COPD

Question 1

What is COPD?

Answer 1

Chronic inflammation, airway narrowing, loss of elastic recoil

COPD = Chronic bronchitis + emphysema

Question 2

What are the primary causes of COPD?

Answer 2

• SMOKING
• Alpha-1 antitrypsin deficiency
• Occupational exposures (cadmium, coal, cotton, cement, grain)

These factors contribute to the development of COPD.

Question 3

List common symptoms of COPD.

Answer 3

• Cough (often productive)
• Dyspnea
• Wheeze
• Severe: RHF with peripheral edema

Symptoms can vary in severity and presentation.

Question 4

What spirometry findings are indicative of COPD?

Answer 4

• FEV-1 significantly reduced
• FVC normal
• FEV1% (FEV1/FVC) < 70%

These measurements help to assess the severity of airflow obstruction.

Question 5

What blood test is used in COPD to rule out secondary polycythemia?

Answer 5

FBC (Full Blood Count)

This condition occurs as the body produces excess RBCs in response to low oxygen levels.

Question 6

What are common chest X-ray findings in COPD?

Answer 6

• Hyperinflation
• Bullae (can mimic pneumothorax)
• Flat hemidiaphragm
• Hyperexpansion - Barrel chest

These findings can indicate the presence and severity of COPD.

Question 7

How is the severity of COPD categorized?

Answer 7

Using FEV1

This classification helps in treatment planning and management.

Question 8

What lifestyle management strategies are recommended for stable COPD?

Answer 8

• Smoking cessation
• Vaccination (annual influenza + one-off pneumococcal)
• Pulmonary rehabilitation

These strategies aim to improve quality of life and reduce exacerbations.

Question 9

What is the first-line drug management for COPD?

Answer 9

SABA or SAMA

Short-acting bronchodilators are essential for symptom relief.

Question 10

What features suggest steroid responsiveness in COPD patients?

Answer 10

If the patients has ‘asthmatic’ features:
* Previous diagnosis of asthma/atopy
* Higher blood eosinophil count
* FEV1 variation (at least 400ml)
* Substantial peak expiratory flow diurnal variation (20%)

These features can guide the addition of inhaled corticosteroids.

Question 11

What is the drug management for COPD patients without asthmatic features?

Answer 11

• SABA as required
• - Add in LABA +LAMA regulalry

This combination therapy helps manage symptoms effectively.

Question 12

What is the drug management for COPD patients WITH asthmatic features?

Answer 12

• SAMA or SABA as required (already 1st line)
• - Add in LABA +ICS regulalry

Question 13

What is 3rd line treatment for COPD?

Answer 13

SABA as required
LABA+LAMA+ICS regularly

Question 14

When should oral Theophylline be used in COPD management?

Answer 14

Only after bronchodilator therapy or if inhaled therapy cannot be used

Dosage may need adjustment if certain antibiotics are prescribed.

Question 15

What is the purpose of oral prophylactic antibiotic therapy in COPD?

Answer 15

Azithromycin prophylaxis in select patients

This can help prevent exacerbations in certain individuals.

Question 16

What are the signs of cor pulmonale in COPD?

Answer 16

• RHF (pulmonary edema)
• Raised JVP
• Systolic parasternal heave
• Loud P2

These signs indicate right heart failure due to lung disease.

Question 17

What is long-term oxygen therapy (LTOT) shown to improve in COPD?

Answer 17

Survival

LTOT is crucial for patients with severe hypoxemia.

Question 18

What are the oxygen saturation targets for COPD patients on LTOT?

Answer 18

88-92%

Maintaining this range is essential for patient safety.

Question 19

What criteria indicate a patient may need LTOT?

Answer 19

• Very severe airflow obstruction (FEV1 <30%)
• Cyanosis
• Polycythemia
• Peripheral edema or raised JVP
• O2 saturation =/<92% on air

These criteria help determine eligibility for LTOT.

Question 20

What are the contraindications for LTOT?

Answer 20

Do not offer LTOT to those who still smoke

Risk assessment is crucial for all patients considering LTOT.