COPD

Question 1

What are the spirometry features of COPD?

Answer 1

FEV1/FVC < 0.7 post bronchodilator. FEV1 60-80% predicted = mild, 40-59% moderate, < 40% is severe.

Bronchodilation >400mL or 200mL +12% suggests concurrent asthma

Question 2

What are the key aspects of COPD management?

Answer 2

Pharmacotherapy, regular exercise, pulmonary rehabilitation, smoking cessation, vaccinations, nutrition, action plan, self management, comorbidities.

Question 3

What inhalers are recommended for COPD?

Answer 3

SABA PRN, add LAMA (eg. tiotropium), then LAMA/LABA (spiolto) then triple therapy.

Question 4

What are some indications for specialist referral in COPD?

Answer 4

Age < 40, diagnostic uncertainty, rapid decline, frequent infections (>1 a year), bullous lung disease, sats < 92% when stable.

Question 5

What is the biggest predictor of a COPD exacerbation? How can exacerbations be prevented?

Answer 5

Recent (< 12mo) exacerbation. Action plans, treat early w increased inhalers and use steroids if mod/severe, flu and pneumococcal vaccines.

Question 6

When should a COPD pt be hospitalised?

Answer 6

Marked increase in symptoms, not responding to treatment, unable to eat/sleep or move between rooms if able before, altered mental status, new hypoxaemia.

Question 7

How are COPD exacerbations treated?

Answer 7

Salbutamol 4-8 puffs every 3-4 hours, steroids for 5 days, abx if infective (colour/amount sputum, fever), oxygen 88-92%. Pulmonary rehab post.

Question 8

What is the role of antibiotics in COPD exacerbations?

Answer 8

Use if bacterial infection, to hasten recovery not eradicate bacteria. Amoxicillin 500mg TDS or 1G BD for 5 days, OR doxy 100mg D for 5 days.

Abx only improve outcomes in about 8% of mild/mod exacerbations.