2154 ic17 (COPD)

Question 1

Risk factors for developing COPD

Answer 1

Tobacco, Genetic eg. alpha 1 antitrypsin deficiency, Female, History of asthma, Severe childhood respiratory infection, Lung growth and development, SES, Old age, Family history.

Question 2

Clinical presentation of COPD

Answer 2

Dyspnea (persistent, progressively worse), Chronic Cough, ± Sputum, Wheezing, chest tightness, weight loss (from exertion), muscle loss.

Question 3

MOA of B2 agonists

Answer 3

Bind to B2 GPCR → ↑adenylyl cyclase → ↑cAMP → ↑PKA → ↓MLCK activity → Airway SM relaxation

Question 4

MOA of muscarinic antagonist

Answer 4

1) Inhibit M3 receptor mediated bronchoconstriction,
2) Reduce bronchospasm, mucus secretion, inflammation and airway SM hyperplasia.

Question 5

Considerations before starting ICS in COPD

Answer 5

Strong: History of hospitalisation, > 2 moderate exacerbations per year, EOS > 300, History of asthma.
Consider: 1 moderate exacerbation, EOS < 100-300.
Against use: Repeated pneumonia events, EOS < 100, History of mycobacterial infection.

Question 6

Antibiotics use in stable COPD treatment

Answer 6

used at low dose and regularly for immunomodulation effect
may reduce exacerbation rate

Question 7

Antibiotics use in exacerbation in COPD, when should be used

Answer 7

viral infections as common as bacterial infections
use when theres 3 cardinal symptoms (worsening dyspnea, sputum purulence and increased sputum volume)
or 2 symptoms, where sputum purulence is one of them

Question 8

Non pharmacological for COPD

Answer 8

smoking cessation
engage in exercise
vaccination (pneumococcal, zoster, flu, covid)
pulmonary rehab
self management on breathlessness
healthy
written action plan

Question 9

What does Pulmonary Rehab Programme entail?

Answer 9

Patient education
Exercise
Nutritional support
Psychosocial support