Asthma COPD 2

Question 1

How do we screen and prevent COPD?

Answer 1

prevention before it starts
-> don’t start smoking
-> quit smoking
-> avoid lung irritants and second-hand smoke
-> spirometry catches early cases before symptoms
*Ask-Advise-Assess-Aid-Arrange

Slowing progression and avoiding complications
– Quit smoking
– Get vaccinated (flu, pneumonia, COVID-19, whooping cough)
– Adhere to treatment
– Exercise (carefully)
– Ensure to avoid malnutrition
– AAT screening recommended by WHO (& screen family)

Question 2

How do we treat stable COPD ?(NICE)

Answer 2

• Non-pharmacological management
  – Inhaled therapy
  – Oral therapy
  – Oxygen therapy
  – Surgery

Question 3

How do we treat COPD exacerbations ?(Flare ups)

Answer 3

-Antibiotics
– Treatments delivered in hospital
= Inhaled therapy; Systemic corticosteroids; IV theophylline;
Non-invasive ventilation; IV doxapram; Invasive ventilation

Question 4

Why is oxygen therapy a key treatment in cor pulmonale?

Answer 4

It reduces alveolar hypoxia, decreasing hypoxic pulmonary vasoconstriction and pulmonary hypertension.

Question 5

In COPD patients, oxygen therapy is used to treat which problem — breathlessness or hypoxia?

Answer 5

To treat hypoxaemia - not breathlessness
Oxygen not prescribed routinely in moderate cases

Question 6

When should we assess for long - term oxygen therapy?

Answer 6

very severe airflow obstruction (FEV1 below 30% predicted)
– cyanosis (blue or grey tint to skin - depends on skintone)
– polycythaemia
– peripheral oedema (swelling)
– raised jugular venous pressure
– oxygen saturations of 92% or less breathing air
– severe airflow obstruction (FEV1 30–49%)
* To assess, measure ABG twice (3 weeks apart)

Question 7

What pharmacological treatments are offered for inhaled therapy (stable COPD) if the person is breathless and has exercise limitation?

Answer 7

After non-pharmaceutical interventions

offer inhaled bronchodilators - either SABA - e.g. - salbutamol
OR SAMA e.g. - ipratropium

for inhaled therapies:
Use as needed to relieve breathlessness and improve exercise
tolerance
Consider individual factors when choosing delivery system
(e.g. age, dexterity, coordination, inspiratory flow)
Ensure appropriate training
Regularly review medication, adherence and inhaler technique

Question 8

what interventions should be offered before starting inhaled therapies?

Answer 8

*need a confirmed diagnosis of COPD
*then interventions:
->offer treatment and support to stop smoking
->offer pneumococcal and influenza vaccinations
->offer pulmonary rehabilitation if indicated
-> co-develop a personalised self management plan
-> optimise treatment for co-morbidities

Question 9

what pharmacological management is offered if symptoms continue to be limiting or patient has exacerbations despite taking short-acting bronchodilators and they have no asthmatic features? (there’s steps)

Answer 9

1) perform a review (optimal non-pharmacological management, other conditions?)
2) if NO asthmatic features -
offer BOTH a long acting beta 2 agonist (LABA) e.g. - salmeterol
+ a Long acting muscarinic antagonist (LAMA) e.g. - tiotropium
(dual-long acting bronchodilation)

Question 10

what if symptoms still get worse after offering dial-bronchodilation therapy ?(inhaled therapy treatment pathway)

Answer 10

IF STILL gets worse - LABA PLUS LAMA PLUS ICS

Question 11

what if asthmatic features or steroid responsiveness features are present?

Answer 11

Then offer LABA plus ICS e.g. - formeterol with budesonide

IF still gets worse - LABA PLUS LAMA PLUS ICS

Question 12

what are the oral therapy options for stable COPD?

Answer 12

Oral corticosteroids aren’t normally recommended
BUT may need continuation if given during an exacerbation and
cannot be withdrawn (keep low)

Theophylline, an oral non-steroidal bronchodilator
– NICE advise its use only after trying short-acting and long-acting
inhaled bronchodilators OR if patient cannot use inhaled therapy
* Mucolytic therapy, not recommended for routine prevention of exacerbations in stable cases
– only continue if there is symptomatic improvement

Question 13

what are surgical options for treating stable COPD?

Answer 13

Usually last resort
* Severe symptoms that do not improve with medication
* Bullectomy removes one or more very large bullae from lungs
* One-way endobronchial valve implants
* Lung volume reduction
* Lung transplantation

Question 14

what steps can be taken to manage symptoms of COPD to slow the progression of the disease?

Answer 14

Avoid lung irritants
Get ongoing medical care
Manage COPD and its symptoms
Pulmonary rehabilitation
Prophylactic antibiotics
Prepare for emergencies
Get emotional support

Question 15

What is an acute exacerbation of COPD?

