COPD

Question 1

LAMA

Answer 1

Long acting antimuscarinc agent: tiotropium

Question 2

LABA

Answer 2

Long acting beta agonist: salmeterol, formeterol.

Question 3

What is COPD?

Answer 3

Chronic Obstructive Pulmonary Disease:

Chronic bronchitis and Emphysema.

Question 4

The biggest cause of COPD is:

Answer 4

Smoking.

Question 5

What are the clinical features of COPD?

Answer 5

Exertional dyspnoea
Cough
Sputum production
Wheeze

*Symptoms are typically ‘fixed’ whilst the disease is progressive and relentless.

Question 6

Why would we need to measure the post-bronchodilator spirometry?

Answer 6

To avoid missing a diagnosis of asthma.

Question 7

What is bronchiectasis?

Answer 7

Disease in which there is permanent enlargement of the airways of the lung. Symptoms typically include a chronic cough, productive of mucus.
NOT THE SAME AS COPD.

Question 8

In what patients would we consider a diagnosis of bronchiectasis?

Answer 8

In patients with a chronic cough and frequent infections: or evidence of permanent enlargement of the lung.

Question 9

Why should we always consider a CXR before diagnosing new COPD?

Answer 9

There may be an alternative diagnosis, COPD is often misdiagnosed.

Question 10

What are the aims of inhaler treatment of COPD?

Answer 10

1. Reduce breathlessness

2. Reduce exacerbation frequency.

Question 11

ICS/LABA inhalers have been associated with an increased risk of

Answer 11

pneumonia

Question 12

ICS/LABA leads to adrenal _______, ______ risk of TB, ______ incidence of type ___ diabetes.

Answer 12

ICS/LABA leads to adrenal suppression, increased risk of TB, increased incidence of type 2 diabetes.

Question 13

What are the four LAMAs licensed for COPD?

Answer 13

1. Tiotropium
2. Aclidinium
3. (Glycopyronium)
4. Umeclindinium

Question 14

What is the brand name of tiotropium? what class of COPD treatment is it?

Answer 14

Triotropium = spiriva = LAMA.

Question 15

What is the brand name of aclidinium? what class of COPD treatment is it?

Answer 15

Aclidinium = Eklira = LAMA

Question 16

What LABAs are licensed for COPD?

Answer 16

Salmeterol
Formoterol
(Indacaterol)
(Olodaterol)

Question 17

What ICS/LABAs are licensed for COPD?

Answer 17

Fostair 
Symbicort
Duoresp
Seretide
Relvar

Question 18

Salmeterol

Answer 18

LABA for COPD

Question 19

Symbicort

Answer 19

ICS/LABA for COPD

Question 20

Formoterol

Answer 20

LABA for COPD

Question 21

Aclidinium

Answer 21

= Eklira = LAMA for COPD

Question 22

Seretide and Relvar

Answer 22

Both ICS/LABAs for COPD

Question 23

Tiotropium

Answer 23

LAMA for COPD

Question 24

Duoresp

Answer 24

ICS/LABA for COPD

Question 25

LAMA/LABAs for COPD

Answer 25

Anoro (umeclidinium + vilanterol) | Duaklir (formeterol + aclidinium)

Question 26

What is carbocyteine?

Answer 26

Mucolytic: 375-750 mgs tds

Question 27

A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally _______) and who present with one or more of:

Answer 27

A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with one or more of the following symptoms: exertional breathlessness chronic cough regular sputum production frequent winter 'bronchitis' wheeze

Question 28

Patients in whom a diagnosis of COPD is considered should also be asked about the presence of:

