COPD

Question 1

Define COPD

Answer 1

Chronic progressive condition affecting the airways. Chronic bronchitis results in inflammation of the bronchi and increased mucus production leading to airway obstruction. Emphysema leads to damage to the alveoli leading to reduced SA for gas exchange

Question 2

Sx of COP

Answer 2

SOB
Productive cough
Wheeze
Recurrent resp infections

Question 3

Scale for assessing SOB inCOPD

Answer 3

Medical research council dyspnoea scale

1. SOB on exercise
2. SOB walking uphill
3. SOB flat
4. SOB >100 metres
5. Can’t leave house due to SOB

Question 4

Spirometry results seen in COPD

Answer 4

• Obstructive picture
• FEV1 : sig reduced
• FVC : reduced or normal
• FEV1/FVC ratio reduced <0.7.70-%

Question 5

Explain the stepwise management of COPD if no asthmatic features

Answer 5

1. SABA / SAMA
2. Combination LABA + LAMA (+SABA)

Question 6

Stepwise management of COPD if there are asthmatic features

Answer 6

1.SABA / SAMA
2. SABA + LABA + ICS
3. LABA + LAMA + ICS

Question 7

Non pharmacological management of COPD

Answer 7

Pulmonary rehabilitation
One of pneumococcal vaccine
Annual influenza

Question 8

Prophylactic Abx if recurrent exacerbations

Answer 8

Azithromycin

Question 9

When is LTOT considered in COPD

Answer 9

• pO2 of <7.3kpa on 2 occasions 3 wks apart
  OR
• pO2 of 7.3 - 8 WITH secondary polycythaemia, peripheral oedema, pulmonary HTN

Question 10

Stepwise management of an acute exacerbation of COPD

Answer 10

1. 15L O2 via non rebreathe : this can be titrated down based on serial ABG to keep sats 88-92 if chronic retainer
2. Nebulised salbutamol
3. Nebulised ipratropium bromide
4. Oral 40mg prednisolone
5. Abx if signs of infection
6. Consider NIV

Question 11

ABG seen in COPD exacerbation

Answer 11

Respiratory acidosis

Question 12

Most common cause of infective exacerbation of COPD

Answer 12

Haemophilus influenza

Question 13

When is NIV considered for pts with exacerbation

Answer 13

pH of 7.25-7.35

Question 14

what NIV is used inCOPD

Answer 14

BiPAP

Question 15

What criteria are used to determine if COPD pt has asthmatic features

Answer 15

1. Previous dx of asthma or atopy
2. High blood eosinophil count
3. Diurnal variation in peak flow of at least 20%
4. Variation in FEV1 of at least 20%

Question 16

What needs to be done prior to giving prophylactic azithromycin

Answer 16

LFTs and an ECG to exclude QT prolongation

Question 17

what can reduced risk of COPD exacerbation

Answer 17

• Oral phosphodisterase 4 inhibitoprs (Roflumilast)

Question 18

How is severeity of COPD determined

Answer 18

1. Mild >80%
2. Mod : 50-79%
3. Severe : 30-49%
4. Very severe <30%

Question 19

When is oral PDE-4 inhibitor considered

Answer 19

• Severe disease
• 2 or more exacerbations in previous 12 mnths despite trip;le therapy