COPD

Question 1

What are the conditions and risk factors of COPD

Answer 1

-progressive and not fully reversible

-Persistent respiratory symptoms

• airflow limitation due to combination of obstructive bronchiolitis and emphysema
• symptoms includes: Dyspnoea, wheeze, chronic cough and regular sputum production (would give carbocisteine )

Main risk factor: smoking
Other risk factors: pollution and occupational exposures, genetic factors

Question 2

What is the drug treatment pathway of non-asthmatic COPD

Answer 2

Step 1: SABA or SAMA

Step 2: LAMA +LABA (discontinue SAMA)

Step 3: LAMA + LABA + ICS (if patient has severe exacerbations or 2+ moderate ones in a year)

Step 4: If non-asthmatic feel that there is no change after 3 months, revert back to LAMA +LABA

Must continue SABA throughout all stages!!

Question 3

What is the drug treatment pathway of asthmatic COPD

Answer 3

Step 1: SABA or SAMA

Step 2: ICS +LABA (discontinue SAMA)

Step 3: LAMA + LABA + ICS (if patient has severe exacerbations or 2+ moderate ones in a year)

Step 4: Theophylline oxygen therapy mucolytics

Offer pneumococcal and influenza vaccine

Continue SABA throughout all stages!!

Question 4

What antibiotic would you prescribe to patients who has COPD in the winter months

Answer 4

Azithromycin

Question 5

What do you do if a patient has had a COPD exacerbations

Answer 5

Patients with exacerbations in the last year- rescue pack
-oral corticosteroid + antibiotic
— amoxicillin
— doxycycline
— clarithromycin - avoid if taking prophylactic azithromycin because they are both macrolides

Non drug treatment
Positive expiratory pressure helps sputum clearance

Question 6

What is the drug treatment for patients who have COPD exacerbation

Answer 6

SABA/ SAMA (with hold LAMA treatment if a SAMA is given)

Hospitalised: short course of prednisalone along with other therapies

Community: short course of prednisalone if significant breathlessness

Aminophylline added if there is an adequate response to nebulised bronchodilators

Oxygen if needed to keep oxygen saturation of arterial blood levels in range

Question 7

What can be given at the same time and what can’t be given at the same time

Answer 7

SAMA and LAMAs can’t because the muscarinic effects will be too much
LAMA and LABA can

Question 8

What is the only licences lama is the uk

Answer 8

Tiotropium