Answer 28

``` Weight loss Effort intolerance Waking at night Ankle swelling Fatigue Occupational hazards ```

Question 29

At the time of their initial diagnostic evaluation in addition to spirometry all patients should have:

Answer 29

CXR. FBC. BMI calculated.

Question 30

How does smoking status differ between COPD and Asthma patients?

Answer 30

COPD: Nearly all. Asthma: Possibly.

Question 31

All COPD patients should be encouraged to stop

Answer 31

Smoking - if they do.

Question 32

How can COPD patients be aided in quitting smoking?

Answer 32

NRT, varenicline or bupropion, unless contraindicated.

Question 33

What should be the initial empirical treatment for the relief of breathlessness and excercise limitation in COPD?

Answer 33

Short-acting beta2 agonists (SABA) and short-acting muscarininc antagonists (SAMA)

Question 34

What are the side effects of inhaled corticosteroids that patients should be aware of?

Answer 34

Most important: non-fatal pneumonia

Question 35

People with stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators as required can be offered what?

Answer 35

OD long-acting muscarinic antagonist (LAMA) in preference to four-times-daily short- acting muscarinic antagonist. SAMA.

Question 36

What should be the maintenance therapy in pts with stable COPD who remain breathless etc. with FEV1 >50% predicted?

Answer 36

If FEV >50% predicted: LABA or LAMA. If FEV <50% predicted: Either LABA+ICS or LAMA.

Question 37

In a pt with stable COPD but still breathlessness when would LABA+ICS be recommended as maintanence therapy?

Answer 37

When the FEV1: <50% predicted. Could also use LAMA instead.

Question 38

In patients with stable COPD and an FEV1 >50% who remain breathless or have exacerbations despite maintenance therapy with LABA, what can be considered as further treatment?

Answer 38

LABA+ICS in a combinaton inhaler. LAMA in addition to the LABA when ICS are declined/not tolerated/contraindicated.

Question 39

We should offer LAMA (in addition to LABA+ICS) to people with COPD who remain breathless or have exacerbations despite taking LABA + ICS irrespective of what?

Answer 39

Irrespective of their FEV1.

Question 40

In whom would maintenance use of oral corticosteroid therapy be found?

Answer 40

Those with advanced COPD.

Question 41

What must be considered in those on long term oral corticosteroid treatment?

Answer 41

Monitor for the development of osteoporosis. Those over 65 should be started on prophylactic treatment, without monitoring.

Question 42

In whom should mucolytic therapy be used?

Answer 42

Patients with a chronic cough productive of sputum.

Question 43

Before stepping up treatment what should be checked? [3]

Answer 43

1. Inhaler technique 2. Compliance with administration instructions 3. tolerance of current device.

Question 44

A LABA and LAMA are recommended in what patients?

Answer 44

1. Pts who remain breathless or have exacerbations despite; 2. Using short-acting bronchodilators as needed and have 3. FEV1 less than 50% of predicted and 4. Have declined or cannot tolerated an ICS.

Question 45

When converting from IV aminophylline to the oral theophylline dose, the bioavailability and ____ ______ must be considered.

Answer 45

Salt factor for aminophylline is approx 0.8.

Question 46

The total daily dose of IV aminophylline is the same for _____ aminophylline.

Answer 46

IV same as oral.

Question 47

If IV aminophylline is changed to oral theophylline, then the total daily dose of IV aminophylline should be multiplied by

Answer 47

0.8 (salt factor) | Alternatively, multiply the hourly aminophylline dose by 10, to obtain the theophylline dose to be given every 12 hours.

Question 48

Normal control of COPD consists of

Answer 48

SABA + SAMA | Salbutamol + Ipatropium

Question 49

If COPD not controlled by SABA (Salbutamol + Ipatropium) and the FEV1 is <50% of expected what can be added?

Answer 49

LABA/ICS combination or LAMA.

Question 50

If COPD not controlled by SABA (Salbutamol + Ipatropium) and the FEV1 is higher than 50% of expected what can be added?

Answer 50

LAMA or a LABA.

Question 51

What is triple therapy?

Answer 51

SABA prn + LABA/ICS combo + LAMA

Question 52

What 5 things should be considered in the management of an acute exacerbation of COPD?

Answer 52

1. Antibiotics (duration and 5 days post, oral when possible). 2. Steroids (prednisolone 30mg 7-14 days + CONTINUE patients ICS if they have it) - this is based on severity, response and previous treatment. If patient has had a week post admission before maybe try two weeks). 3. Bronchodilators nebulised driven by AIR (not oxygen) [STOP any tiotropium]. Salbutamol 2.5mg 4 hourly + ipatroprium QDS [maximum] 500micrograms (write this in exam not ug) 4. VTE risk assessment. 5. Oxygen sats target lower than asthma at 88-92%.

Question 53

What needs to be considered when discharging a patient who has had a COPD exacerbation? [6]

Answer 53

1. Carbocysteine - use if helps symptoms. 2. Refer for pulmonary rehabilitation. 3. Change medicines back to inhalers not nebs. 4. 2 week follow up appointment with nurse. 5. Rescue pack of oral steroids. 6. Ensure vaccinations have been done and stop smoking.

Question 54

Managing COPD in hospital setting: antibiotics for how long?

Answer 54

1. Antibiotics (duration and 5 days post, oral when possible). 2. Steroids (prednisolone 30mg 7-14 days + CONTINUE patients ICS if they have it) - this is based on severity, response and previous treatment. If patient has had a week post admission before maybe try two weeks). 3. Bronchodilators nebulised driven by AIR (not oxygen) [STOP any tiotropium]. Salbutamol 2.5mg 4 hourly + ipatroprium QDS [maximum] 500micrograms (write this in exam not ug) 4. VTE risk assessment. 5. Oxygen sats target lower than asthma at 88-92%.

Question 55

Managing acute COPD in hospital: what steroids?

Answer 55

1. Antibiotics (duration and 5 days post, oral when possible). 2. Steroids (prednisolone 30mg 7-14 days + CONTINUE patients ICS if they have it) - this is based on severity, response and previous treatment. If patient has had a week post admission before maybe try two weeks). 3. Bronchodilators nebulised driven by AIR (not oxygen) [STOP any tiotropium]. Salbutamol 2.5mg 4 hourly + ipatroprium QDS [maximum] 500micrograms (write this in exam not ug) 4. VTE risk assessment. 5. Oxygen sats target lower than asthma at 88-92%.

Question 56

Acute COPD in hospital: what bronchodilators? Driven by what?

Answer 56

1. Antibiotics (duration and 5 days post, oral when possible). 2. Steroids (prednisolone 30mg 7-14 days + CONTINUE patients ICS if they have it) - this is based on severity, response and previous treatment. If patient has had a week post admission before maybe try two weeks). 3. Bronchodilators nebulised driven by AIR (not oxygen) [STOP any tiotropium]. Salbutamol 2.5mg 4 hourly + ipatroprium QDS [maximum] 500micrograms (write this in exam not ug) 4. VTE risk assessment. 5. Oxygen sats target lower than asthma at 88-92%.