Chapter 3 - COPD

Question 1

What two diseases make up COPD?

Answer 1

Chronic bronchitis and emphysema

Question 2

What is chronic bronchitis?

Answer 2

Narrowing of bronchioles due to inflammation and excess mucus build up.

Symptoms:

Chronic cough
Sputum production

(Diagnosis - cough and sputum production for at least 3 months in 2 consecutive years)

Question 3

What is emphysema?

Answer 3

Loss of lung elasticity and alveolar membrane breakdown.

(Alveoli function to facilitate gas exchange. O2 from inhaled air diffuse through alveolar membrane and is then transported to tissues in the body)

Question 4

What does FEV1 stand for?

Answer 4

Forced expiratory volume in 1 second

Question 5

What does FVC stand for?

Answer 5

Forced vital capacity - (max volume of air that can be expelled from the lungs)

Question 6

In COPD FEV1 is generally reduced or increased?

Answer 6

Reduced

Question 7

In COPD do you expect FVC to be reduced, increased or stay normal?

Answer 7

Generally FVC is normal, may be slightly reduced

Question 8

What are the predicted FEV1 % and their corresponding stages of COPD?

Answer 8

FEV1 > 80% is stage 1 COPD (mild)
FEV1 50-79% is stage 2 COPD (moderate)
FEV1 30-49% is stage 3 COPD (severe)
FEV1 < 30% is stage 4 COPD (very severe)

Question 9

Which bacteria are frequently associated with exacerbations of COPD?

Answer 9

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

Question 10

NICE CG recommends the use of which antibiotics for the treatment of exacerbations of COPD?

Answer 10

Amoxicillin - 500mg-1g TDS
Macrolides (e.g clarithromycin 250mg - 500mg BD)
Tetracyclines (e.g doxycycline 200mg stat, 100mg thereafter)

Choice of antibiotics and duration depend on local policies

Question 11

What strength of Prednisolone is usually used for the treatment of COPD exacerbation?

Answer 11

30mg/ day for 7-14days

Question 12

What CHM advice (July 2008) is there regarding the use of Fostair in comparison to traditional beclometasone inhalers?

Answer 12

Fostair - contains extra fine particles of beclometasone and is therefore more potent than traditional beclometasone CFC free inhalers. Dose of Fostair should be lower than traditional formulations

Question 13

What is Fostair?

Answer 13

Beclometasone and formoterol

Question 14

Can beclometasone CFC inhalers Qvar and Clenil be prescribed generically or must they be brand specific?

Answer 14

Brand specific - Qvar has extra fine particles of beclometasone and is much more potent than traditional beclometasone inhalers and Clenil (~ twice as potent)

Question 15

As of July 2008 MHRA has advised that beclometasone inhalers should be prescribed by brand. Is this statement True or False

Answer 15

True

Question 16

100micrograms of Qvar (beclometasone dipropionate) is equivalent to how many micrograms of the following:

1) generic beclometasone
2) budesonide
3) fluticasone

Answer 16

1+2) 200-250micrograms of generic beclometasone or budesonide
3) 100micrograms of fluticasone propionate

Question 17

Which of the following brands are licensed for use in COPD?

Clenil modulite 
Qvar 
Fostair 
Budelin Novolizer
Pulmicort Turbohaler 
DuoResp Spiromax
Symbicort Turbohaler 
Alvesco 
Flixotide Evohaler 
Flutiform
Seretide
Relvar Elipta
Anoro Elipta

Answer 17

Fostair (beclometasone + formoterol)
DuoResp Spiromax (budesonide + formoterol)
Symbicort (budesonide + formoterol)
Seretide (fluticasone + salmeterol)
Relvar Elipta (fluticasone + vilanterol)
Anoro Elipta (umeclinidium + vilanterol)

Question 18

What is Step 1 therapy for the treatment of COPD (NICE + BNF)?

Answer 18

SABA and/or SAMA

Question 19

What is Step 2 treatment for COPD (NICE + BNF)?

Answer 19

FEV1 >/= 50%:
LABA or LAMA (discontinue SAMA)

FEV1 < 50%:
LABA + ICS or LAMA

Question 20

What is Step 3 for the treatment of COPD (NICE + BNF)?

Answer 20

If patient was on LABA alone previously (FEV1 >50%) add in ICS

Or

LABA + ICS and LAMA

Question 21

Which LAMA is a twice daily dose?

Aclidinium bromide
Glycopyrronium bromide
Tiotropium bromide
Umeclinidium

Answer 21

Aclidinium bromide

Question 22

What are the general side-effects of inhaled antimuscarinics?

Answer 22

‘Anticholinergic side effects’ - dry mouth, constipation, diarrhoea, headache, sinusitis
More uncommon: angle-closure glaucoma, blurred vision, dizziness, AF

Question 23

What are the side effects associated with inhaled B2 agonists?

Answer 23

Fine tremor (particulary of hands), headaches, nervous tension, muscle cramps, palpitations.

High doses also associated with hypokalaemia and hyperglycaemia (more common with IV)

Question 24

What is the duration of action of formoterol and salmeterol?

Answer 24

Approximately 12 hours

Question 25

What is the duration of action of salbutamol?

Answer 25

Approximately 3-5hours