COPD Flashcards
What is the role of inhaled steroids?
Reduce exacerbations but may increase risk of pneumonia
List the modified MRC Dyspnoea Scale.
mMRC 0 I only get breathless with strenuous exercise
mMRC 1 I get SOB when hurrying on the level or walking up a slight hill
mMRC 2 I get slower than people of the same age on the level because of breathlessness, or I have to stop for breath when walking on my own pace on the level
mMRC 3 I stop for breath after walking about 100m or after a few minutes on the level
mMRC 4 I am too breathless to leave the house or I am breathless when dressing or undressing
What is the COPD Assessment Test (CAT)?
Likert scale of 0 to 5
From I never cough to I cough all the time
I have no phlegm in my chest at all to My chest is completely full of phlegm
My chest does not feel tight at all to My chest feels very tight
When I walk up a hill or one flight of stairs I am not breathless to When I walk up a hill or one flight of stairs I am very breathless
I am not limited doing any activities at home to I am very limited doing activities at home
I am confident leaving my home despite my lung condition to I am not at all confident leaving my home because of my lung condition
I sleep soundly to I don’t sleep soundly because of my lung condition
I have lots of energy to I have no energy at all
What is the GOLD classification of severity of airflow obstruction?
In patients with FEV1/FVC < 0.7
GOLD 1 Mild FEV1 greater or equal to 80% predicted
GOLD 2 Moderate FEV1 between 50% and less than 80% predicted
GOLD 3 Severe FEV1 between 30% and less than 50% predicted
GOLD 4 Very severe FEV1 less than 30% predicted
What is the refined ABCD assessment tool?
Patients undergo spirometry to determine the severity of airflow limitation i.e. spirometric grade
Patients then undergo assessment of either dyspnoea using mMRC or symptoms using CAT
Finally their history of exacerbations (including prior hospitalisations) is recorded
Group A mMRC 0-1 OR CAT < 10 AND 0-1 exacerbations NOT requiring hospitalisation
Group B mMRC 2 or above OR CAT 10 or above AND
0-1 exacerbations NOT requiring hospitalisation
Group C mMRC 0-1 OR CAT < 10 AND At least 2 exacerbations or at least 1 exacerbation requiring hospitalisation
Group D mMRC 2 or above OR CAT 10 or above
AND At least 2 exacerbations or at least 1 exacerbation requiring hospitalisation
How is pharmacological treatment for COPD stratified by refined ABCD assessment?
Group A Bronchodilator
Group B LAMA or LABA +/- combination LAMA and LABA
Group C LAMA +/- combination LAMA and LABA (or LABA + inhaled steroids)
Group D LAMA +/- combination LAMA and LABA
If more exacerbations, LAMA/ LABA/ inhaled steroids
If further exacerbations, consider macrolides for former smokers; consider roflumilast if FEV1 < 50% and patient has chronic bronchiti
