COPD

Question 1

what are the symptoms of COPD

Answer 1

dyspnoea (difficulty breathing), wheeze, chronic cough, and regular sputum production.

Question 2

what is Asthma-COPD overlap syndrome (ACOS)

Answer 2

persistent airflow limitation that displays features of both asthma and COPD.

Question 3

describe the treatment plan for COPD

Answer 3

step 1: all patients on SABA (salbutamol/ terbutaline) or SAMA (Ipratropium)

step 2:
- No asthmatic features: LABA (Salmeterol, formoterol) + LAMA (e.g Tiotropium, Aclidinium, glycopyrronium and umeclidinium). If LAMA given, SAMA must be stopped

• Asthmatic features: LABA ( (Salmeterol,formoterol )+ ICS (beclometasone, budesonide,, fluticasone, mometasone.)

step 3: triple therapy LABA + LAMA + ICS

note: treatment with a SABA as required may be continued in all stages of COPD.

Question 4

which 2 classes of drugs should not be given together in COPD

Answer 4

Discontinue SAMA treatment if a LAMA is given

Question 5

TRUE OR FALSE

Treatment with a SABA as required may be continued in all stages of COPD.

Answer 5

TRUE

SABA= (salbutamol/ terbutaline)

Question 6

when could you step up treatment in COPD

Answer 6

• if the patient has 1 severe or 2 moderate exacerbations
  within a year
  or

-if patient has has day-to-day symptoms that adversely
impact quality of life

Question 7

when would you use azithromycin as antibiotic prophylaxis in COPD

Answer 7

azithromycin used to reduce the risk of exacerbations in patients who are non-smokers + have optimised all other treatment options who:

• who either have prolonged or frequent (4 or more per year) exacerbations with sputum production

or

• exacerbations resulting in hospitalisation

Question 8

why might Roflumilast be used in COPD

Answer 8

add-on treatment in patients with severe COPD with chronic bronchitis (respiratory specialist initiation only),

Question 9

why might Modified-release theophylline be used in COPD

Answer 9

• if the patient is unable to use inhaled treatment
  or
• after a trial of short-acting and long-acting bronchodilators

Question 10

how do you manage exacerbations of COPD

Answer 10

• a short course of antibacterials e.g doxycycline (non-macrolide if on prophylactic azithromycin) and oral corticosteroids (prednisolone) should be kept at home -also known as rescue pack
• short-acting inhaled bronchodilators, usually at higher doses than the patient’s maintenance treatment through a nebuliser or hand-held device to manage breathlessness

Question 11

what are the common side effects for all inhaled antimuscarinics

Answer 11

Arrhythmias; constipation; cough; dizziness; dry mouth; headache; nausea

Question 12

what is Croup

Answer 12

an infection of the upper airway, which obstructs breathing and causes a characteristic barking cough

note: this is most commonly seen in children + normally goes away within 48 hours

Question 13

how do you treat Croup

Answer 13

a single dose of a oral corticosteroid (e.g. dexamethasone or prednisolone)

note: can use dexamethasone (by intramuscular injection) or budesonide (by nebulisation) as alternatives if child too unwell or oral route