Asthma and COPD

Question 1

Features seen on CXR of patient with COPD

Answer 1

Hyperinflation
Flattened hemidiaphragms
Hyperlucent lung fields

Question 2

What are the clinical features seen in an acute exacerbation of COPD

Answer 2

Increased cough.
Increased sputum (or change of colour).
Increased dyspnoea.

Question 3

Signs seen on examination of patient with AE of COPD

Answer 3

Obs: tachypnoea, hypoxia, tachycardia.
Inspection: increased work of breathing, may be cyanosis.
Palpation: reduced expansion.
Percussion: hyperresonance.
Auscultation: wheeze, prolonged expiratory phase, decreased breath sounds.

Question 4

In COPD an predicted FEV1 >80 and FEV1/FVC of <70 is categorised as..

Answer 4

Stage 1 - mild severity

Question 5

COPD diagnosed when FEV1/FVC is 1) ______ and 2)______

Answer 5

<70% and there are symptoms suggestive of COPD

Question 6

What criteria determines whether LTOT should be given to COPD patients

Answer 6

2 ABG measurements of pO2 < 7.3 kPa

Question 7

Main SE of inhaled beclometasone (steroid) is..

Answer 7

Oral candidiasis (white spots in mouth and loss of taste sensation)

Can be prevented by rinsing the mouth or brushing the teeth straight after use

Treat with anti-fungals = nystatin or miconazole

Question 8

When is NIV considered in patients with AE of COPD

Answer 8

if PaCO2 >6kPa, pH <7.35 levels continue despite immediate medical management (Nebulisers, steroids and theophylline)

Question 9

investigation for occupational asthma

Answer 9

Serial peak flow measurements at work and at home

Question 10

Most common cause of infective exacerbations of COPD

Answer 10

1. Haemophilus influenzae
2. Streptococcus pneumoniae
3. Moraxella catarrhalis

Question 11

Most common cause of pneumonia

Answer 11

Streptococcus pneumoniae

Question 12

What is characteristic of an acute exacerbation of COPD

Answer 12

Increase in dyspnoea, cough, wheeze
Increase in sputum
Patient possibly hypoxic and in some cases have acute confusion

Question 13

Treatment of acute exacerbation of COPD

Answer 13

Increase frequency of bronchodilator use (consider nebuliser use)
Prednisolone 30 mg daily for 7-14 days
ABX (amoxicillin/clarithromycin)- if sputum is purulent or there are clinical signs of pneumonia

Question 14

Life threatening asthma indicators

Answer 14

PEFR <33%, O2 Sats <92% + CHEST

Cyanosis
Hypotension
Exhaustion
Silent chest, poor respiratory effort
Tachy/brady/arrhythmia

Question 15

LTOT in COPD can be given if

Answer 15

very severe airflow obstruction (FEV1 < 30% predicted).
cyanosis
polycythaemia
peripheral oedema
raised jugular venous pressure
oxygen saturations less than or equal to 92% on room air

Question 16

Severe asthma management

Answer 16

1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol