COPD

Question 1

What are the four further investigations that could be used to diagnose COPD?

Answer 1

X-ray
Sputum culture
ECG
FBC

Question 2

What would you expect to see on a X-ray with a patient positive for COPD?

Answer 2

Hyperinflation of the lungs due to air trapping
Flattered diagram
Bullae in the lungs (emphysema) due to air pockets

Question 3

What is an ECG?

Answer 3

Electrocardiogram used to detect heart rhythm and electrical activity. Changes in these factors are a common indicator of COPD.

Question 4

What is a FBC?

Answer 4

Full blood count. In COPD patients you would expect to see raised hemoglobin count to compensate for hypoxemia.

Question 5

What are some of the non-pharmacological interventions that could be made for COPD patients upon initial diagnosis?

Answer 5

Offer pulmonary rehabilitation
Offer STOP smoking service
Offer influenza/ pneumonia vaccines

Question 6

What is the late stage symptom of Emphysema?

Answer 6

Hypoxemia and hypercapnia

Question 7

What symptoms are suggestive of an emphysema diagnosis?

Answer 7

Shortness of breath (dyspnea)
Wheezing
Productive cough
Weight loss
Sputum production

Question 8

What symptoms are suggestive of a bronchitis diagnosis?

Answer 8

Sputum production
Hypercapnia and hypoxemia
Wheezing
Shortness of breath

Question 9

What symptoms would not be suggestive of a COPD diagnosis?

Answer 9

Chest pain
Coughing up blood
Responsiveness to bronchodilator (greater than 12%)
Diurnal variation
No progression in symptoms
Under 35
Non-smoker

Question 10

What is the first line treatment for a COPD patient?

Answer 10

Prescribed either a SABA or SAMA to use when needed

Question 11

If patient displays some asthmatic symptoms what is the add on therapy?

Answer 11

ICS & LABA

Question 12

When would you intitate add on therapy?

Answer 12

Patient is still limited by symptoms or has had exacerbations

Question 13

If patient displays no asthmatic symptoms what is the add on therapy?

Answer 13

LABA & LAMA

If on a SAMA switch to SABA upon introduction of the add on therapy

Question 14

A patient has been admitted to hospital following a chest infection. He is currently prescribed:
Salbutamol MDI inhaler
Ultibro Breezehaler 1 puff 1OD

However he is continuing to experience wheezing and shortness of breath throughout the day and is struggling to load the breezehaler correctly, what would you recommend?

Answer 14

Most likely introduce a 3-month trial of ICS + LABA + LAMA and she if there is an improvement in their symptoms. If there is no improvement revert back to LAMA + LABA.
A Trimbow inhaler can be prescribed, no issues with manual dexterity for a MDI.

If does switch back to LAMA + LABA perhaps switch to an accuhaler combination such as Anoro Ellipta