Management of COPD

Question 1

What is COPD?

Answer 1

Chronic bronchitis or emphysema

Question 2

What is chronic bronchitis?

Answer 2

Airway obstruction (narrow airways)

Question 3

What is emphysema?

Answer 3

Hyperinflation (damaged alveoli making gas exchange more difficult)

Question 4

What caused the airway to narrow?

Answer 4

Mucus builds up

Airway muscles tighten

Airway lining swells up (inflamation)

Question 5

What are symptoms of COPD?

Answer 5

Breathlessness

Cough

Recurrent chest infection

Question 6

What is the most common reason why people develop COPD?

Answer 6

Tobacco smoke

Question 7

Why does tobacco smoke cause COPD?

Answer 7

1) Nicotine and oxygen free radicals in tobacco acts on neutrophils causing them to degranulate and inactivates anti-proteases
2) Releases neutrophil elastase inactivates anti proteases and causes tissue damage

Question 8

What does tobacco smoke do to neutrophils?

Answer 8

Causes them to degranulate and release elastase

Question 9

What does tobacco smoke do to anti-proteases?

Answer 9

Inactivates them

Question 10

What does COPD cause not within the respiratory system?

Answer 10

Loss of muscle mass

Weight loss

Cardiac disease

Depression

Anxiety

Question 11

How do you diagnose COPD?

Answer 11

Relevent history (symptoms)

Look for clinical signs

Confirmation of diagnosis and assessment of severity

Other relevent tests

Question 12

When would you suspect COPD?

Answer 12

35 years or more

Current or former smoker

Chronic cough

Exertional breathlessness

Sputum production

Frequent winter bronchitis

Wheeze

Chest tightness

Question 13

What is the difference in age between COPD and asthma?

Answer 13

COPD is generally older than 35

Asthma is any age

Question 14

What is the difference between the cough due to COPD and asthma?

Answer 14

COPD cough is persistent and productive

Asthma cough is intermitten and non-productive

Question 15

What is the difference between smoking in COPD and asthma?

Answer 15

COPD smoking is almost invariable

Asthma smoking is possible

Question 16

What is the difference in breathlessness between COPD and asthma?

Answer 16

COPD is progressive and persistant

Asthma is intermittent and variable

Question 17

What is the difference in nocturnal symptoms in COPD and asthma?

Answer 17

COPD is uncommon unless in severe distress

Asthma is common

Question 18

What is the difference in family history in COPD and asthma?

Answer 18

COPD is uncommon unless family members also smoke

Asthma is common

Question 19

What is the difference in allergies between COPD and asthma?

Answer 19

COPD is possible

Asthma is common

Question 20

What is typically seen in a COPD examination?

Answer 20

May be normal in early stages

Reduced chest expansion

Prolonged expiration/wheeze

Hyperinflated chest

Respiratory failure

Question 21

What is the chest expansion like in COPD?

Answer 21

Reduced

Question 22

What is the inflation of the chest like in COPD?

Answer 22

Hyperinflated chest

Question 23

What is the expiration like in COPD?

Answer 23

Prolonged/wheeze

Question 24

What are signs of respiratory failure?

Answer 24

Tachypneoa

Cyanosis

Use of accessory muscles

Pursed lip breathing

Peripheral oedema

Question 25

What is tachypneoa?

Answer 25

Abnormally rapid breathing

Question 26

What is the process of the COPD diagnosis?

Answer 26

Clinical history (cough, breathlessness, chest infections, winter bronchitsis) Examination (may be normal, tachypneoa, wheeze, hyperinflated chest) Spirometry (confirms diagnosis and assesses severity)

Question 27

What is used to confirm the diagnosis of COPD and assess the severity?

Answer 27

Spirometry

Question 28

When is spirometry obstructive?

Answer 28

When FEV₁/FVC is less than 70%

Question 29

What are the different levels of COPD severity?

Answer 29

Mild (FEV₁​ \>80%) Moderate (FEV₁​ 50-79%) Severe (FEV₁​ 30-49%) Very severe (FEV₁​ \<30%) All values are relative to the predicted FEV₁ (70% of FVC)

Question 30

When is COPD mild?

Answer 30

FEV1​ \> 80%

Question 31

When is COPD moderate?

