(009) COPD

Question 1

what is COPD characterized by ?

Answer 1

persistent respiratory symptoms and airflow limitation due to airway to alveolar abnormalities

Question 2

what is a pink puffer ?

Answer 2

patient usually has a cachectic appearance , pursed lips using accessory muscles for breathing, is undergoing compensatory hyperventilation
usually associated with emphysema

Question 3

what is a blue bloater ?

Answer 3

patient usually looks cyanosed , has oedema , can hear wheezes and crackles and is usually associated with chronic bronchitis

Question 4

what is the difference between FEV1 and FVC ?

Answer 4

FEV1 is the forced expiratory volume in the first second of expiration
FVC is the forced vital capacity which is the max volume of air that is expelled from the lungs after max inspiration

Question 5

what is the FEV1/FVC value in COPD ?

Answer 5

less than 70% (post bronchodilator)

Question 6

how would you measure the degree of airway obstruction ?

Answer 6

FEV1

Question 7

how would you measure the degree of dyspnea ?

Answer 7

mMRC scale system

Question 8

what are the levels/degree of airway obstructions (FEV1)?

Answer 8

GOLD 1 - mild - FEV1 is more than 80%
GOLD 2 - moderate - 50%< x < 80%
GOLD 3 - severe - 30% < x < 50%
GOLD 4 - very severe - less than 30 %

Question 9

what is the grading for dyspnea ?

Answer 9

grade 0- dyspnea with strenuous exercise
grade 1- dyspnea when hurrying or walking up a hill
grade 2- dyspnea when walking on level, stops after 15 min
grade 3- dyspnea when walking fewer than 100m
grade 4- dyspnea is very severe and cannot leave home

Question 10

when to classify the patient as to having a mild exacerbation history ?

Answer 10

if they’ve experienced 0 or 1 exacerbations in the last year that have not lead to hospital admission

Question 11

when would a patient have moderate to severe exacerbation history ?

Answer 11

if there are 2 or more or 1 or more exacerbations that have led to hospital admission

Question 12

what is the combined score system for COPD ?

Answer 12

group A - mMRC 0-1, 0 or 1 moderate exacerbations not leading to hospitalization
group B - mMRC > 2 , 0 or 1 moderate exacerbation not leading to hospitalisation 
group E - any symptom but went to the hospital or 2 or more moderate exacerbation 

Question 13

what is roflumilast and what are the indications for taking it ?

Answer 13

phosphodiesterase inhibitor, can be taken in COPD patients who have a FEV1 less than 50% with no success in previous therapies
and patients with chronic bronchitis

Question 14

what is the management for acute exacerbations ?

Answer 14

1. consider other differential diagnosis
2. antibiotics over the causative bacteria
3. start oral corticosteroid for 5-7 days
4. bronchodilators; rapid acting B2 agonist and anticholinergic
5. ventilation support

Question 15

when to discharge a patient after an acute exacerbation ?

Answer 15

clinically stable patient with normal lab results
asses inhaler technique
asses need for oxygen therapy
schedule a follow up visit in 1-4 weeks

Question 16

what are the nebulizer drugs ?

Answer 16

short acting b2 agonist: salbutamol (farcolin)
short acting anticholinergic - ipatroprium bromide (atrovent)
Inhaled corticosteroid - budesonide - plumicort

Question 17

what are the three main types of inhaler devices ?

Answer 17

metered dose inhaler
dry powder inhaler
soft mist inhaler

Question 18

what is oxygen therapy ?

Answer 18

long term oxygen therapy - 18-24 h/day

Question 19

when is oxygen therapy indicated ?

Answer 19

when Po2 is less than 55 mmhg
OR
Po2 is less than 60 mmhg along with right sided heart failure and/or polycythemia

Question 20

how often should you follow up with oxygen therapy ?

Answer 20

every 2 to 3 months

Question 21

what is the target HB o2 saturation with oxygen therapy ?

Answer 21

88-92%

however if PCO2 is high dont exceed 92%

Question 22

what are the side effects of oxygen therapy ?

Answer 22

nose dryness
respiratory depression in type 2

respiratory depression in type II RF

Question 23

if a COPD patient is on beta blocker for controlling his hypertension what must be done ?

Answer 23

avoid beta blockers give a calcium channel blocker instead eg. Verapamil

Question 24

define an acute exacerbation of COPD ?

Answer 24

worsening symptoms over less than 14 days

Question 25

what drugs are taken for each group in COPD classification ?

Answer 25

group A - a bronchodilator
Group B - LABA + LAMA
Group C - LABA + LAMA and consider ICS if eos is above 300

Question 26

what is the algorithm for thee management of exacerbations ?

Answer 26

give LABA or LAMA initially
then measure eos
if above 300 - add ICS
below 300 give both LAMA and LABA

measures the eos tany after LAMA+LABA administration
if above 100 - add ICS
if below 100 - move on to last step

last step were going to give either roflumilast or azithromycin

Question 27

who takes roflumilast and who takes azithromycin in the acute exacerbation of COPD ?

Answer 27

previous smoker - azithromycin
chronic bronchitis or FEV1 below 50 - give roflumilast

Question 28

what are the contraindications to using ICS in COPD ?

Answer 28

if the eosinophil count is below 100
if there is history of recurrent pneumonia
if there is history of recurrent TB infection

Question 29

what drugs are not encouraged for usage in COPD management ?

Answer 29

ICS + LABA
theophylline