COPD

Question 1

What is the definition of COPD?

Answer 1

A progressive, largely irreversible airflow obstruction due to chronic bronchitis (productive cough ≥3 months for 2 years) and emphysema (destruction of alveolar walls).

Question 2

What is the main cause of COPD?

Answer 2

Cigarette smoking (≈90%).

Question 3

Which genetic disorder causes early-onset COPD?

Answer 3

Alpha-1 antitrypsin deficiency causing panacinar emphysema.

Question 4

What are the key risk factors for COPD?

Answer 4

Smoking, passive smoke exposure, occupational dust/fumes, biomass fuel exposure, A1AT deficiency.

Question 5

What is the diagnostic spirometry finding in COPD?

Answer 5

Post-bronchodilator FEV1/FVC <0.7 confirming obstruction.

Question 6

What CXR features are seen in COPD?

Answer 6

Hyperinflation, flattened hemidiaphragms, bullae, hyperlucent lungs.

Question 7

What blood test helps identify A1AT deficiency?

Answer 7

Serum alpha-1 antitrypsin level.

Question 8

What symptoms characterise COPD?

Answer 8

Progressive dyspnoea, chronic productive cough, wheeze, frequent infections.

Question 9

What signs may be present in COPD?

Answer 9

Barrel chest, hyperinflation, pursed-lip breathing, accessory muscle use, wheeze, cyanosis, oedema if cor pulmonale.

Question 10

What are the GOLD severity stages based on FEV1?

Answer 10

Mild >80%, Moderate 50–79%, Severe 30–49%, Very severe <30%.

Question 11

What is the first-line bronchodilator in stable COPD?

Answer 11

SABA or SAMA as needed.

Question 12

What determines inhaler escalation in COPD?

Answer 12

Presence or absence of asthma/steroid-responsive features.

Question 13

What are steroid-responsive features in COPD?

Answer 13

High eosinophils, atopy, past asthma, >400 mL FEV1 variability, >20% PEF variability.

Question 14

How is COPD treated if NO steroid-responsive features?

Answer 14

LABA + LAMA.

Question 15

How is COPD treated if steroid-responsive features?

Answer 15

LABA + ICS, escalating to triple therapy (LABA + LAMA + ICS).

Question 16

When are mucolytics used in COPD?

Answer 16

Chronic productive cough with symptomatic benefit.

Question 17

When is azithromycin prophylaxis used in COPD?

Answer 17

Non-smokers with optimised therapy and ≥2 exacerbations despite triple therapy, after CT & sputum culture.

Question 18

What improves survival in COPD?

Answer 18

Smoking cessation, LTOT, lung volume reduction surgery in selected patients.

Question 19

What are the LTOT referral indicators?

Answer 19

O₂ sats ≤92%, severe COPD (FEV1 <30%), cyanosis, polycythaemia, cor pulmonale.

Question 20

What are the ABG criteria for LTOT?

Answer 20

PaO₂ <7.3 kPa OR PaO₂ 7.3–8 kPa with cor pulmonale, oedema, or polycythaemia.

Question 21

When should LTOT NOT be given?

Answer 21

Patients who continue smoking due to fire risk.

Question 22

What are the main causes of COPD exacerbations?

Answer 22

Haemophilus influenzae, Strep pneumoniae, Moraxella catarrhalis, rhinovirus.

Question 23

What are the clinical features of a COPD exacerbation?

Answer 23

Worsening dyspnoea, cough, sputum volume/colour change, fever, wheeze, confusion.

Question 24

How is an acute COPD exacerbation initially managed?

Answer 24

Oxygen to 88–92%, nebulised salbutamol + ipratropium, prednisolone 30 mg 5 days, antibiotics if sputum purulent.

Question 25

What are the first-line antibiotics for COPD exacerbation?

Answer 25

Amoxicillin or doxycycline or clarithromycin.

Question 26

When is NIV indicated in COPD exacerbation?

Answer 26

Type 2 respiratory failure with pH 7.25–7.35 & elevated pCO₂ despite medical therapy.

Question 27

What are the main complications of COPD?

Answer 27

Cor pulmonale, polycythaemia, pneumonia, pneumothorax, depression.

Question 28

What ECG changes are seen in COPD?

Answer 28

Right axis deviation, P pulmonale, RBBB.

Question 29

What is cor pulmonale?

Answer 29

Right heart failure due to chronic pulmonary hypertension; causes JVP rise, oedema, loud P2.

Question 30

How do you treat cor pulmonale in COPD?

Answer 30

LTOT and diuretics; avoid ACEi/CCB/alpha blockers.