GP - Asthma and COPD

Question 1

What is asthma associated with?

Answer 1

• Airway inflammation and hyper-responsiveness
• Characterised by SOB, coughing, wheezing, chest tightness

Question 2

What are the risk factors for asthma?

Answer 2

• Family history of atopy
• Pre-puberty - more common in males. Reverse for adulthood
• Respiratory infections during infancy
• Exposure to tobacco smoke
• Pollution inhalation

Question 3

How is asthma diagnosed?

Answer 3

• History and examination
• PEFR
• Spirometry with bronchodilator reversibility
• FeNO testing

Question 4

How is asthma usually managed?

Answer 4

• Smoking cessation
• Lifestyle advice
• SABA
• Inhaled corticosteroids - if SABA used/asthma symptoms more than 3 times a week or woken up by asthma symptoms more than once a week

Question 5

Describe asthma prognosis.

Answer 5

• Earlier onset, better prognosis in non-atopic children
• Worse prognosis in atopic children - suffer form further respiratory complications

Question 6

Describe the stepwise approach in asthma.

Answer 6

• SABAs
• Inhaled corticosteroids (ICS) - low dose
• Inhaled LABA to low dose ICS
• Alter ICS dosages, alternative therapies depending on response to LABA/extent of control
• High dose ICS

Question 7

What is COPD associated with?

Answer 7

• AIrway inflammation and hyper-responsiveness
• Combination of airway disease (obstructive bronchitis) and parenchymal damage (emphysema)

Question 8

What are the risk factors for COPD?

Answer 8

• Direct/passive smoking
• Air pollution
• Occupational exposure
• Genetics - alpha-1 antitrypsin deficiency
• Older than 35 (usually but not always)

Question 9

What symptoms would someone with COPD potentially present with?

Answer 9

• Exertional breathlessness, chronic cough with sputum production, wheezing, recurrent chest infections
• Weight loss
• Fatigue
• Ankle swelling
• Cyanosis

Question 10

How would COPD be diagnosed?

Answer 10

• HISTORY
• EXAMINATION - Assess oxygen levels and chest auscultation
• INVESTIGATION - CXR, blood tests

Question 11

How is COPD severity assessed?

Answer 11

• FEV1/ FVC ratio is less than 0.7
• Stage 1- FEV1 – 80% OF PREDICTED
• Stage 2- FEV 1- 50-79% OF PREDICTED
• Stage 3- FEV1- 30-49% OF PREDICTED
• Stage 4- FEV1 – Less than 30% OF PREDICTED

Question 12

What are the groupings in COPD management?

Answer 12

• Group A - less symptoms, low risk
• Group B - more symptoms, low risk
• Group C - less symptoms, high risk
• Group D - more symptoms, high risk

Question 13

What would be done during COPD management for each group?

Answer 13

• Group A - bronchodilator
• Group B - LABA or LAMA
• Group C - LAMA
• Group D - LAMA/ LAMA+LABA (if highly symptomatic) / ICS+LABA

Question 14

Describe the prognosis for COPD

Answer 14

• Progressive disease
• Smoking cessation key to halting progress
• 30,000 deaths per year
• Causes disability, depression, chest infections, respiratory failure, lung cancer