COPD

Question 1

What is COPD?

Answer 1

Persisten respiratory symptoms and air flow limitations
progressive disease

symptoms;
dyspnoea
wheeze
chronic cough
regular sputum production

Question 2

What are risk factors of COPD?

Answer 2

Smoking
Environmental pollution and occupational exposures
genetic factorsaa( alpha 2 antitryspin deficiency)
poor lung growth during childhood

Question 3

What are complications of COPD?

Answer 3

Cor pulmonale
depression
anxiety
type 2 resp failure
secondary polycythaemia

Question 4

What vaccine should patients with COPD offered?

Answer 4

Pneumococcal
annual influenza vaccine

Question 5

What is first line treatment for all patients?

Answer 5

SABA or SAMA
to relieve breathlessness and exercise limitation

Question 6

What is step up treatment(2nd line treatment) of COPD?

Answer 6

LABA and LAMA (discontinue SAMA first)
SABA treatment should be continued in all stages of COPD.

Add ICS - if 2 or more moderate exacerbations in 1 year or daily symptoms affects day to day life quality.

Question 7

What is step up treatment for patients with asthmatic symptoms/steroid responsiveness?

Answer 7

LABA +ICS

If 2 or more exacerbations in a year or day to day impact in lifer; Add LAMA

Question 8

What antibiotics can be given for prophylaxis of exacerbation?

Answer 8

Azithromycin

Given if;
non smoker
all other treatments have been optimised
prolonged or frequent exacerbations >4 or more a year with sputum production

Question 9

EXACERBATION;

What is drug treatment for exacerbation of COPD?

Answer 9

High dose of SABA via hand held device or nebuliser.

Short course prednisolone

Aminophylline add on when there is inadequate response to nebulised bronchodilator

Oxygen used necessary

Question 10

What should be monitored for during long term treatment of steroids?

Answer 10

Osteoporosis
if patient aged over 65;
give prophylaxis.

Question 11

SPIROMETREY;
What is it and what do the figures mean?

Answer 11

Needed to confirm diagnosis

Post bronchodilator FEV1/FVC less than 0.7 (maybe more in young children) confirms persistent airflow obstruction

(Maybe alternative diagnosis if 0.7 in elderly patients)

Question 12

SPIROMETREY;

How is it carried out?

Answer 12

Carried out 15-20minutes after the person inhales SABA (400mcg)

Question 13

SPIROMETREY;
How is severity of airflow obstruction classified?

Answer 13

Stage 1; mild FEV1 80% predicted value or higher
Stage 2; moderate FEV1 50%-79%
Stage 3; severe FEV1 30-49%
Stage 4; very severe
FEV1 less than 30% of predicted value or FEV1 less than 50% with respiratory failure.