Chronic obstructive pulmonary disease

Question 1

Symptoms

Answer 1

• Dyspnoea
• Wheezing
• Chronic cough
• Sputum

Question 1

COPD: diff btw asthma

Answer 1

• characterised by irreversible airflow obstruction: chronic bronchitis + emphysema
• diff with asthma: COPD is irreversible + asthma is reversible + symptoms are temporary

Question 2

Treatment: inhalers

Answer 2

SABA OR SAMA (when required)

Asthmatic features (or steroid responsiveness)→
- Yes: LABA + ICS
- No: LABA + LAMA (stop SAMA)

Daily symptoms affecting QoL OR exacerbations (severe: hospital 2+ per year + systemic corticosteroid or abx) → LABA + ICS + LAMA (stop SAMA)

ICS for 3 months + not effective → it can be discontinued

Question 3

Treatment: oral

Answer 3

• Alt bronchodilator: theophylline
• Chronic cough w sputum: mucolytic
• Acute COPD exacerbation: abx (macrolide or quinolone) + oral corticosteroids (30mg prednisolone daily for 5 days)
• Severe COPD + chronic bronchitis: roflumilast (add on to bronchodilators)

Severe COPD + hypoxaemia: O2 therapy
- 15H a day
- O2 target: 88-92%
- Oxygen alert card

Question 4

Inhaled antimuscarinics: MOA

Answer 4

bronchodilation + red mucus secretion

Question 5

Inhaled antimuscarinics: drugs

Answer 5

SAMA: ipratropium (TDS lasts 3-6H)

LAMA:
- Aclidinium eg. genuair (BD, green-red win dow, dose indicator)
- Glycopyronnium eg. seebri, breezhaler
- Tiotropium eg. spiriva (COPD), spiriva respimat (severe asthma)
- Umeclidinium eg. incruse ellipta

Question 6

Inhaled antimuscarinics: dose

Answer 6

Once daily
- MHRA: pMDI inhalers: airway obstruction
- MHRA: tiotropium: risk of inhaling capsule

Aclidinium: BD

Question 7

Inhaled antimuscarinics: side effect

Answer 7

Urinary retention
- Caution: prostatic hypertrophy

Glaucoma
- Caution: risk of acute angle closure glaucoma, protect eyes

Dry mouth
Blurred vision
Constipation