COPD

Question 1

What is COPD?

Answer 1

Non-reversible, long term deterioration in air flow through the lungs caused by damage to lung tissue

Question 2

Why are patients with COPD more prone to infections?

Answer 2

Damage to the lung tissues causes an obstruction to the flow of air through the airways making it more difficult to ventilate the lungs and making them prone to developing infections

Question 3

How does COPD present?

Answer 3

Long term smoker presenting with:

• chronic SOB
• cough
• sputum production
• wheeze
• recurrent respiratory infections

Question 4

Explain the grades of the MRC dyspnoea score?

Answer 4

• 1 – Breathless on strenuous exercise
• 2 – Breathless on walking up hill
• 3 – Breathless that slows walking on the flat
• 4 – Stop to catch their breath after walking 100 meters on the flat
• 5 – Unable to leave the house due to breathlessness

Question 5

How to diagnose COPD?

Answer 5

Clinical presentation + spirometry

• Obstructive picture
• FEV1/FVC ratio <0.7
• No dramatic response to reversibility testing

Question 6

How is the severity of COPD graded?

Answer 6

• Stage 1: FEV1 >80% of predicted
• Stage 2: FEV1 50-79% of predicted
• Stage 3: FEV1 30-49% of predicted
• Stage 4: FEV1 <30% of predicted

Question 7

List 4 other investigations for COPD

Answer 7

Question 8

List 4 types of NRT to aid in quitting smoking

Answer 8

1. skin patches
2. chewing gum
3. inhalators
4. tablets, oral strips and lozenges
5. nasal and mouth spray

Question 9

Treatment for COPD?

Answer 9

Question 10

List an example of a combination LABA + LAMA inhaler

Answer 10

1. Anoro Ellipta
2. Ultibro Breezhaler
3. DuaKlir Genuair

Question 11

List an example of a combination LABA + ICS inhaler

Answer 11

1. Fostair
2. Symbicort
3. Seretide

Question 12

List an example of a combination LABA + LAMA + ICS inhaler

Answer 12

1. Trimbo
2. Trelegy Ellipta

Question 13

Criteria for LTOT in COPD?

Answer 13

pO2 < 7.3 kPa OR

pO2 7.3 - 8 kPa and one of:

• secondary polycythaemia
• peripheral oedema
• pulmonary hypertension

Question 14

Contraindication for LTOT therapy

Answer 14

Still smoking!

Question 15

How does an exacerbation of COPD present?

Answer 15

Worsening of symptoms ie. cough, SOB, sputum production and wheeze

Question 16

What are the target stats, and how are these achieved during an acute exacerbation of COPD?

Answer 16

28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92%

Question 17

Most common causative organism in a COPD exacerbation

Answer 17

Haemophilus influenzae

Question 18

Management of an acute exacerbation of COPD?

Answer 18

1. Increase frequency of bronchodilator, consider giving via neb
2. Prednisolone 30 mg daily for 5 days
3. Oral amoxicillin, clarithromycin or doxycycline if sputum is purulent or there are clinical signs of pneumonia

Question 19

Prophylactic antibiotic therapy for COPD?

Answer 19

Azithromycin

Must do LFTs and an ECG to exclude QT prolongation (can be cause by azithro)