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)
  • FEV₁ grades severity
• Chest X-ray
  • Hyperinflation (>8 anterior ribs visible)
  • Flat hemi-diaphragms
  • Decreased lung markings
  • Black lesions (bullae)
  • Prominent hila

Severity grading

Mild	FEV1 >80%
Moderate	FEV1 50-80%
Severe	FEV1 30-50%
Very severe	FEV1 <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

Common inhalers

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

Here are some questions

Try some stations

1. COPD exacerbation prescribing
2. COPD data interpretation
3. Acute management – COPD
4. COPD history
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