COPD

Question 1

unmodifiable risk factors for COPD

Answer 1

• Lower socioeconomic status
• Asthma / airway hyper-reactivity
• Chronic bronchitis
• Childhood infection

age
being female

Question 2

emphysema in base of lungs is probably caused by

Answer 2

Alpha-1 Antitrypsin Deficiency

Question 3

emphysema in apex of lungs is likely caused by

Answer 3

smoking

Question 4

how does Alpha-1 Antitrypsin Deficiency cause COPD

Answer 4

eventually causes elastase to be produced

destroying alveoli elastic capacity

Question 5

spirometry can be used to diagnose

Answer 5

airway obstruction

Question 6

stage 1 COPD FEV1 value

Answer 6

80%

diagnosis is only done by symptoms at this point

Question 7

stage 2 COPD FEV1 value

Answer 7

50–79%

Question 8

stage 3 COPD FEV1 value

Answer 8

30-49%

Question 9

stage 4 COPD FEV1 value

Answer 9

less than 30%

Question 10

residual volume and total lung capacity in COPD

Answer 10

RV increased

TLC increased

RV/TLC MORE THAN 30%

Question 11

some general clinical features of COPD

Answer 11

• Cough
• Breathlessness
• Sputum
• Frequent chest infections
• Wheezing
• Weight loss
• Fatigue
• Swollen ankles

Cyanosis
Pursed lip breathing 
Use of accessory muscles
Wheeze
Peripheral oedema

Question 12

how is COPD diagnosed

Answer 12

• Typical symptoms
• > 35 years•Presence of risk factor (smoking or occupational exposure)
• Absence of clinical features of asthma

AND Airflow obstruction confirmed by post-bronchodilator spirometry

Question 13

signs of sever COPD exacerbation

Answer 13

Breathless  (RR>25/min) 
Accessory  muscle use at rest
Purse lip breathing
Fluid retention
Cyanosis (Sats<92% o/a)
Confusion
FLAPPING TREMOUR
tripod postition

Question 14

primary care management of exacerbations

Answer 14

• Change in inhalers (technique, device, add bronchodilator, increase or add inhaled steroid)
• Oral steroids (Prednisolone tablets)
• Antibiotics if caused by bacterial infection

Question 15

secondary care management of severe exacerbation

Answer 15

Oxygen
Nebulised bronchodilator (2 & anti-muscarinic) Oral/IV corticosteroid
+/-antibiotic

Question 16

type 1 vs type 2 respiratory failure

Answer 16

• Type 1: ↓ pO2

* Type 2: ↓ pO2and ↑ pCO2 (ventilatory failure)

Question 17

whats Secondary polycythaemia

Answer 17

Body produces ↑ erythropoietin in response to low O2
•↑ Haemoglobin, ↑ Haematocrit
•↑ bloody viscosity

Question 18

COPD – Non- Pharmacological Management

Answer 18

• Smoking Cessation
• Vaccinations –Annual Flu vaccine–Pneumococcal vaccine
• Pulmonary Rehabilitation
• Nutritional assessment
• Psychological support

Question 19

Short acting Bronchodilators

Answer 19

–SABA (eg- Salbutamol)

–SAMA (eg- Ipratropium)

Question 20

Long acting bronchodilators

Answer 20

–LAMA (Long acting anti – muscarinic agents, eg-Umeclidinium, Tioptropium etc)

–LABA (Long acting B2agonist, eg- Salmeterol)

Question 21

High dose inhaled corticosteroids (ICS) and LABA–

Answer 21

Relvar (Fluticasone/vilanterol)

Fostair MDI

Question 22

when is long term O2 use used

Answer 22

PaO2 <7.3kPa

Or PaO7.3-8kPa if 
polycythaemia
nocturnal hypoxia 
peripheral oedema 
pulmonary hypertension

Question 23

when to admit to hospital

Answer 23

–Tachypneoa
–Low Oxygen saturation (< 90-92%)
–Hypotension etc