Chronic obstructive pulmonary disease (COPD)

Respiratory (12%) Core Clinical Conditions

1A: Able to diagnose and manage

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Definition

Chronic obstructive pulmonary disease (COPD) is a progressive lung condition characterised by narrowing of the airways. This is a chronic condition that can be categorised as either emphysema or chronic bronchitis.

Aetiology

Long term exposure to irritants which causes damage and inflammation to the airways e.g. smoking.
Other causes:

Exposure to air pollution, dust and chemicals.
Genetic predisposition.
Recurrent infections which damage the airways.
Ageing.
Background of Asthma, allergies or other respiratory conditions.

Pathophysiology

Reduced airflow: caused by constriction of bronchi, airway inflammation and destruction of alveolar walls.
Chronic inflammation of airways caused by irritants e.g. air pollution, cigarette smoking.
Mucus production increased.
Alveolar destruction, common in emphysema.
Pulmonary hypertension.

Risk factors

Smoking, air pollution and other environmental causes.
Genetic predisposition.
Ageing.
Repeated respiratory infections.
Asthma.
Male gender.

Sign and symptoms

Cough with excess mucus production is often clear in colour.
Wheeze, SOB and fatigue.
Repeated chest infections.
O/E: barrel chest, hyperresonance on percussion and widespread wheeze.

Diagnosis and investigations

Physical examination: respiratory examination + pulse oximetry, respiratory rate and capillary refill, smoking history.
Oxygen saturation measurement.
Chest X-ray / CT scan.
Blood test: full blood count (FBC), C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR).
Sputum culture.
Spirometry.
Arterial Blood Gas (ABG) Test.

Management

Smoking cessation.
Chest physiotherapy.
Oxygen therapy.
Vaccination (pneumonia + flu) to prevent respiratory infections.

Medication:

Reliever: short-acting bronchodilators (SABA) or short-acting muscarinic antagonists (SAMA) e.g. such as salbutamol as needed for relief of breathlessness.
If no asthma symptoms: dual therapy with a long-acting bronchodilator inhaler (LABA) e.g. Salmeterol + long-acting muscarinic antagonist (LAMA) e.g. Tiotropium.
If asthma symptoms: LABA + inhaled corticosteroids (ICS) e.g. Fluticasone.
Consider triple therapy: LAMA+LABA+ICS if symptoms are still not controlled.