COPD Diagnosis and Management

Question 1

COPD Chronic Cough

Answer 1

Cough and sputum for >3 months in each of 2 consecutive years

Question 2

COPD - When to Suspect

Answer 2

> 35 + 1 Risk Factor + 1 Symptom

Question 3

COPD Diagnosis

Answer 3

Clinical Features and Spirometry results

Question 4

What do scales do you use in the history and examination of a COPD patient?

Answer 4

MRC Dsypnoea Scale

CAT Score

Question 5

COPD Investigations

Answer 5

Routine bloods
CXR
Spirometry

Consider:
ECG
Peak Flow
Sputum culture

Question 6

COPD Severity is classified by

Answer 6

FEV1

Question 7

COPD GOLD Score

Answer 7

> 80%
50%
30%

<30% or <50% with respiratory failure

Question 8

Initial Management

Answer 8

Stop smoking 
Pulmonary Rehabilitation 
Influenza and pneumococcal vaccine 
Mucolytic therapy for symptoms
Self-management plans

Question 9

COPD Stepwise Management

Answer 9

1. SABA or SAMA
2. Asthmatic = LABA + ICS
   Non-Asthmatic = LABA + LAMA
3. LABA + LAMA + ICS

Question 10

Asthmatic Features

Answer 10

PMH of Asthma/Atopy
Eosinophilia

FEV1 variation of 400ml
PEFR diurnal variation of >20%

Question 11

LTOT Criteria

Answer 11

Non-smoker
PaO2 <7.3kPa
PaO2 <8kPA and polycythaemia, peripheral oedema, pulmonary HTN

Question 12

When to review COPD patients

Answer 12

Annually

6 month review if very severe COPD

Question 13

COPD Annual Review

Answer 13

MRC Dyspnoea scale 
Spirometry 
Inhaler technique 
Smoking Status 
Vaccinations 
Exacerbations 
Assess for cor pulmonale

Question 14

ABCD

Answer 14

Risk assess patients for chance of future exacerbations

Based on MRC scale and spirometry
AB = low risk, low symptoms
CD = high risk, high symptoms

Question 15

Preventative medications to give if frequent occurring exacerbations

Answer 15

Azithromycin
Inhaled Corticosteroids

NOTE - if current infective exacerbation give Amoxicillin, Clarithromycin or Doxycycline