COPD

Question 1

Who do you give a LABA/LAMA too?

Answer 1

Anyone that is symptomatic MRC 1-4 with confirmed spiro
Can also add it if they start exacerbating

GOLD- everyone basically

Question 2

Who do you give LABA/ICS to?

Answer 2

element of reversibility exacerbating x2/yr- should review after 3 months

In GOLD you don’t give it! You follow asthma guidelines if they are overlap

Question 3

Who do you give LABA/LAMA/ICS to?

Answer 3

LABA/LAMA not cutting it, 1x severe or 2x moderate exacerbations/yr

consider stopping ICS if not cutting it

In GOLD only if blood eosinophils are high

Question 4

What is roflumilast?

Answer 4

Phosphodiesterase 4 inhibitor
Who: FEV1<50% with 2+ exacs/yr and on triple inhaler already (NICE)
LABA/LAMA with exacs with low Eo also included (GOLD)

Question 5

Who should be considered for LVRS?

Answer 5

completed PR
FEV1 <50%
breathlessness affecting QOL despite optimal treatment
they do not smoke
6MWT at least 140 m

Must have:
hyperinflation, emphysema and be medically optimised

Question 6

Who gets a bullectomy?

Answer 6

occupies at least 1/3 of hemithorax

Question 7

Who is referred for transplant?

Answer 7

same as LVRS
FEV1 <50%
breathlessness affecting QOL despite optimal treatment
they do not smoke
6MWT at least 140 m

Question 8

risk factors for exac?

Answer 8

smoking
exposure to passive smoke
viral or bacterial infection
air pollution
lack of physical activity
seasonal variation (winter and spring)

Question 9

Who gets a rescue pack?

Answer 9

an exacerbation within a year, and remain at risk of exac
confident about when and how to take these medicines, and associated benefits and harms
they know to tell their healthcare professional when they have used the medicines, and to ask for replacements.

Question 10

what is doxapram?

Answer 10

respiratory stimulant, can be used when NIV inappropriate/unavailable

Question 11

What is the biggest genetic risk factor in COPD?

Answer 11

SERPINA1, leading to alpha-1 antitrypsin deficiency

Question 12

GOLD guidelines- what has changed for treatment?

Answer 12

A- still SABA
B- LABA/LAMA
E- still LABA/LAMA add ICS if exacerbates but if Eo are low then to add roflumilast or azithro

Question 13

Answer 13

Question 14

What is the criteria for LVRS?

Answer 14

MRC 3 or more
* Non-smoker >4 months
* Completion of a PR within last 12 months or ongoing participation in a post-PR exercise programme
* Six minute walk distance >140m or Incremental Shuttle Walk Test >80m
* FEV1 <50% predicted
* TLCO> 20% predicted
* RV: TLC ratio > 55%
* RV> 150%
* PaCO2<7KPa
* BMI> 18