COPD

Question 1

Spirometric definition of obstructive lung disease?

Answer 1

FEV1/FVC ratio <70%.

Question 2

Spirometric definition of restrictive lung disease?

Answer 2

FEV1/FVC ratio >70% (with reduced lung volumes).

Question 3

Global ranking of COPD as cause of death?

Answer 3

4th

Question 4

How many people died from COPD in 2012?

Answer 4

> 3 million (~6% of global deaths).

Question 5

UK deaths per year?

Answer 5

~25,000.

Question 6

Estimated UK cost to NHS?

Answer 6

> £1.2 billion/year.

Question 7

COPD is what rank cause of emergency admission?

Answer 7

2nd most common.

Question 8

What characterises COPD?

Answer 8

Persistent respiratory symptoms and airflow limitation due to airway/alveolar abnormalities from noxious exposure.

Question 9

Main risk factor for COPD?

Answer 9

Smoking.

Question 10

Other environmental risk factors?

Answer 10

• Biomass fuel
  -indoor pollution
  -occupation.

Question 11

Host factors affecting COPD risk?

Answer 11

• Genetics
• lung development
• low birth weight
• socioeconomic status.

Question 12

What causes airflow limitation in COPD?

Answer 12

• Small airway narrowing
• Loss of elastic recoil (emphysema)
• Mucus hypersecretion

Question 13

Why does small airway narrowing dramatically increase resistance?

Answer 13

Resistance ∝ 1/radius⁴ (Poiseuille’s law).

Question 14

When should COPD be suspected?

Answer 14

• Dyspnoea
• chronic cough/sputum
• risk factor exposure.

Question 15

What confirms COPD?

Answer 15

Post-bronchodilator FEV1/FVC <0.70.

Question 16

What determines airflow limitation severity?

Answer 16

% predicted FEV1.

Question 17

What does ABCD assessment tool evaluate?

Answer 17

• Symptoms
• Exacerbation risk
• Impact on health status

Question 18

Three goals of COPD assessment?

Answer 18

1. Determine airflow limitation
2. Assess symptom burden
3. Assess risk of future events

Question 19

Most effective intervention in COPD?

Answer 19

Smoking cessation.

Question 20

Long-term quit success with dedicated support?

Answer 20

Up to 25%.

Question 21

Why vaccinate COPD patients?

Answer 21

Reduce infection-related exacerbations.

Question 22

Benefit of pulmonary rehabilitation?

Answer 22

Improves symptoms and quality of life (not FEV1).

Question 23

What characterises COPD disease trajectory?

Answer 23

Gradual decline with exacerbations.

Question 24

Mortality following hospitalisation for exacerbation?

Answer 24

23–80%.

Question 25

Indication for LTOT (PaO2)?

Answer 25

≤7.3 kPa (or ≤8.0 kPa with complications).

Question 26

What complications allow LTOT at PaO2 7.3–8.0 kPa?

Answer 26

* Pulmonary hypertension * Peripheral oedema * Polycythaemia (Hct >55%)

Question 27

Does LTOT improve survival?

Answer 27

Yes, in severe resting hypoxaemia.

Question 28

Core treatment for COPD?

Answer 28

Bronchodilation.

Question 29

Why are bronchodilators effective?

Answer 29

Small increase in airway radius greatly reduces resistance.

Question 30

First-line inhalers for airflow obstruction?

Answer 30

LAMA/LABA combination.

Question 31

When are ICS useful in COPD?

Answer 31

Eosinophilic airway inflammation.

Question 32

Risk of ICS in COPD?

Answer 32

Increased pneumonia risk.

Question 33

Airflow obstruction trait treated with?

Answer 33

LAMA/LABA.

Question 34

Eosinophilic inflammation trait treated with?

Answer 34

Inhaled corticosteroids.

Question 35

pH 7.25, pCO2 9.6, pO2 15 → What type of failure?

Answer 35

Acute Type 2 respiratory failure (hypercapnic with acidosis).

Question 36

Why is pO2 high on NRB?

Answer 36

High oxygen delivery despite ventilation failure.

Question 37

pH 7.28
pCO2 8.0
pO2 7.4 Interpretation of repeat ABG?

Answer 37

Persistent Type 2 respiratory failure with inadequate oxygenation.

Question 38

When is NIPPV indicated?

Answer 38

* pH <7.35 * PaCO2 >6.5 kPa * Despite optimal medical therapy

Question 39

Goals of NIPPV?

Answer 39

* Improve pH * Reduce CO2 * Reduce work of breathing

Question 40

When consider intubation?

Answer 40

* Deteriorating pH * Reduced consciousness * Failure of NIPPV

Question 41

Post-bronchodilator FEV1/FVC <0.70 = ?

Answer 41

COPD.

Question 42

PaCO2 >6 kPa + acidosis = ?

Answer 42

Type 2 respiratory failure.

Question 43

Best survival treatment in severe hypoxaemia?

Answer 43

LTOT.

Question 44

Most important modifiable factor?

Answer 44

Smoking cessation.