COPD

Question 1

What does NICE 2010 CG101 tell us with regards who to consider might have COPD?

Answer 1

1. Consider COPD in anyone >35 years who is a smoker/Ex-smoker with exertional breathlessness, chronic cough, regular sputum production, wheeze and **winter bronchitis **and DO NOT have symptoms of asthma: nocturnal breathlessness, chronic unproductive cough, diurnal variability.

Question 2

If someone is thought to have COPD, what are some questions to ask?

Answer 2

• SOB
• Cough
• Sputum
• Reduced exercise tolerance
• Smoking status

Question 3

If someone is thought to have COPD, what can be found on examination, what questionnaires can be used & what investigations can be done?

Answer 3

On examination

• Finger clubbing
• Chest examination
• Pulse - resp rate

Questionnaires

• MRC Dyspnoea Score
• CAT (COPD Assessment Test)
• Depression questions

Investigations

• Oxygen saturations.
• Peak flow - pre and post inhaler/diary
• CXR
• FBC (anaemia)
• BMI

Question 4

How does one diagnose COPD?

Answer 4

Spirometry - refferal for spirometry can be made to spiometry clinic.

COPD (Obstructive lung disease) if FEV1/FVC is <0.7.

Question 5

How is COPD severity graded?

Answer 5

It is graded by the FEV1%

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

Question 6

What should be done at the annual review?

Answer 6

• Questions
  
  • Breathlessnes and exercise tolerance
  • MRC Dyspnoea score.
  • Frequency of exacerbations
  • Sputum – colour and consistency.
• Check inhaler technique
• Assess BMI and nutrition
• Spirometry yearly.
• Pulse oximetry (Consider LTOT if <92%)
• Consider Osteoporosis prevention.
• CAT, Depression Questions.

Question 7

What options of referral can considered with regards to COPD?

Answer 7

• Smoking cessation
• Pulmonary rehabilitation
• Occupational therapy
• Respiratory specialist

Question 8

Can you prescribe B-Blockers with COPD?

Answer 8

Yes. Don’t use as treatment but if heart failure can improve COPD symptoms..

Question 9

What is your first step in the management of SOB in COPD?

Answer 9

SABA (Salbutamol)

OR

SAMA (Ipratropium Bromide)

Question 10

What is the second step in managing COPD if FEV1 => 50%

Answer 10

LABA (Salmeterol or Formeterol)

OR

LAMA (Tiotropium Bromide)

Question 11

What is the second step in managing COPD if FEV1 < 50%

Answer 11

LAMA (Glycopyrronium bromide (Seebri Breezhaler), Tiotropium Bromide)

or

LABA + ICS (In combination inhaler- Fostair, Seretide, Symbicort)

(Consider LAMA + LABA if ICS declined)

Question 12

If someone is on a LAMA and they continue to have SOB, what should they they be started on?

Answer 12

Triple therapy

LAMA + LABA + ICS

Question 13

If someone is on LABA + ICS and they continue to get SOB, what should they be given?

Answer 13

Triple therapy

LABA + ICS + LAMA

Question 14

If someone is on LABA and they get SOB despite an FEV1 of > 50%, what should you do?

Answer 14

Prescribe LABA + ICS in a combination inhaler

(Or LABA + LAMA if ICS declined)