Chronic Obstructive Pulmonary Disease

• What does COPD stand for?

  Chronic Obstructive Pulmonary Disease
• What are the main components of COPD?

  Airway obstruction, chronic bronchitis, and emphysema
• What is the primary cause of COPD?

  It is almost always the result of smoking
• Is COPD reversible?

  No, it is not reversible but it is treatable
• What happens to lung tissues in COPD?

  Damage to the lung tissues obstructs the flow of air through the airways
• What does chronic bronchitis refer to?

  Long-term symptoms of a cough and sputum production due to inflammation in the bronchi
• What is emphysema characterized by?

  Damage and dilatation of the alveolar sacs and alveoli, decreasing the surface area for gas exchange
• How does airway obstruction in COPD differ from asthma?

  Airway obstruction in COPD is minimally reversible with bronchodilators
• What are exacerbations in COPD?

  Periods during which lung function worsens
• What are infective exacerbations of COPD?

  Exacerbations triggered by infection
• What are typical symptoms of COPD?

  Shortness of breath, cough, sputum production, wheeze, and recurrent respiratory infections
• What symptoms should NOT be caused by COPD?

  Clubbing, haemoptysis, or chest pain
• What is the MRC Dyspnoea Scale used for?

  It is used for assessing breathlessness
• What are the grades of the MRC Dyspnoea Scale?

  • Grade 1: Breathless on strenuous exercise
  • Grade 2: Breathless on walking uphill
  • Grade 3: Breathlessness that slows walking on the flat
  • Grade 4: Breathlessness stops them from walking more than 100 meters on the flat
  • Grade 5: Unable to leave the house due to breathlessness
• How is COPD diagnosed?

  Diagnosis is based on clinical presentation and spirometry results
• What does spirometry show in COPD?

  Spirometry shows an obstructive picture with a FEV1:FVC ratio of less than 70%
• What does little or no response to reversibility testing indicate?

  It indicates that reversible obstruction is more suggestive of asthma
• How is the severity of COPD graded?

  Severity is graded using the FEV1:

  • Stage 1 (mild): FEV1 more than 80% of predicted
  • Stage 2 (moderate): FEV1 50-79% of predicted
  • Stage 3 (severe): FEV1 30-49% of predicted
  • Stage 4 (very severe): FEV1 less than 30% of predicted
• What other investigations are conducted for COPD?

  • Body mass index at baseline
  • Chest x-ray to exclude other pathology
  • Full blood count for polycythaemia, anaemia, and infection
  • Sputum culture for chronic infections
  • ECG and echocardiogram for heart failure and cor pulmonale
  • CT thorax for alternative diagnoses
  • Serum alpha-1 antitrypsin for deficiency
  • Transfer factor for carbon monoxide (TLCO) to test diffusion
• What is the impact of continuing smoking on COPD?

  Continuing smoking will progressively worsen lung function and prognosis
• What vaccinations should COPD patients receive?

  Patients should have the pneumococcal and annual flu vaccine
• What does pulmonary rehabilitation involve?

  • A multidisciplinary approach
  • Aims to improve function and quality of life
  • Includes physical training and education
• What is the initial medical treatment for COPD according to NICE guidelines?

  Short-acting beta-2 agonists and short-acting muscarinic antagonists
• What determines the second step of treatment for COPD?

  It is determined by whether there are asthmatic or steroid-responsive features
• What are the features indicating asthmatic or steroid-responsive characteristics?

  Previous diagnosis of asthma or atopy, variation in FEV1 of more than 400mls, diurnal variability in peak flow of more than 20%, and raised blood eosinophil count
• What is the treatment for COPD without asthmatic or steroid-responsive features?

  • Combination of long-acting beta agonist (LABA) and long-acting muscarinic antagonist (LAMA)
  • Examples: Anoro Ellipta, Ultibro Breezhaler, DuaKlir Genuair
• What is the treatment for COPD with asthmatic or steroid-responsive features?

  • Combination of long-acting beta agonist (LABA) and inhaled corticosteroid (ICS)
  • Examples: Fostair, Symbicort, Seretide
• What is the final inhaler step for COPD treatment?

  • Combination of LABA, LAMA, and ICS
  • Examples: Trimbow, Trelegy Ellipta, Trixeo Aerosphere
• What additional options are available for severe COPD cases?

  Options include nebulisers, oral theophylline, oral mucolytic therapy, prophylactic antibiotics, oral corticosteroids, oral phosphodiesterase-4 inhibitors, long-term oxygen therapy, and lung volume reduction surgery
• What monitoring is required for patients taking azithromycin?

  Patients need ECG and liver function monitoring before and during treatment
• When is long-term oxygen therapy (LTOT) used?

  LTOT is used for severe COPD with chronic hypoxia, polycythaemia, cyanosis, or cor pulmonale
• Why is smoking a contraindication for long-term oxygen therapy?

  Smoking is a contraindication due to the fire risk
• What does cor pulmonale refer to?

  Right-sided heart failure caused by respiratory disease
• What causes cor pulmonale?

  Causes include COPD, pulmonary embolism, interstitial lung disease, cystic fibrosis, and primary pulmonary hypertension
• What are the symptoms of cor pulmonale?

  Symptoms include shortness of breath, peripheral oedema, breathlessness on exertion, syncope, and chest pain
• What signs indicate cor pulmonale on examination?

  Signs include hypoxia, cyanosis, raised JVP, and peripheral oedema
• What is a contraindication for treating patients with cor pulmonale?

  Smoking is a contraindication due to the fire risk.
• What does cor pulmonale refer to?

  Cor pulmonale refers to right-sided heart failure caused by respiratory disease.
• How does pulmonary hypertension affect the right ventricle?

  It limits the right ventricle's ability to pump blood into the pulmonary arteries.
• What are the consequences of back-pressure in cor pulmonale?

  It causes back-pressure into the right atrium, vena cava, and systemic venous system.