COPD

Question 1

What is COPD?
What is it a combination of?
What is it a response to?

Answer 1

Progressive airflow obstruction due to a combo of airway disease (chronic bronchitis) & parenchymal disease (emphysema)
Enhanced inflammatory response to particles (e.g. cigarette smoke)

Question 2

What is chronic bronchitis?

Answer 2

Chronic productive cough for at least 3 months of the year for 2 or more consecutive years

Question 3

What should be considered as an alternative cause of COPD in someone under 40?

Answer 3

Alpha 1 antitrypsin deficiency

Question 4

What may be signs of COPD on ECG?
In which leads?
What would this indicate?

Answer 4

Peaked P waves
2, 3, aVF
Cor pulmonale (RVH)

Question 5

What are 3 contraindications of spirometry?

Answer 5

Recent MI
Surgery
Unstable angina

Question 6

What results are needed in spirometry?

Answer 6

3 consistent readings (within 100ml or 5% of each other)

Question 7

What are 2 ways of assessing severity?

Answer 7

FEV1

MRC dyspnoea scale (grade 1-5)

Question 8

With what MRC score should you consider pulmonary rehab?

Answer 8

MRC >3

Question 9

What could a FBC show and why?

Answer 9

anaemia or secondary polycythaemia (to compensate for chronic hypoxia)

Question 10

What is first line treatment for COPD?

Answer 10

SABA or SAMA

Question 11

What must you do if prescribing a LAMA to someone on SAMA?

Answer 11

Discontinue the SAMA

Question 12

What is step-up treatment for someone with asthmatic features?

Answer 12

LABA + ICS

e.g. simbacort

Question 13

What is step-up treatment for someone without asthmatic features?

Answer 13

LABA + LAMA

e.g. enoro elipta

Question 14

What advice would you give if someone is on a LABA + LAMA inhaler?

Answer 14

Wash mouth out after use to get rid of residue

Question 15

What is triple therapy for COPD?

Answer 15

LABA + LAMA + ICS

e.g. trimbo

Question 16

When should someone be referred for LTOT?

Answer 16

O2 sats <92% on room air

Severe airflow obstruction (<30% of predicted value)

Question 17

What is a COPD rescue pack?

Answer 17

Antibiotics & steroids for someone who has frequent exacerbations

Question 18

What is the first line abx for COPD exacerbation?

Answer 18

Amoxicillin (or clarithromycin if allergic)

Question 19

What is pulmonary rehab?

Answer 19

Physical exercise programme, info on symptom management & lung care
Psychological & behavioural education

Question 20

What are the 3 parts of management for COPD exacerbation?

Answer 20

Short acting bronchodilator
Oral corticosteroids
Oral antibiotics