapy in COPD

ABG on two occasions at least 3/52 apart in stable COPD on optimal management, either:

  • PaO2 <7.3 kPa when stable
  • PaO2 >7.3kPa and <8kPa, plus one of:
    • Secondary polycythaemia
    • Peripheral oedema
    • Pulmonary HTN


What are the criteria for long term oxygen therapy?

  • Willing to use at least 16hr/day
    • Improves life expectancy
    • Greater benefit when used 20hr/day
  • Must be a non-smoker
  • Must not retain high PaCO2


Describe Cor pulmonale and its link with COPD

Can occur in advanced COPD

  • Either:
    • Secondary RV hypertrophy due to pulmonary HTN
    • Peripheral oedema due to salt & water retention
  • Causes chronic alveolar hypoxia and hypercapnia
    • Due to vasoconstriction of the pulmonary arterioles


Outline the treatment of cor pulmonale

  • Optimal COPD treatment, including smoking cessation help
  • Diuretics: symptom relief