1.2 Obstructive airway disease (part 2)

Question 1

What is COPD

Answer 1

Characterised by irreversible airflow obstruction and worsens overtime

Two main form;
- Chronic bronchitis (long term inflammation of the bronchioles)

-Emphysema (Permanent damage to alveoli, making the exchange of gases difficult)

Question 1

Symptoms of COPD

Answer 1

Dyspnoea
Wheezing
Chronic cough which produces mucus
Sputum (thick, green yellow)

Question 2

COPD vs asthma

Answer 2

Respiratory symptoms are more persistent in COPD as COPD is irreversible whilst asthma is reversible

Question 3

COPD treatment

Answer 3

1: Reliever therapy
SABA or SAMA when required

2. If they have asthmatic features
   LABA + ICS

if there are no asthmatic features
LABA + LAMA (stop SAMA)

3. If patient has had an exacerbation that lands them in hospital OR 2+ moderate exacerbations in the last year year requiring systemc corticosteroids or antibiotic:

LABA + ICS + LAMA (stop SAMA)

If a patient has daily symptoms present with asthmatic features impacting quality of life, they can also be offered this regimen

LABA + ICS + LAMA (stop SAMA)

If a patient has daily symptoms with NO asthmatic features, they can be offered a course of ICS for 3 months.

Question 4

Examples of long-acting muscarinic antagonists

Answer 4

Tiotropium

Glycopyrronium

Question 5

Examples of short-acting muscarinic antagonists

Answer 5

Ipratropium

Question 6

Typical COPD treatment

Answer 6

*Theophylline bronchodilator
When SAMA or SABA is unsuitable, theophylline can be offered

*Chronic cough with sputum
mucolytic

*Acute COPD exacerbation
Antibiotic + oral corticosteroids

*Severe COPD + chronic bronchitis
Roflumilast

*COPD that causes low blood oxygen:
O2 therapy can be offered 15 hours a dat

Question 7

Inhaled antimuscarinics mechanism of action

Answer 7

They block muscarinic receptors in the lungs, which relaxes the smooth muscle within the bronchioles to dilate the airways

Question 8

Inhaled antimuscarinic doses

Answer 8

Ipratropium - can be taken up to three times a day
LAMA can be taken once a day

Question 9

Inhaled antimuscarinic side effects

Answer 9

Urinary retention
Glaucoma
Dry mouth
Blurred vision
Constipation

Typical antimuscarinic symptoms