COPD

Question 1

How is COPD diagnosed?

Reference COPD X

Answer 1

The diagnosis of COPD rests on the demonstration of airflow limitation which is not fully or substantially reversible

Airflow limitation that is not fully reversible is defined as post-bronchodilator FEV1/FVC < 0.70 and FEV1 < 80% predicted.

If the FEV1 response to bronchodilator is:
• > 400 mL, strongly consider asthma or asthma / COPD overlap.
• < 400 mL (but ≥ 200 mL and ≥ 12%), consider asthma / COPD overlap or an asthma component depending on history and pattern of symptoms

Question 2

Treatment of exacerbation

Answer 2

ventolin 4-8 puffs Q3-4
pred 30-50mg daily for 5/7
amoxycillin

Question 3

When to refer to hospital?

Answer 3

Marked increased intensity of symptoms
New or worsening peripheral oedema
Worsening of hypoxaemia from usual (if known)
SpO2 <92% if not on home oxygen
Shortness of breath that is worsening and/or at rest
High fever
Altered mental state (confusion, slurred speech,
drowsiness)
Chest pain
Worsening of co-morbidities (e.g. heart failure,
ischaemic heart disease, diabetes)
Inability to perform daily activities
Increased anxiety (feeling scared/afraid)

Question 4

Management of COPD (broadly)

Answer 4

Smoking - quit 
Meds: Puffers and vaccinations 
Oxygen 
Kormorbidity: IHD, AF, Sleep apnoea, Osteoporosis, Anxiety and depression, GORD 
Exercise + Rehab + Physio 
Surgery: bulectomy

Question 5

When may you consider starting a ICS?

Answer 5

FEV1 <50% of predicted or 1-2 exacerbtaions in 12 months (Australian Lung Foundation)

Question 6

Which puffers maybe started in the following:
(note FEV1 not good indicator of the impact on life, assess frequency & day to day impact of sx)
Mild FEV1 60-80%
Mod FEV1 40-59%
Severe FEV1 <40%

Answer 6

1. SABA
2. LAMA/LABA
3. Consider a ICS and refer

Question 7

What is the main side effect of ICS?

Answer 7

Increases the risk of pneumonia

Question 8

What are the risk factors for COPD?

Answer 8

Smoking 
Occupational: dust, silica cadmium
COAD
Natural fuels: coal 
Alpha-1-antitrypsin

Question 9

What constitutses a exacerbation of copd?

Answer 9

Increase cough, sob and sputum volume + purulence

Question 10

Exacerbation of COPD, causes?

Answer 10

infection 
heart failure
PE 
non pulmonary infections
cold air
allergens
smoking 

(CHECK acute respiratory disease 2012)

Question 11

Side effects

1. LAMA’s
2. Corticosteroids?

Answer 11

1. urinary retetion (in pt’s with prostatic enlargement)
   arrythmia
   worsening glaucoma

(Ref: NPS Article on COPD drugs)