COPD

Question 1

Severity of COPD

Answer 1

Mild - FEV1 of 0.6-0.8. Breathless on moderate exertion
Mod - FEV1 of 0.4-0.59. Breahtless on walking on level ground. Recurrent chest infections. Exacerbations requiring PO Corticosteroids and PO Abx
Sev - FEV1 < 0.4. Breathless on minimal exertion

Question 2

Non-pharmacological Intervention of COPD

Answer 2

• Smoking cessation
• Immunisation (Pneumococcus, COVID, Influenza)
• Regular exercise and physical activity > 150mins/week
• Written COPD action plan.
• Symptomatic patients to attend pulmonary rehab
• Consider advanced care planning in severe disease
• Consider home O2 if severe.

Question 3

COPD Pharmacological Interventions

Answer 3

Mild
- SABA/SAMA + LAMA/LABA

Moderate
+ ICS

SABA - Salbutamol 100microg INH MDI
Terbutaline 500microg INH DPI

SAMA - Ipratropium (Not usually used for symptom relief in COPD and contrindicated if taking a LAMA. Also increases risk of cardiovascular events

LAMA
- Tiotropium, Aclidinium, Glycopyrronium, Umeclidinium
- OD dosing

LABA
- Indacaterol OD.

ICS
- Fluticasone
- Beclometasone
- Ciclesonide
- Budesonide