COPD Primary Care

Question 1

What is looked at when diagnosing COPD ?

Answer 1

History (symptoms & risk factors)
Examination
Chest x-ray
Spirometry

The diagnosis is principally based on the history

Question 2

What are symptoms of COPD ?

Answer 2

Breathlessness
Cough
Sputum
Frequent chest infections
Wheeze

Feeling of drowning/being strangled

Question 3

What are the levels of the mMRC Dyspnoea Scale ?

Answer 3

Question 4

What should be looked at in an examination for COPD ?

Answer 4

Should include:
-Vital signs (RR, O2 sats)
-General exam (cyanosis, tar staining, etc.)
-Chest exam (hyperinflated chest, crackles, wheeze, etc.)

Examination may be normal

Question 5

What are differential diagnoses of COPD ?

Answer 5

Just because someone labelled with COPD doesn’t mean we trust diagnoisus
-Is no definitive test for COPD, just like asthma

Question 6

What spirometry results indicate which levels of COPD severity ?

Answer 6

Looking for persistent airflow obstruction
-Post-bronchodilator FEV₁/FVC < 0.70
-Reduced FEV₁
-FVC may be normal or reduced
-Obstruction is not fully reversible

Spirometry may be normal e.g. may have been supernormal before

Question 7

When is COPD considered and spirometry carried out in an individual over 40 ?

Answer 7

Question 8

What is invovled in non-drug treatment of COPD ?

Answer 8

Also pulmonary rehabilitation
Also achieving healthy weigth; malnutrituion common in COPD
-Brething gast so high BMR
-Patietns choose breathing over eating
-May be too breathless to get food

Question 9

What is pulmonary rehabiliation ?

Answer 9

Graded exercise programme to help improve fitness and help manage breathlessness.

Question 10

Give examples of comorbidities which can be managed as a non-drug treatment of COPD

Answer 10

Heart failure
Ischaemic heart disease
Obesity
Interstitial Lung Disease
Bronchiectasis

LVF, IHD, IPF – all smoking related.
Obesity – exacerbates all symptoms of COPD, particularly breathlessness
Bronchiectasis – bronchiectasis that complicates COPD confers a very poor outcome, particularly if colonised with pseudomonas

Question 11

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Give examples of drugs which can be used to treat COPD

Answer 11

Bronchodilators
ICS
Combination therapies
Oral therapies

Question 12

Which criteria are used to group COPD patients into severity categories ?

Answer 12

This is carrier out after COPD indicated bronchodialtor spirometry, nMRC scale, CAT (CAT is a subjective self-questionaire)

Question 13

How are bronchodilators used to treat stable COPD ?

Answer 13

LABA and LAMA significantly improve lung function, dyspnoea, health status, and reduce exacerbation rates
-combination increases FEV1 and reduces symptoms and exaccerbations compared with monotherapy
-always used together

Theophylline exerts a small bronchodilator effect in COPD (A) associated with modest symptomatic benefits
-but is too toxic so never rlly used

Question 14

What are the initial pharmacological treatments for COPD and who gets them ?

Answer 14

ICS not that useful (esp long-term); increases risk of pneumonia which is very dangerous here, needs high Eos to be worthwhile, they dont actually help that much anyway, they may help some peopel feel better so can use pallitave (but exam andwer is whay is in box)

Guidline is bronchodilators, consider ICS, consider antibtioics - for exam know this
-steroids and antibtoiocs probbaly gonna get bootde though

Dry power recommended over meter dose; environmental

Question 15

Explain the use of Mucolytics in COPD treatment

Answer 15

In patients not receiving ICS, mucolytics may reduce exacerbations and improve health status.

e.g. carbocystine and N-acetylcystine

An oral therapy

Question 16

How does COPD cause malnutrition ?

Answer 16

Question 17

Why are biologics not used much in COPD ?

Answer 17

COPD is usually neutrophilic → biologics less effective

A subset of COPD patients have eosinophilic inflammation

Biologics may help in that subgroup

They are not routine COPD therap.

These are mainly used in eosinophilic asthma.

Question 18

What is a COPD exaccerbation ?

Answer 18

An acute worsening of respiratory symptoms that results in additional therapy
-symptoms are not COPD specific – relevant differential diagnoses should be considered
-goal for treatment is to minimize the negative impact of the current exacerbation

Question 19

What are differential diagnoses for exaccerbations of COPD ?

Answer 19

Pneumonia
Pneumothorax
Pleural Effusion
Pulmonary Embolism
Pulmonary Oedema
Cardiac arrhythmias

Question 20

How are COPD exaccerbations managed ?

Answer 20

-Increased short acting bronchodilators are recommended as initial management
-Systemic steroids can improve lung function, oxygenation and shorten recovery time. Duration of therapy should be not more than 5 days
-Antibiotics, when indicated, can shorten recovery time, reduce the risk of early relapse, treatment failure. Duration of therapy should be 5 days.
-Consider admission

Question 21

Who to refer to Secondary Care in COPD thing ?

Answer 21

Diagnosis uncertain
Young age of onset (Alpha 1 antitrypsin deficiency?)
Rapidly declining FEV1
For consideration of:
-Lung Volume Reduction Surgery
-Bronchoscopic Valves
-Lung Transplant