Working problem 8-COPD

Question 1

What is COPD?

Answer 1

COPD is a preventable and treatable disease state characterised by airflow limitation that is not fully reversible. It encompasses both emphysema and chronic bronchitis. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases. It is primarily caused by cigarette smoking. Although COPD affects the lungs, it also has significant systemic consequences.

Question 2

What is the difference in immunological response in COPD and asthma?

Answer 2

UNlike asthma in COPD there is no eosinophil involvement

Question 3

How do you assess COPD?

Answer 3

COPD has an insidious onset and usually presents in older people. A history of productive cough, wheezing, and shortness of breath, particularly with exercise, is typical. The patient’s smoking history, occupational exposures, and any family history of lung disease should be determined.
Patients with COPD may also present with acute, severe shortness of breath, fever, and chest pain during acute infectious exacerbation.
Examination may show tachypnoea, respiratory distress, use of accessory muscles, and intercostal retraction. Barrel chest is a common observation. There may be hyper-resonance on percussion, and distant breath sounds and poor air movement on auscultation. Wheezing, rhonchi, clubbing, and cyanosis, as well as signs of right-sided heart failure (distended neck vein, loud P2, hepatomegaly, hepatojugular reflux, and lower-extremity oedema), may be present.

Question 4

What are the investigations?

Answer 4

• Spirometry - FEV1/FVC ratio 50 mmHg and/or PaO2 of

Question 5

What is the management of COPD?

Answer 5

• Acute exacerbation
o Short acting bronchodilator – salbutamol and ipratropium bromide
o Systemic corticosteroid – prednilosone
o Transition to inhaled corticosteroid – beclometasone or budesonide
o Oxygen
o Antibiotics if exacerbated by infection
• Ongoing
o Smoking cessation
o Patient education and vaccination
o Pulmonary rehabilitation
o Short acting bronchodilator as required - salbutamol and ipratropium bromide
o Long-acting bronchodilator – salmeterol or tiotropium bromide
o Theophylline