Our notes are now found under OSCE Learning! Click here
image

Chronic obstructive pulmonary disease (COPD)

Clinical features

  • Symptoms: exertional dyspnoea, chronic productive cough, wheeze
  • Signs: accessory muscle use, tar-stained fingers, bounding pulse, CO2 retention asterixis, lip pursing, central cyanosis, tracheal tug, hyperexpanded chest, quiet breath sounds/wheeze/prolonged expiratory phase

Investigations

  • Spirometry 
    • Obstructive pattern: ↓FEV1 (<80%), normal FVC (>80%), ↓FEV1/FVC ratio (<0.7)
    • FEVgrades severity
  • Chest X-ray
    • Hyperinflation (>8 anterior ribs visible)
    • Flat hemi-diaphragms
    • Decreased lung markings
    • Black lesions (bullae)
    • Prominent hila

Severity grading

MildFEV1 >80%
ModerateFEV1 50-80%
SevereFEV1 30-50%
Very severeFEV1 <30%

Management

image
Produced using NICE ‘CG101 chronic obstructive pulmonary disease in over 16s: diagnosis and management’ 2010
  • Abbreviations 
    • LABA = long-acting β2 agonist  
    • LAMA = long-acting muscarinic antagonist
    • ICS = inhaled corticosteroid
  • Common combination inhalers
    • Seretide = salmeterol + fluticasone
    • Symbicort = formoterol + budesonide
    • Fostair = formoterol + beclomethasone
    • Trimbow = formoterol + beclomethasone + glycopyrronium
  • Tablets
    • Mucolytics, e.g. carbocisteine
    • Theophylline
image