COPD

Question 1

What are the two main pathological features of COPD?

Answer 1

Emphysema –> loss of alveolar attachments

Chronic bronchitis –> mucus hyper secretion

Question 2

Which mucus producing cells are increased in COPD?

Answer 2

Goblet cells

Question 3

What are the signs of right sided heart failure which may develop from COPD?

Answer 3

Distended neck veins
hepatomegaly
hepatojugular reflex
leg oedema

Question 4

What is a CO2 flap?

Answer 4

Tremor seen when arms outstretched, wrists extended

Due to hypercapnia

Question 5

What are the investigations for COPD?

Answer 5

Spirometry –> obstructive pattern (can also measure post-bronchodilator to confirm)
CXR –> other pathologies
FBC –> anaemia, polycythaemia

Question 6

What is the non-pharmacological management of COPD?

Answer 6

Smoking cessation
Vaccinations
Pulmonary rehab
Chest physiotherapy

Question 7

Which vaccinations should be offered to someone with COPD?

Answer 7

Pneumococcal

Annual flu vaccine

Question 8

What is the pharmacological treatment algorithm for COPD?

Answer 8

1. SABA or SAMA as required for SOB
2. LABA + LAMA if limited by symptoms of frequent exacerbations
3. LABA + LAMA + ICS (3 month trial)

Question 9

What is Rofumilast and when can it be used?

Answer 9

PDE4 inhibitor

Used for severe COPD but adverse GI side effects

Question 10

What is a SAMA? Give an example

Answer 10

Short acting muscarinic receptor antagonist

Ipratropium

Question 11

What is a LAMA? Give an example

Answer 11

Long acting muscarinic receptor antagonist

Tiotropium

Question 12

Comment on the selectivity of tiotropium and ipratropium

Answer 12

Ipratropium is non-selective for M1, M2 and M3
Tiotropium is selective for M3
(blockage of M2 is undesirable as effects vasculature)

Question 13

When should the need for long term oxygen therapy be considered in COPD?

Answer 13

Very severe airflow obstruction (FEV1 < 30%)
Cyanosis
Polycythaemia
Peripheral oedema
Raised JVP
Oxygen < 92% on air

Question 14

How do you assess for long term oxygen need?

Answer 14

2 ABGs, 3 weeks apart

Question 15

What is the condition for using long term oxygen therapy?

Answer 15

Patient must have stopped smoking

Question 16

What is the treatment for an acute exacerbation of COPD?

Answer 16

Consider antibiotics only if increased sputum purulence or evidence of consolidation on CXR or signs of pneumonia
–> Oral amoxicillin or doxycycline

Question 17

What are the pharmacological treatments for allergic rhinitis?

Answer 17

Oral or intranasal antihistamines
Intranasal sodium cromoglicate
Leukotriene receptor antagonists (montelukast)
Intranasal corticosteroid
Intranasal ipratropium

Question 18

What is non-allergic rhinitis?

Answer 18

Rhinitis with the absence of triggers and a negative IgE response by skin or serology

Question 19

What are the pharmacological treatments for non-allergic rhinitis?

Answer 19

Congestion:
- corticosteroid (intranasal)
- antihistamine (intranasal)
Rhinorrhoea:
- Ipratropium (intranasal)