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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

Expiratory wheeze

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

Inhaled therapy

Abbreviations: SABA = short-acting Ξ²2 agonist; SAMA = short-acting muscarinic antagonist; LABA = long-acting Ξ²2 agonist; LAMA = long-acting muscarinic antagonist; ICS = inhaled corticosteroid

Common inhalers

SABA

Ventolin (salbutamol)

SAMA

Atrovent (ipratropium)

LABA + LAMA

Anoro = Vilanterol + Umeclidinium
Ultibro = Indacaterol + Glycopyrronium
Duaklir = Formoterol + Aclidinium
Spiolto = Olodaterol + Tiotropium

LABA + ICS

Fostair = formoterol + beclomethasone
Seretide = salmeterol + fluticasone
Symbicort = formoterol + budesonide

LABA + LAMA + ICS

Trimbow = formoterol + glycopyrronium + beclomethasone
Trelegy Ellipta = vilanterol + umeclidinium + Fluticasone

Tablets

  • Mucolytics, e.g. carbocisteine
  • Theophylline

Non-pharmacological

  • Smoking cessation
  • Pulmonary rehabilitation
  • Pneumococcal/influenza vaccines
  • Lung transplant

Oxygen therapy

  • Long-term oxygen therapy: considered in chronic hypoxaemia if PaO2<7.3kPa (or <8kPa in presence of pulmonary hypertension or secondary polycythaemia)
  • Ambulatory home oxygen therapy: considered if hypoxaemic on exertion/activity

Learn more here…

Learn how to manage an acute exacerbation of COPD here!

Here are some questions

What are the different types of inhaler devices are available?

How would you instruct a patient on how to use a metered dose inhaler?

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What is type 1 and type 2 respiratory failure?

Try some stations

  1. COPD exacerbation prescribing
  2. COPD data interpretation
  3. Acute management – COPD
  4. COPD history
  5. More here!

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