COPD

Question 1

What is chronic obstructive pulmonary disease (COPD)?

Answer 1

COPD is a disease characterised by progressive airflow obstruction that is not fully reversible and does not change significantly over several months.

Question 2

What are the two pathological components of COPD?

Answer 2

Chronic bronchitis and emphysema.

Question 3

How is chronic bronchitis defined clinically?

Answer 3

Cough and sputum production on most days for at least 3 consecutive months in at least 2 successive years.

Question 4

What is the fundamental physiological abnormality in COPD?

Answer 4

Persistent airflow obstruction due to airway inflammation and parenchymal destruction.

Question 5

What is the most important risk factor for COPD?

Answer 5

Smoking, which accounts for over 95% of cases.

Question 6

Which occupational exposures increase the risk of COPD?

Answer 6

Exposure to coal dust and cadmium.

Question 7

Which genetic condition predisposes to COPD?

Answer 7

Alpha-1 antitrypsin deficiency.

Question 8

What pulmonary symptoms are commonly seen in COPD?

Answer 8

Breathlessness, wheeze, chronic cough, and sputum production.

Question 9

What systemic features can occur in COPD?

Answer 9

Muscle weakness, peripheral oedema, weight loss, and osteoporosis.

Question 10

Why do patients with COPD develop peripheral oedema?

Answer 10

Due to impaired salt and water excretion.

Question 11

Why does weight loss occur in COPD?

Answer 11

Due to altered fat metabolism and increased energy expenditure.

Question 12

On what three components is the diagnosis of COPD based?

Answer 12

Clinical history, physical signs, and spirometry.

Question 13

What spirometry finding confirms airflow obstruction in COPD?

Answer 13

An FEV₁/FVC ratio < 70% of predicted.

Question 14

What FEV₁ value supports the diagnosis of COPD?

Answer 14

FEV₁ < 80% of predicted.

Question 15

Which index is used to assess prognosis in COPD?

Answer 15

The BODE index.

Question 16

How is COPD severity graded using FEV₁?

Answer 16

Mild: ≥80%

Moderate: 50–79%

Severe: 30–49%

Very severe: ≤30%

Question 17

What does BODE stand for?

Answer 17

Body mass index, airflow Obstruction, Dyspnoea, and Exercise capacity.

Question 18

What does a BODE score of 0–2 predict?

Answer 18

Approximately 10% mortality at 52 months.

Question 19

What does a BODE score of 7–10 predict?

Answer 19

Approximately 80% mortality at 52 months.

Question 20

Which scale is used to assess breathlessness in COPD?

Answer 20

The MRC dyspnoea scale.

Question 21

What does MRC grade 0 indicate?

Answer 21

Breathlessness only with strenuous exercise.

Question 22

What does MRC grade 4 indicate?

Answer 22

Breathlessness with dressing or inability to leave the house

Question 23

What are the key adjunctive treatments in stable COPD?

Answer 23

Smoking cessation, pulmonary rehabilitation, weight loss, influenza vaccination, mucolytics, and monitoring for depression.

Question 24

What is the first-line inhaler therapy in COPD?

Answer 24

A bronchodilator inhaler (β₂-agonist or anticholinergic).

Question 25

When should combination bronchodilator therapy be used?

Answer 25

When symptoms persist despite single-agent therapy.

Question 26

When are long-acting bronchodilators indicated?

Answer 26

When short-acting agents are insufficient.

Question 27

When are inhaled corticosteroids used in COPD?

Answer 27

In patients with persistent symptoms despite bronchodilators.

Question 28

What is the role of theophylline in COPD?

Answer 28

As a later-line add-on therapy.

Question 29

When is long-term oxygen therapy indicated in COPD?

Answer 29

PaO₂ < 7.3 kPa or presence of nocturnal hypoxaemia.

Question 30

How is an acute exacerbation of COPD defined?

Answer 30

A sustained worsening of symptoms beyond normal day-to-day variation.

Question 31

What symptoms suggest an acute exacerbation of COPD?

Answer 31

Dyspnoea, tachypnoea, use of accessory muscles, and acute confusion.

Question 32

What conditions should be considered as causes or differentials of an acute COPD exacerbation?

Answer 32

Acute asthma, pneumonia, pneumothorax, left ventricular failure, and pulmonary embolism.

Question 33

What investigations are required during an acute COPD exacerbation?

Answer 33

FBC, U&Es, ABG, blood cultures, sputum microscopy and culture, ECG, and chest X-ray.

Question 34

What is the target oxygen saturation in acute COPD exacerbation?

Answer 34

88–92%.

Question 35

How should oxygen be delivered in acute COPD exacerbation?

Answer 35

Via Venturi mask (24–28%).

Question 36

Which bronchodilators are used acutely in COPD exacerbation?

Answer 36

Nebulised salbutamol and ipratropium.

Question 37

What corticosteroids are used in acute COPD exacerbation?

Answer 37

Prednisolone 30 mg orally or hydrocortisone 100 mg IV 6-hourly.

Question 38

What antibiotics are used in acute COPD exacerbation?

Answer 38

Doxycycline (or IV co-amoxiclav if unable to swallow)

Question 39

When should non-invasive ventilation be considered?

Answer 39

If the patient fails to improve with medical management.