COPD

Question 1

What is airflow obstruction

Answer 1

Measured by spirometry.

Ratio of forced expiratory volume in one sec to forced vital capacity (FEV1/FVC) <0.7 = air flow obstruction

Question 2

What is chronic bronchitis

Answer 2

Clinical term referring to cough and sputum production for atleast 3 months in each of consecutive 2 years

Question 3

What is emphysema

Answer 3

Pathological term referring to loss of parenchymal lung texture ( destruction of alveoli ).

Question 4

What is emphysema

Answer 4

Pathological term referring to loss of parenchymal lung texture ( destruction of alveoli ).

Question 5

COPD risk factors

Answer 5

Smoking 
Genes 
Age/gender 
Lung growth / development 
Exposure to particles - cigarette smoke , occupational dust and fumes , indoor air pollution 
Socioeconomic status 
Asthma / bronchial hyperactivity 
Chronic bronchitis

Question 6

Pathological changes with COPD

Answer 6

Lung parenchyma 
Chronic inflammation ( increase in inflammatory cells)
Structural changes (repeated injury and repair 0)

Resulting in
Increase resistance to airflow obstruction in small conducting airways
Air trapping
Progressive airflow obstruction

Question 7

Pathogenesis of COPD

Answer 7

Oxidative stress

Imbalance of proteases and anti proteases

Question 8

Physiological abnormalities

Answer 8

Mucous hypersecretion - chronic productive cough
Ciliary dis function - struggling to cough up phlegm
Air flow obstruction and hyper inflation - breathlessness and limited exercise capacity
Gas exchange abnormalities - hypoxaemia (low) and hypercapnia ( high)
Pulmonary hypertension due to vasoconstriction of vessels leading to deoxygenated areas
Systemic affects - skeletal muscle wasting , increased risk of CVD, anxiety and depression

Question 9

Diagnosis

Answer 9

Suspect  COPD in people aged >35 yrs with a risk factor >= 1 of following symptoms 
Breathless 
Chronic / reoccurring cough 
Regular sputum production 
Frequent lower resp tract infections 
Wheeze 

Other symptoms 
Weight loss 
Ankle swelling fatigue 
Blueish coat to skin 
Hyper inflated chest

Question 10

What does a spirometer measure

Answer 10

Volume of air patient is able to expel from lungs after maximal inspiration

Question 11

Classification of mild COPD

Answer 11

FEV1>= 80% predicted

Question 12

Classification of moderate COPD

Answer 12

50% <= FEV1 < 80% predicted

Question 13

Classification of severe COPD

Answer 13

30%<= FEV1< 50% predicted

Question 14

Classification of very severe COPD

Answer 14

FEV1 < 30% predicted

Question 15

Goals of COPD therapy

Answer 15

Relieve symptoms
Prevent disease progression
Improve exercise tolerance and health status
Prevent and treat exacerbations and any complications
Reduce mortality

Question 16

Non pharmaceutical management of COPD

Answer 16

Smoking cessation
Vaccinations
Pulmonary rehabilitation

Question 17

Short acting B2 agonist. Example and duration of action

Answer 17

Salbutamol. 4-6 hrs. Inhaler technique.

Question 18

Long action beta 2 agonist. Example and duration of action

Answer 18

Salmeterol. 12+ hrs. Inhaler technique

Question 19

Short acting muscarinic antagonists - example

Answer 19

Ipratropium bromide- slower onset of action than SABA . Inhaler technique

Question 20

LABA - examples

Answer 20

Tiotropium. Longer duration of action than LABAs . Inhaler technique.

Question 21

Types of drugs used to treat COPD

Answer 21

LAMA
SAMA
LABA
SABA
Methyxanthines
Inhaled corticosteroids (ICS)
Oral corticosteroids 
Phosohodiesterase type-4 inhibitors

Question 22

Methylxanthines

Answer 22

For those unable to take inhaled drugs or symptoms get worse
Eg theophylline
Releasable airway smooth muscle
Dose related to toxicity. Narrkw therapeutic window. Significant interactions

Question 23

ICS

Answer 23

Eg beclomethasone

Increased risk of pneumonia
Withdraw may lead to exacerbations
Mono therapy not recommended
Good inhaler technique needed for oral thrush prevention

Question 24

Oral steroids

Answer 24

Eg prednisolone.

Advanced disease only . Low dose. Numerous side effects

Question 25

Phosphodiesterase type 4 inhibitors

Answer 25

Eg roflumilast

Add on therapy to bronchodilators for those w severe COPD
duration of action is 24 hrs
More adverse effects than inhaled medication

Question 26

Delivery systems used to treat patients with stable COPD

Answer 26

Inhalers
Spacer devices
Nebulisers

Question 27

When should spacers be used

Answer 27

All those on high ICS

most elderly using standard metered dose inhalers

Question 28

What is carbocistiene

Answer 28

Mucolytic. Helps you cough up phlegm

Question 29

Who should be considered for oxygen therapy .

Answer 29

Very severe airflow obstruction (FEV1 <30% predicted )
Cyanosis
02 saturations <= 92% breathing air

Question 30

What is an exacerbation

Answer 30

A sustained acute onset worsening of the patients symptoms from their usual stable state which goes beyond normal day to day variations .

Question 31

Commonly reported symptoms of exacerbations

Answer 31

Worsening breathlessness 
Increase sputum volume and colour (y/g colour)
Cough 
Wheeze 
RTI

Question 32

Pharmacological management of exacerbations

Answer 32

Increased dose of SABA
oral corticosteroids may be used if no c/I
Prednisolone 30mg daily for 5 days

Antibiotics if exacerbation is ass with history or more purulent sputum
Oral first line

IV theophylline if adequate response to nebulised bronchodilators

Oxygen sat measured and given if needed

Non invasive ventilation
Asses need for intubation

Question 33

How often should patient be sen for mild / moderate / severe COPD

Answer 33

At least annual

Question 34

How often should patient Be seen for very severe COPD

Answer 34

twice a year