COPD

• What is the spirometry criteria for COPD?


  Post bronchodilator FEV1/FVC < 0.7
• What is COPD?


  Umbrella term that encompasses older terms (chronic bronchitis & emphysema)
• What are the Inx for COPD?


  Obs

  Full Hx & examination

  Sputum culture

  ECG

  Bloods (FBC, U&Es, LFTs, CRP, ABG)

  CXR

  CT

  Spirometry
• What will an ECG in COPD?


  Peaked P waves (P pulmonale) -> atrial hypertrophy

  RBBB or right axis deviation
• What may a CXR show in COPD?


  Non-specific

  May show hyperinflation, bullae or signs of alternative diagnoses (HF or lung cancer)

  
• What is the gold standard Inx for COPD?


  Spirometry

  -> will show obstructive pattern with no reversibility
• What scoring tool can be used to estimate respiratory disability?

  MRC Dyspnoea Scale

  
• What scoring tool can be used to predict hospital mortality in COPD exacerbation?


  DECAF Score

  
• What are the RFs for COPD?


  Smoking (& passive exposure to smoking)

  Pollution & occupational exposures

  Alpha 1 antitrypsin deficiency

  MMP dysregulation

  Increased airway responsiveness & atopy (allergy predisposition)

  Asthma

  Abnormal lung development

  Respiratory infections in early childhood (lowers baseline)
• What are the signs & symptoms of COPD?


  Cough (often productive) -> on most days for > 3 months of year for 2 consecutive years

  SOB

  Wheeze

  Peripheral oedema (severe)

  New O2 requirement

  Parasternal heave

  CO2 flap

  Pursed-lip breathing -> trying to blow off more CO2

  Barrel chest

  Cor pulmonale
• What are the possible complications of COPD?


  Pulmonary HTN

  Cor pulmonale

  Pneumonia

  Acute exacerbations

  Hypoxia & hypercapnia

  Weight loss & malnutrition

  Anxiety & depression
• What is the general management of COPD?


  Smoking cessation advice

  Annual influenza vaccine

  One-off pneumococcal vaccine

  Pulmonary rehabilitation

  Co-develop a personalised self-management plan

  Optimise treatment for comorbidities
• What is the medical treatment/management for COPD?


  Depends whether COPD is steroid-responsive

  • steroid responsive
  • LABA + ICS
  • if symptoms persist, LAMA + LABA + ICS
  • not steroid responsive
  • LABA + LAMA
  • if symptoms persist, add ICS
• Other than inhalers, what are the other potential treatments of COPD?


  Mucolytics

  Oral prophylactic Abx therapy

  Oral steroids

  Oral theophylline

  PDE-4 inhibitors

  LTOT

  Lung volume reduction surgery

  Cor pulmonale treatment
• When is LTOT offered?


  PaO2 < 7.3 kPa

  OR

  PaO2 < 8 kPa + another complication

  • polycythaemia
  • peripheral oedema
  • pulmonary HTN
• What is the most common infective cause of COPD exacerbation?


  Haemophilus influenzae