COPD X

Question 1

(C) Risk Factors for COPD

Answer 1

Smoking (most important)
- Established dose-response relationship

Others:

• Second-Hand Smoking
• Environmental exposure (occupation, air pollution)
• Prematurity & childhood resp issues (I.e., asthma)
• Low SES
• Poor nutrition

Question 2

(C) Hx Findings in COPD

Answer 2

HOPC: >35yo

• dyspnoea, cough +/- sputum
• Current or Ex-smoker

PMHx:
- Multiple resp infections requiring A/bx

Question 3

(C) Elements to Ask in a Smoking Hx

Answer 3

Smoking hx

• Smoking status (current, ex, never smoked)
• Total time as a smoker (not including breaks)
• Pack years (average quantity/day/year over total time)
• Any known complications (I.e., emphysema)

Question 4

(C) How do you Diagnose COPD

Answer 4

Spirometry (pre and post-bronchodilator)
- FEV1/FVC <0.7, or FEV1 <80% of predicted

Others
- CXR
-

Question 5

(C) Differentiating COPD and Asthma

Answer 5

• In COPD, FEV1 is not fully reversible, as it is in asthma. Classically, COPD patients have minimal improvement post-bronchodilator (-ve response)
• If FEV1 improves 12% and at least 200mL after a bronchodilator, this is a +ve response, and can happen in COPD.
• FEV1 increase >400mL suggests underlying asthma (or coexistent asthma-COPD)

Question 6

(C) How to assess severity of COPD

Answer 6

History

• Functional impact (use COPD Assessment Test)
• Degree and severity of dyspnoea
• Mx regimen (I.e., home oxygen, LABA/ICS doses)
• Complications (exacerbations & frequency, hypoxaemia, pulmonary HTN, CCF, polycythaemia)

Exam/Investigations

• Signs of respiratory distress
• Oximetry
• ABG (if sats <92%)
• CXR

Question 7

(C) Differentiating Severity of COPD

Answer 7

For All Categories

• Severity of symptoms, and exacerbations
• At what point (of exertion) are they breathless
• degree of impact on daily activities

Mild (FEV1 80-60% of predicted)

• minimal symptoms (present cough +/- sputum)
• breathless on moderate exertion
• little/no effect on daily activities

Moderate (59-40%)

• Breathless walking on level ground
• ^ limitation on daily activities (impactful)
• Recurrent chest infections
• Exacerbations needing oral steroids/antis

Severe (<40%)

• Breathless on minimal exertion
• Daily activities significantly curtailed/stopped
• Exacerbations ^ frequency and severity

Question 8

(C) Most Common Comorbidities of COPD

Answer 8

• Hypertension
• Hyperglycaemia (DM)
• Atherosclerosis
• Dyslipidaemia
• Osteoporosis