COPD

Question 1

Chronic bronchitis definition

Answer 1

Cough and sputum production for at least 3 months in each of 2 consecutive years.

Question 2

Occupational risk factors for COPD

Answer 2

dusts (such as coal, grains, and silica),
Certain fumes or chemicals such as:
- welding fumes
- isocyanates (in paints and plastic stuff. Particularly car sprays)
- Polycyclic aromatic hydrocarbons coal tar, bitumen, petrol, organic stuff like burning wood.

Question 3

What genetic factor might result in development of COPD

Answer 3

A1AT

Question 4

From what age does NICE say to suspect COPD?

Answer 4

Over 35 if symptoms and one risk factor

Question 5

What heart problems do people with COPD get

Answer 5

Cor pulmonale (right sided HF due to pulmonary HTN).

Question 6

Initial COPD workup

Answer 6

CXR
FBC - Anaemia/ polycythaemia
Spiro

Question 7

COPD stages

Answer 7

Stage 1 - mild - FEV1 80% of predicted value or higher.

Stage 2, moderate — FEV1 50–79% of predicted value.

Stage 3, severe — FEV1 30–49% of predicted value.

Stage 4, very severe — FEV1 less than 30% of predicted value or FEV1 less than 50% with respiratory failure.

Question 8

What is the value of airflow obstruction on Spiro

Answer 8

ratio Less than 0.7

Question 9

Dyspnoea scale grades

Answer 9

1 - SOB with strenuous exercise

2 - SOB when hurrying or walking up a slight hill

3 - Walks slower than their contemporaries on the level because of breathlessness, or has to stop for breath when walking at their own pace

4 - Stops for breath after walking about 100 m or after a few minutes on the level

5 - Too breathless to leave the house, or breathless when dressing or undressing

Question 10

Who does NICE say you should refer to a specialist early on

Answer 10

Frequent infections -? Bronchiectasis
Very severe COPD (PEFR less than 30) or rapidly progression
A1AT personal or fax in anyone under 40
Cor pulmonale

Question 11

Who gets pulmonary rehab

Answer 11

Anyone with COPD and score of 3 on dyspnoea scale.
Anyone who’s been in hospital with an exacerbation

If they won’t go F2F consider digital (myCOPD)

Question 12

Who should you refer for consideration of LTOT

Answer 12

Very severe or severe COPD (FEV1 less than 30% or 30-49%)
JVP elevated
Sats less than 92%
Polycythaemia
Cor pulmonale

If they’re mobile ask for ambulatory o2

Question 13

How would someone with COPD who has had 0 or 1 COPD exacerbations not leading to hospital be managed

Answer 13

See what their CAT score or MRC dyspnoea score is

If MRC 0-1 +/- CAT less than 10 -
GOLD A - LABA OR LAMA

If MRC 2 +/- CAT over 10 - GOLD B - need LABA and LAMA

Question 14

How would someone with COPD and 2 or more moderate exacerbations or 1 or more exacerbations leading to hospitalisation be treated (GOLD E)

Answer 14

LABA + LAMA and Consider adding an ICS if blood eosinophils are greater than 0.3

Question 15

What would you step up COPD tx to

Answer 15

Step thrEE
Look at eosinophils and exacerbations
If>2 in past year or eosinophils > 0.3 ass ICS.

Steroids work best if:
Eosinophils ≥0.3.
Asthma.
Frequent exacerbations: ≥2/y.
Hospitalisation with exacerbations.

Question 16

Who would you refer for consideration of macrolide (azithromycin)

What Ix do they need

Answer 16

Patients who have had more than three exacerbations requiring steroid therapy and at least one exacerbation requiring hospital admission in the previous year.

** They need to have stopped smoking

ECG (exclude prolonged QT), baseline LFT, TB test

Question 17

Who would BTS recommend a pre flight respiratory assessment for in COPD patients

Answer 17

30% - severe
Air travel issues before
Bullous disease
Comorbidities worsened by hypoxia
Discharged from an exacerbation within last 6 weeks
Pneumothorax thats still leaking
O2 req >4L/min
VTE in past

Question 18

What specialist assessments might be done to determine fitness to fly

Answer 18

Walk test - walk for 6 to 12 mins.
If cant complete or moderate to severe resp distress on a visual analogue scale = may need in flight o2.

Hypoxic challenge test - used to assess whether a person needs in-flight oxygen.
Measures the person’s response to a simulated aircraft cabin environment.
In this investigation, 15% oxygen is administered and the person is monitored continuously by pulse oximetry.
A PaO2 of 6.6 kPa or an oxygen saturation of 85% is used as the cut-off value below which supplemental oxygen is recommended for air travel.

Question 19

When should you review patients with COPD

Answer 19

After an exacerbation once stable e.g. 6 weeks

once a year unless v severe (FEV1 less than 30%) then its twice a year

Question 20

Should Spiro be done at annual review

Answer 20

Yes

Question 21

What deterioration in Spiro would make you refer to a specialist

Answer 21

A loss of 500 ml or more over 5 years indicates rapidly progressing disease — consider the need for specialist referral and investigation.

Question 22

IECOPD most common causative organism ?

Answer 22

H influenzae

Question 23

What sats would make you admit a pt with IECOPD

Answer 23

90 or below

Question 24

When would you send a sputum culture in IECOPD

Answer 24

If sx not improved after 2-3d

Question 25

What abc in IECOPD

Answer 25

Amox/doxy/clari for 5d. If higher risk of tx failure e.g. multiple prev abx/ v unwell then cloud try Co-amoxiclav or Co-trimoxazole

Question 26

What kind of Spiro to diagnose COPD

Answer 26

POST bronchodilator