Asthma/COPD

Question 1

How to diagnose asthma

Answer 1

History and examination (wheeze, cough, chest tightness)
Peak expiratory flow reading
Spirometry with bronchodilator reversibility (FEV1/FVC needs to be below 0.7)

Question 2

How to manage asthma

Answer 2

• Aim of management is for control of disease
• Smoking cessation advice
• Lifestyle advice
• Start Short Acting BETA-2 Agonist (SABA)
Reliever for symptoms
• Start Inhaled Corticosteroid if preventer needed:
Using a SABA for more than 3 times a week
Have asthma symptoms more than 3 x week
Woken by asthma symptoms more than 1 x week

Question 3

What is Feno (fractional exhaled nitric oxide)

Answer 3

a test that measures the levels of nitric oxide in your breath,
High levels show that you have inflamed airways and can be used to test for asthma

Question 4

What is COPD

Answer 4

Combination of airways disease (obstructive bronchitis) and
parenchymal damage (emphysema)

Question 5

COPD risk factors

Answer 5

• Cigarettes- approx 90% of cases
• Pipe/ Water pipe and cannabis smokers
• Passive smoking
• Occupational exposure
• Air pollution
• Genetics
Homozygous alpha-1 antitrypsin deficiency in 1 % of cases
Significant familial risk of airflow obstruction in smoking siblings of people with severe COPD

Question 6

Symptoms of COPD

Answer 6

• Exertional breathlessness
• Chronic cough usually with sputum production
• Recurrent chest infections
• Wheeze
• Examination findings- Use of accessory muscles (using neck muscles), hyperinflated chest, Wheeze or quiet breath sounds, cyanosis

Question 7

COPD diagnosis

Answer 7

• History
Older than 35
Presence of a risk factor
Typical symptoms

• Examination
Oxygen levels, chest auscultation

• Investigations
Post bronchodilator airflow obstruction on spirometry
CXR- to r/o other pathology
Blood tests

Question 8

How to stage COPD

Answer 8

Assessed using the Spirometry findings
• FEV1/ FVC ratio is less than 0.7
• Then look at the FEV1
Stage 1- FEV1 – 80% OF PREDICTED
Stage 2- FEV 1- 50-79% OF PREDICTED
Stage 3- FEV1- 30-49% OF PREDICTED
Stage 4- FEV1 – Less than 30% OF PREDICTED

Question 9

How to manage COPD

Answer 9

Question 10

What is prognosis of COPD

Answer 10

• Progressive disease
• Smoking cessation is the key to halting the progress
• 30,000 deaths each year (5%)
• Hospital admissions due to COPD exaccerbations account for 3-4 % mortality
• Causes disability, depression/ anxiety, frequent chest infections, Respiratory failure, Lung cancer