COPD Part 1

Question 1

Goals of health care

Answer 1

Preventive
Curative
Restorative
Pallative (if uncurable)

Question 2

Chronic Disease Managment

Answer 2

Assessment of risk-clinical and social
Diagnosis
Clinical Advice
Enhance patients ability to implement advice/self-manage

Question 3

Clinical medicine is limited to help those who have had a chronic disease for over 10 yrs. Instead the focus is more on

Answer 3

Health behaviours, living circumstances, environmental factors, personal profile

Question 4

Link between personal profile and disease management

Answer 4

The extent of ones mental health impairs their ability to self care

Question 5

COPD Definition

Answer 5

Disease characterised by airflow limitation that’s not fully reversible.
Limitation both progressive and associated with abnormal inflammatory response (neutrophiils) to noxious particles/gases

Question 6

History

Answer 6

productive cough
dyspnoea
cigarette smoking

Question 7

The noxious particles and gases that cause COPD are from

Answer 7

Cigarette and smoke, coal dust, pollution, biomass fuels

Question 8

Spirometry FEV/FVC
Normal value
Obstructive (flow change)
Restrictive (lung volume)

Answer 8

FEV/FVC
Normal value : 3.5/5 = 70
Obstructive: 2.0/4.0 = 50
Restrictive: 1.5/1.8 = 84

Question 9

Difference visually in obstructive spirometry. Why is work of breathing harder.

Answer 9

Concavity of loop, low elasticity so lower flow rates. Breathing at much high lung volumes, increased work of breathing due to elasticity higher up and the airway resistance.

Question 10

Differential symptoms between COPD and Asthma

Answer 10

COPD:

• long smoking history
• slowly progressive
• dyspnoea during exercise
• onset in mid-life
• largely irreversible airflow limitation
• Neutrophil major inflam cell

Asthma:

• Early onset in life
• symptoms vary day-to-day
• at night/early morning
• Allergy, rhinitis and eczema also
• Family history
• Largely reversible airflow
• eosinophil (responsive) main inflamm cell

Question 11

Risk Factors for COPD

Answer 11

1) Genes
2) Noxious gases and particles (not just smoking)
3) Lung growth & development
4) Oxidative stress
5) Gender
6) age
7) socioeconomic
8) Co-morbidities ( weight gain, lack of movement)

Question 12

COPD- X checklist

Answer 12

Confirm diagnosis
Optimise management
Prevent deterioration
Develop self-management plan
manage eXacerbations

Question 13

To see COPD severity post B.dilator FEV1

Answer 13

Mild : 60-80%
Mod: 40-49%
Severe:

Question 14

P- prevent deterioration

Answer 14

Influenza and pneumococcal vaccination
Long term home O2? When hypoxia becomes an issue

Hypoxia and/or hypercapnoea&raquo_space; Respiratory failure.

Risk Factor reduction

• Check current smoking status
• advise of the risks of smoking
• refer to a Quit programme
• Pharmacological treatments for nicotine.
• assess occupation

Question 15

D- develop self-management plan

Answer 15

Check for psychological issue and suggest supportive strategies (MAGIC)
-Refer for pulmonary rehabilitation
-Refer to respiratory physician to:
clarify diagnosis, considere other therapies or Long-term home O2), facilitate pulmonary rehab

Question 16

X

Answer 16

Ensure understanding of exacerbations (URT infection, cough, dyspnoea, night waking, breathless at rest)

Question 17

Patient visits at home

Answer 17

-Useful, eases their transport, You can see a huge amount of medication, most who don’t use or don’t know how to use (denial?) .
They are unable to manage