Chronic Obstructive Pulmonary Disease (COPD)

COPD

• Progressive airflow limitation that is not fully reversible

Aetiology

• Smoking accounts for 90% of cases
• Rarely, alpha1-antitrypsin deficiency

Clinical features

• Cough and sputum
• Wheeze
• Breathlessness
• Exacerbating factors
• Upper respiratory tract infection
• Cold/foggy weather
• Pollution
• Tachypnoea with prolonged expiration
• Use of accessory muscles
• Intercostal muscle recession on inspiration
• Pursed lips on expiration
• Reduced chest expansion
• Hyperinflation
• Cyanosis
• Signs of:
• Right ventricular failure (oedema, hepatomegaly, increased JVP)
• CO2 retention (bounding pulse, peripheral vasodilatation, tremor, confusion, coma)

Investigations

• Spirometry
• Chest X-ray
• Blood gases
• ECG (P pulmonale, right branch bundle block, right ventricular hypertrophy)
• Haemoglobin and packed cell volume
• White cell count
• A1-antitrypsin level

Management

• Stop smoking
• Flu and pneumococcal vaccines
• B2-agonists
• Antimuscarinics e.g. tiotropium
• Corticosteroids
• Prompt antibiotics if infection present
• Diuretics for right ventricular failure
• Assisted ventilation with bilevel positive airway pressure ventilatory support - (BiPAP)
• Home oxygen (if meets recognised criteria for benefit)

Surgery

• Lung volume reduction in carefully selected patients

Prognosis

• 50% of patients with severe breathlessness die within 5 years
• Stopping smoking improves prognosis