Gold

Question 1

Definition of copd

Answer 1

Persistent respiratory symptoms and airflow limitation due to airway / alveolar abnormalities caused by significant exposure to noxious particles and gases

Question 2

Risk factors

Answer 2

Smoking
Pollution
Genetic
Abn lung development 
Airway hyper responsiveness

Question 3

What is exacerbation

Answer 3

Periods of acute worsening of resp symptoms

Question 4

Def of emphysema

Answer 4

Abnormal permanent dilatation of air spaces distal to the terminal bronchioles accompanied by destruction of alveolar walls without obvious Fibrosis

Question 5

What is the reason for chronic air flow

Answer 5

Caused by small Airway disease and parenchymal destruction that is emphysema

Question 6

Path

Answer 6

Protease - antiprotease imbalance
Inflammatory cells.
Local iga def- translocation of bacteria

Question 7

Path phys

Answer 7

Inflammation/ narrowing if peripheral airways- fev1 decreased
Gas trapping- static hyperinflation- decreases insp capacity
Mucus Hypersecretion- due to inc in no
Pulm htn- hypoxic vc , structural changes in initma-hyperplasia

Question 8

Diagnosis

Answer 8

Post bd fev1/fvc less than 0.7

Symptoms +r/f+ spirometry

If b/w o.6-0.8 repeat
If <0.6 - no need to repeat
10-15 min after saba
30-35 min after sama

Question 9

Severity assessmeny

Answer 9

Saint george resp questionnaire
Chronic resp questionnaire
Cat- cutpoint is 10

Question 10

Role of spirometry

Answer 10

Diagnosis
Severity
Identification of lung decline

Question 11

Bode index

Answer 11

Bmi
Obstruction 
Dyspnoea 
Exercise 
Gives composite score that is better predictor of subsequent survival than any other single component

Question 12

Ltot

Niv

Answer 12

Severe resting chronic hypoxemia

Chronic hypercapnia and hostory of hospitalization for acute resp failure

Question 13

5A

Answer 13

Ask- tobacco use status
Advise- to quit
Assess- willingness 
Assist
Arrange

Question 14

Moa bd

Answer 14

Inc fev1
Alter airway sm tone
Decrease dynamic hyperinflation at rest

Relax sm by beta2 adrenergic receptors- inc cyclic amp

Question 15

Od laba

Answer 15

Indacetraol- decreases exacerbation
Cough-s/e
Other od
Oladaterol/vilanterol

Question 16

Moa muscaranuc drugs

Answer 16

Inhibit bc effecrs of ach on m3 muscaranic receptors

Sama- ipratropium and oxitropium
Inhibit neuronal receptor m2, which potentially can cause vagally induced bc

Question 17

Lama

Answer 17

Tiotropium
Aclidinium
Glycopyronnium
Umeclidinum
.prolonged binding to m3 nuscaranic receptors, with faster dissociation ftom m2

Question 18

Side effect pf anticholinergic

Answer 18

Dry mouth
Ipratropium- bitter and metallic taste
Mild inc in cva
Tiotropium- no effect on cvd

Question 19

Methyl xanthine

Answer 19

Non Selective phospodieserase inhibitors metabolized by p450
Inc resp muscle function
S/e arrythmias
Grand mal seizures
c/i with digitalis, coumadin

Question 20

Pde4 inhibitors

Answer 20

Roflumilast
Improves lung function and dec exacerbation who are on laba/ics

In pts with chronic bronchitis, severe to very severe cood and history of exacerbations
Od dosage
S/e wt loss. Intestinal

Question 21

Role of antibiotics

Answer 21

Decrease exacerbation ovr one yr
Risk of resistance and hearing loss
250 od or 500 thrice weekly
Erythro 500 bd

Question 22

Other rx

Answer 22

Mucoregulators- decrease exacerbation
Ics- in moderate copd - no incresed risk of pneumonia
Rf for pneumonia- smoker, 55, h/o pneumonia, exacerbation, low bmi

Mepoli/ benrali- Recurrent exacerbation and eo despite high ics

Question 23

Strong ix for ics

Answer 23

H/o hospitalization for exacerbation 
>2 mod exacerbation/yr 
H/o conocomjtant asthma
Mod: eosinophil 300
1 mod exacerbation 
Against use- mtb, eo100 , rpt pneumonia

Question 24

Aatd augmentation

Answer 24

Never Smokers, or ex , fev1 35-60
Mosg suitable - delays progression of emphysema

Progressive lung disease despite optimal therapy

Question 25

Rehab

Answer 25

Improves dyspnoea , exercise tolernace in stable pts | Dec hospitalization

Question 26

Air travel

Answer 26

50mmhg pao2 - can travel by flight At sealevel 3lit/min or 31% venturi- maintains this much in mod to severe hypoxemia Restinh sat 95 6mwt- >84 - may travel without further assessment

Question 27

Surgeries

Answer 27

Lvrs- dec hyperinflation, improves elastic recoil , improves fev1 and exacerbation Bullectomy- decompresses adjacent parenchyma Dec dyspnoea, improves lung function and exercise tolerance Tx- increases survival in <60 yrs Endobronchial valve placement- collapse ,i/l non targeted lobe expansion- inducator of successful occlusion Targeted thermal vapour ablation of diseased segments

Question 28

Initial mx of stable copd

Answer 28

``` Risk factors Vaccination Meds- copd class Comorbs Review- symptoms , exacerbation , techniques, adherence, smoking status Physical activity O2 Niv ```

Question 29

Initial assessment

Answer 29

``` Gold Symptoms- cat/mmrc Exacerbation history Smoking Alpha 1 Comorbs ```

Question 30

Components of pulm rehab

Answer 30

Suoervised exercise training Smoking cessation Nutrition counselling Self management education

Question 31

Ix of transplant

Answer 31

Hosp for exacerbation with acute hypercapnia Pulm htn and or corpulmonale despite o2 Fev1 <20 , dlco <20 or homogenous distribution of emphysema

Question 32

Mx of exacerbation

Answer 32

``` Saba Start laba before discharge Ocs- 5-7 days Methylxanthines not recommended Niv ```

Question 33

Classification of exacerbation

Answer 33

Mild - only saba Mod- saba plus abx and or ocs Severe- emergency visit/ hospitalization

Question 34

Classification in hospitalized pts

Answer 34

``` No resp failure- rr <30 , no accessory muscles , no alt sensorium, no inc in pco2 , o2 maintaied with 28-35% venturi Arf- non life threatening- pco2 increased Rr>30, acc muscles But no altered sensorium Arf- altered sensorium P 7.25 Co2 60 Venturi >40 ```