SALE. 20% off limited time only. 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

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 β2 agonist; SAMA = short-acting muscarinic antagonist; LABA = long-acting β2 agonist; LAMA = long-acting muscarinic antagonist; ICS = inhaled corticosteroid

image
  • SABA/SAMA nebulisers – may also be considered in severe disease

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 inhaler devices available?

Oops! This section is restricted to members.

Create an account or log in to continue reading.

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

Oops! This section is restricted to members.

Create an account or log in to continue reading.

What is type 1 and type 2 respiratory failure?

Oops! This section is restricted to members.

Create an account or log in to continue reading.

Try some stations

  1. COPD exacerbation prescribing
  2. COPD data interpretation
  3. Acute management – COPD
  4. COPD history
  5. More here!
image
Join our email list!
For free OSCE tips and updates