COPD

Question 1

what is COPD split into

Answer 1

chronic bronchitis and emphysema

Question 2

what is chronic bronchitis

Answer 2

chronic irritation, defensive increase in mucus production and epithelial cell numbers (especially mucus glands)
non-reversible obstruction (some may have reversible asthmatic component)

Question 3

what is emphysema

Answer 3

tissue destruction in the alveoli leading to loss in alveolar walls and increase in size of airspaces distal to terminal bronchiole (without fibrosis)

Question 4

what causes it

Answer 4

smoking
passive smoking
fumes
dust

Question 5

what are symptoms

Answer 5

develop over number of years
increasing breathlessness
persistent cough with sputum 
frequent exacerbations
wheezing 
weight loss
malaise 
swollen ankles
increased infection risk

Question 6

how is it diagnosed

Answer 6

spirometry - decrease in PERF, FEV1, FVC and TLCO
FEV1/FVC <75%
FEV1 response to B2 <15%
CXR - lung infiltrates if infection
Blood test - rule out other cause
Sputum culture - grow organism causing exacerbation

Question 7

1st line treatment

Answer 7

SABA (salbutamol)
or SAMA (ipratropium)

Question 8

2nd line treatment (if FEV1>50%)

Answer 8

LABA (salmeterol)
or LAMA (tiotropium) and discontinue SAMA

Question 9

3rd line treatment (if FEV1<50%)

Answer 9

LABA (salmeterol) plus ICS (becomethasone, budesonide, prednisolone)
or LAMA (tiotropium) and discontinue SAMA

Question 10

4th line treatment

Answer 10

LAMA (tiotropium) plus LABA (salmeterol) plus ICS

Question 11

5th line treatment

Answer 11

if patient has 2 or more exacerbations in 12 months despite triple therapy, PD4 receptor antagonist (roflumilast) used

Question 12

what is used in acute exacerbation

Answer 12

oral corticosteroids (prednisolone) and antibiotics

Question 13

1st line antibiotics?

Answer 13

doxycycline / amoxicillin

Question 14

2nd line antibiotics?

Answer 14

clarithromycin, moxifloxacin, (AND IV aminophylline (methylxanthine))