COPD/Asthma/Bronchiectasis/CF

Question 1

Interventions proven to improve survival in COPD, and not proven to improve survival in COPD

Answer 1

Improve survival: lung volume reduction surgery, lung transplantation, smoking cessation, long term oxygen therapy

Not proven to improve survival: beta agonists and inhaled corticosteroids

Question 2

Withdrawal of ICS in stable COPD on triple therapy (LABA/LAMA/ICS) - ?outcome

Answer 2

WIDSOM Trial - follow up over 12 weeks - continuation vs withdrawal of ICSnon inferior for primary endpoint first moderate/severe COPD exacberation.
Did demonstrate a decline in FEV1 in withdrawal group ?significance not clear
Long-term benefits not known - likely reduced pneumonia rates, reduced oropharngeal candiasis

Question 3

Emphysema group most likely to benefit from endobronchial valve replacement

Answer 3

Heterogeneous emphysema without collateral ventilation. EBV treatment in hyperinflated patients with heterogeneous emphysema without collateral ventilation resulted in clinically meaningful benefits in lung function, dyspnea, exercise tolerance, and quality of life, with an acceptable safety profile (TRANSFORM TRIAL)
In other studies, patients with pathologies or nodules which require further assessment and follow-up, infiltrations or cavity (suggesting active infection) or unfavourable CT findings such as severe bronchiectasis, severe paraseptal emphysema, extensive fibrosis are excluded as they are likely to have poor outcomes with EBV placement

Question 4

Assessment tool for predicting mortality and readmission risk following hospital admission with exacerbation COPD

Answer 4

CODEX - cormobidity, obstruction, dyspnoea and previous severe exacberation

Question 5

Benefits of pulmonary rehabilitation in COPD

Answer 5

Improved exercise tolerance
Improved breathlessness
Improved mood
Improved overall quality of life

Question 6

Markers of a poor prognosis in COVID 19 infection

Answer 6

Baseline lymphocyte count was significantly higher in survivors than non-survivors; in survivors, lymphocyte count was lowest on day 7 after illness onset and improved during hospitalisation, whereas severe lymphopenia was observed until death in non-survivors
Levels of d-dimer, high-sensitivity cardiac troponin I, serum ferritin, lactate dehydrogenase, and IL-6 were clearly elevated in non-survivors compared with survivors throughout the clinical course, and increased with illness deterioration
In non-survivors, high-sensitivity cardiac troponin I increased rapidly from day 16 after disease onset, whereas lactate dehydrogenase increased for both survivors and non-survivors in the early stage of illness, but decreased from day 13 for survivors