Answer 15

A sustained worsening of COPD symptoms such as Cough, breathlessness, sputum, wheezing, fatigue, and tachypnoea from the patient’s usual stable state.

Question 16

What are common triggers of acute COPD exacerbations?

Answer 16

Smoking, respiratory tract infections (e.g. rhinovirus), environmental pollutants, and sometimes bacterial infections.

Question 17

What initial clinical checks should be performed in a suspected COPD exacerbation?

Answer 17

Check vital signs (temperature, blood pressure, oxygen saturation, heart rate)
Assess for confusion/consciousness
Examine the chest

Question 18

What should be done if hospital admission not needed for COPD exacerbation?

Answer 18

suggest patient increases dose or frequency of short - acting bronchodilators (without exceeding maximum dose)
Possible oral corticosteroids (5 days max)
If no improvement after 2-4 days - Send sputum for culture.

Question 19

Why is caution needed when diagnosing a COPD exacerbation?

Answer 19

Other conditions may present with similar symptoms.

Question 20

Which respiratory conditions can mimic a COPD exacerbation?

Answer 20

: Pneumonia, pulmonary embolism, pneumothorax, pleural effusion, upper airway obstruction.

Question 21

Which cardiac conditions can mimic a COPD exacerbation?

Answer 21

Acute heart failure, cardiac ischaemia, cardiac arrhythmia.

Question 22

Which malignancy should also be considered?

Answer 22

Lung cancer.

Question 23

What severity features may require emergency hospital admission in COPD?

Answer 23

Severe breathlessness
Inability to cope at home
Poor/deteriorating general condition
including significant comorbidity
Rapid onset of symptoms
Cyanosis
Low oxygen saturation (< 90%)
Worsening peripheral oedema
New arrhythmia
Failure of exacerbation to respond to initial treatment
Already receiving LTOT
Changes on chest X-ray

ICU: Changes in mental state/coma,
worsening hypoxaemia (PaO2 <5.3kPa)
and/or severe hypercapnia/acidosis pH<7.25

Question 24

What is the first-line initial pharmacological treatment in acute COPD exacerbations?

Answer 24

Short-acting bronchodilators: SABA ± SAMA.

Question 25

What treatment follows initial short-acting bronchodilators?

Answer 25

Long-acting bronchodilators. ( BOTH LABA and LAMA offer)

Question 26

When should LABA + LAMA + ICS be considered during exacerbations?

Answer 26

If exacerbations are frequent and eosinophil levels are elevated.

Question 27

What should be done once the patient becomes stable?

Answer 27

Reassess treatment.

Question 28

What treatments are used for severe COPD exacerbations?

Answer 28

Systemic corticosteroids IV theophylline (with careful monitoring) Non-invasive mechanical ventilation for acute respiratory failure IV doxapram (respiratory stimulant) Invasive mechanical ventilation / intubation

Question 29

What is the overall outlook of COPD in terms of disability and progression?

Answer 29

It is a major cause of disability and develops slowly.

Question 30

In which age group is COPD most commonly diagnosed?

Answer 30

Middle-aged or older adults.

Question 31

Is there a cure for COPD and is it contagious?

Answer 31

Not contagious no cure for it - lung damage can't be reversed

Question 32

What comorbidities commonly coexist with COPD?

Answer 32

Cardiovascular disease Lung cancer Osteoporosis Depression and anxiety

Question 33

What can slow the progression of COPD?

Answer 33

Treatments and lifestyle changes.

Question 34

Key points

Answer 34

COPD is a common, preventable and treatable disease, but it is not currently curable * Most common symptoms include dyspnoea, cough and/or sputum production * Main risk factor is smoking but other environmental exposures contribute * A rare genetic predisposition to lung damage accounts for 1-2% of COPD cases * Spirometry is a key tool for diagnosis; while bronchodilators are the most common treatment, with corticosteroids and mucolytics * COPD may be punctuated by periods of acute worsening of symptoms, called “exacerbations” * COPD is associated with significant concomitant chronic diseases in most patients which contribute to morbidity and mortality

Question 35

MCQ - Which of the following spirometry measures would be most useful in diagnosing COPD? a) FVC b) TLC c) FEV1/FVC d) PEF e) RV/VC

Answer 35

c) FEV1/FVC

Question 36

SAQ - How does COPD contribute to the enlargement of the right ventricle known as cor pulmonale?

Answer 36

Chronic lung disease in COPD causes alveolar hypoxia, due to airflow obstruction and impaired gas exchange. Alveolar hypoxia triggers hypoxic pulmonary vasoconstriction, which is normally protective but becomes widespread in COPD. Chronic vasoconstriction increases pulmonary vascular resistance, further worsened by capillary destruction in emphysema, acidosis, and polycythaemia (increased blood viscosity). Increased pulmonary vascular resistance leads to pulmonary hypertension, raising pressure in the pulmonary circulation. Pulmonary hypertension increases right ventricular afterload, causing right ventricular hypertrophy and eventually right ventricular failure, known as cor pulmonale.