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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 inhaler devices available?

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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?

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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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