COPD

Question 1

What is COPD?

Answer 1

Airflow obstruction that is not fully reversible.

Question 2

Can COPD be reversed?

Answer 2

No there is only modest reversibility following a bronchodilator

Question 3

What are the symptoms of COPD?

Answer 3

Wheeze, exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis.

Question 4

Why is airflow obstructed in COPD?

Answer 4

Due to airway and parenchymal damage caused by chronic inflammation that differs from that seen in asthma.

Question 5

Give 3 risk factors for COPD

Answer 5

Smoking, male gender, alpha 1 antitrypsin deficiency

Question 6

List the stages of COPD and their corresponding FEV1

Answer 6

Stage 1- mild, FEV1 >80%
Stage 2- moderate, FEV1 50-79%
Stage 3- severe, FEV1 30-49%
Sage 4- very severe, FEV1 <30%

Question 7

What is used to asses prognosis of COPD?

Answer 7

The BODE index

Question 8

What does the BODE index stand for?

Answer 8

BMI, obstruction, dyspnoea and exercise capacity

Question 9

What is the mechanism of action of antmuscarinics?

Answer 9

Block bronchoconstrictor effects of acetylcholine on M3 muscarinic receptors. Reduce vagal airway tone and reflex bronchoconstriction

Question 10

Give an example of a SAMA

Answer 10

Ipratropium

Question 11

Give an example of a LAMA

Answer 11

Tiotropium

Question 12

What are the side effects of antimuscarinics?

Answer 12

Dry mouth, blurred vision, constipation, urinary retention and hypotension

Question 13

Why is smoking a caution in the use of methylxanthines?

Answer 13

Because they interact with cigarette smoke

Question 14

Why are bone protective agents such as calcium and vitamin D prescribed in patients on long term oral steroids?

Answer 14

Because a side effect of oral steroids is osteoporosis

Question 15

What is the mechanism of action of mucolytics such as carbocisteine and mecysteine?

Answer 15

They facilitate expectoration by reducing sputum viscosity

Question 16

Which antibiotic is used prophylactically in COPD patients?

Answer 16

Azithromycin 250mg TDS

Question 17

Which patients is long term oxygen therapy indicated for?

Answer 17

If the patient has an FEV1 of less than 30% and is symptomatic or if the patient has polycythaemia or cor pulmonale or if the patients oxygen sats are less than 92% or the patient is chronically breathless to the point it affects daily life.

Question 18

Name the main hazard for long term oxygen therapy

Answer 18

Smoking!

Question 19

How long is long term oxygen therapy?

Answer 19

More than 15 hours a day

Question 20

What concentration of oxygen should be used in COPD patients and how is this different to asthma patients?

Answer 20

Use 24-28% oxygen, this is much lower than asthma (40-60%) in order to prevent a reduction in respiratory drive

Question 21

What is the target oxygen sats for COPD patients?

Answer 21

88-92%

Question 22

What is hypercapnia?

Answer 22

When COPD patients have a change in respiratory drive so take breath in response to low oxygen levels instead of high CO2 levels

Question 23

What is cor pulmonale?

Answer 23

Right sided heart failure due to COPD

Question 24

What is polycythaemia?

Answer 24

Increased viscosity of blood due to increased number of red blood cells in response to hypoxia

Question 25

Why must a patient with COPD’s BMI be maintained between 20 and 25?

Answer 25

Because low BMIs are associated with higher mortality

Question 26

What is a rescue pack?

Answer 26

A course of antibiotics and corticosteroids to keep at home for patients at risk of an exacerbation of COPD