COPD

Question 1

X

Question 2

X

Question 3

C

Question 4

F

Question 5

F

Question 6

D

Question 7

D

Question 8

D

Question 9

F

Question 10

F

Question 11

F

Question 12

F

Question 13

G

Question 14

X

Question 15

General management of COPD

Answer 15

> smoking cessation advice: including offering nicotine replacement therapy, varenicline or bupropion

annual influenza vaccination

one-off pneumococcal vaccination

pulmonary rehabilitation to all people who view themselves as functionally disabled by COPD grade 3 and above)

Question 16

Bronchodilators therapy for COPD ?

Answer 16

a short-acting beta2-agonist (SABA) or short-acting muscarinic antagonist (SAMA) is first-line treatment

======
Then NICE suggest to determine whether a patient has asthmatic/steroid responsive features

Question 17

How can we determine if patient patient has asthmatic/steroid responsive features?

Answer 17

any previous, secure diagnosis of asthma or of atopy

a higher blood eosinophil count - note that NICE recommend a full blood count for all patients as part of the work-up

substantial variation in FEV1 over time (at least 400 ml)

substantial diurnal variation in peak expiratory flow (at least 20%)

Question 18

Asthmatic features/features suggesting steroid responsiveness for COPD first line ?

Answer 18

SABA
+
LABA + inhaled corticosteroid (ICS)

Question 19

Asthmatic features/features suggesting steroid responsiveness for COPD second line ?

Answer 19

offer triple therapy
SABA
+
LABA + LAMA + ICS

Question 20

No asthmatic features/features suggesting steroid responsiveness first line

Answer 20

SABA
+
Laba + lama

Question 21

When can we start oral theophylline ?

Answer 21

only recommends theophylline after trials of short and long-acting

Question 22

When do we start Phosphodiesterase-4 (PDE-4) inhibitors NICE
oral PDE-4 inhibitors such as roflumilast

Answer 22

crisaborole, and roflumilast.

reduce risk of COPD exacerbations in patients with severe COPD and a history of frequent COPD exacerbations

FEV1) after a bronchodilator of less than 50% of predicted normal,
AND
person has had 2 or more exacerbations in the previous 12 months despite triple inhaled therapy with a long-acting muscarinic antagonist, a long-acting beta-2 agonist and an inhaled corticosteroid

Question 23

Cor pulmonale and COPD

Answer 23

consider long-term oxygen therapy

LTOT should be offered to patients with a pO2 of < 7.3 kPa

or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
nocturnal hypoxaemia
peripheral oedema
pulmonary hypertension

Question 24

Factors which may improve survival in patients with stable COPD

Answer 24

smoking cessation
LTOT
lung volume reduction surgery in selected patients