COPD

Question 1

Assessing severity of COPD?

Answer 1

Lung function tests
FEV1/FVC <70%

Mild = FEV1 >80%
Moderate = FEV1 50-80%
Severe = FEV1 30-50%
Very Severe = FEV1 <30%

Question 2

Poor prognosis for COPD?

Answer 2

Worse severity

High number of exacerbations

Question 3

LABA + SABA?

Answer 3

NO!!!

Use LABAs alone –> prolonged symptom relief and more convenient and less side effects than combinations

Question 4

What LABA has the greatest bronchodilator effect?

Answer 4

Indacaterol

Question 5

What is the role of ICS in COPD?

Answer 5

In mild-moderate COPD ICS does not improve symptoms or FEV1 and increases risk of pneumonia

In severe COPD LABA + ICS is better than LABA alone at preventing exacerbations

ICS must only be used in combination

Question 6

What is the role of LAMAs in COPD?

Answer 6

Addition of LAMA to LABA reduces rates of exacerbations and improves FEV1, symptoms scores and QOL

But does not slow the rate of lung loss

LAMA+LABA+ICS can be used in severe COPD

Question 7

Role of antibiotics in COPD exacerbations?

Answer 7

60% of exacerbations are due to bacterial infections

Antibiotics reduce mortality and readmission rates and do not increase rates of C. Diff

Question 8

Systemic effects of COPD?

Answer 8

Muscle atrophy - esp. lower limb
Decreased oxidative capacity
Reduced capillary to fibre ratio

–> exercise limitations

Question 9

Treatment for systemic effects of COPD?

Answer 9

Pulmonary rehabilitation

Question 10

Mortality of COPD?

Answer 10

The only major cause of death increasing in prevalence

Assess risk of mortality with BODE score