Answer 31

FEV1​ 50-79%

Question 32

When is COPD severe?

Answer 32

FEV1​ 30-49%

Question 33

When is COPD very severe?

Answer 33

FEV1​ \< 30%

Question 35

What are some COPD baseline tests?

Answer 35

Spirometry (record absolute and & of predicted values) Chest X-ray ECG Full blood count BMI (weight and height) A1AT (alpha-1-antitrypsin if age of onset \<50 years)

Question 36

When do you check alpha-1-antitrypsin (A1AT) levels?

Answer 36

When the age of onset is less than 50 years old

Question 37

What are the aims of COPD management?

Answer 37

Prevention of disease progression Relieve breathlessness Prevention of exacerbation Management of complications

Question 38

How is prevention of disease progression obtained?

Answer 38

Smoking cessation

Question 39

How is relieving breathlessness obtained?

Answer 39

Inhalers

Question 40

How is prevention of exacerbations obtained?

Answer 40

Inhalers Vaccines Pulmonary rehabilitation

Question 41

How is management of complications obtained?

Answer 41

Long term oxygen therapy

Question 42

What are some non-pharmacological managements of COPD?

Answer 42

Smoking cessation Vaccination Pulmonary rehabilitation Nutritional assessment Psychological support

Question 43

What vaccinations help COPD?

Answer 43

Annual flu vaccine Pneumococcal vaccine

Question 44

What are the benefits of pharmacological management?

Answer 44

Relieves symptoms Prevent exacerbations Improve quality of life

Question 45

What are different kinds of inhaled COPD therapies?

Answer 45

Short acting bronchodilators Long activing bronchodilators High dose inhaled corticosteroids and LABA

Question 46

What are examples of short acting bronchodilators?

Answer 46

SABA, short acting B₂ agonist (salbutamol) SAMA, short acting muscarinic antagonist (ipratropium)

Question 47

What is an example of a short acting B₂ agonist (SABA)?

Answer 47

Salbutamol

Question 48

What is an example of a short acting muscarinic antagonist?

Answer 48

Ipratropium

Question 49

What are examples of long acting bronchodilators?

Answer 49

LAMA, long acting muscarinic antagonist (umeclidinium and tiotropium) LABA, long acting B₂ agonist (salmeterol)

Question 50

What are examples of long acting muscarinic antagonists?

Answer 50

Umeclidinium and tiotropium

Question 51

What are examples of long acting B₂ agonists?

Answer 51

Salmeterol

Question 52

What are examples of high dose inhaled corticosteroids (ICS) and LABA?

Answer 52

Relvar (fluticasone/vilanterol) Fostair MDI

Question 53

What should be known about the cost of COPD treatment?

Answer 53

It is very expensive, from drug costs to support

Question 54

What does LTOT stand for?

Answer 54

Long term oxygen

Question 55

When can long term oxygen be used for COPD?

Answer 55

PaO₂ \< 7.2kPa or PaCO₂ 7.3-8kPa if polycythaemia, nocturnal hypoxia, peripheral oedema or pulmonary hypertension)

Question 56

What symptoms would warrent using long term oxygen?

Answer 56

Polycythaemia Nocturnal hypoxia Peripheral oedema Pulmonary hypertension

Question 57

What is polycythaemia?

Answer 57

Abnormally increased concentration of haemoglobin in the blood

Question 58

What is abnormally increased level of haemoglobin in the blood known as?

Answer 58

Polycythaemia

Question 59

What is the progression of clinical presentation of COPD?

Answer 59

At risk Symptomatic Exacerbations Respiratory failure

Question 60

What happens during COPD exacerbations?

Answer 60

Increasing breathlessness Cough Sputum volume Sputum purulence Wheeze Chest tightness

Question 61

What does AECOPD stand for?

Answer 61

Acute exacerbations of chronic obstructive pulmonary disease

Question 62

What does the management of acute exacerbations of chronic obstructive pulmonary disease involve?

Answer 62

Short acting bronchodilators Steroids Antibiotics Consider hospital admission if unwell

Question 63

What short acting bronchodilators are used during exacerbations of COPD?

Answer 63

Salbutamol and/or ipratropium Nebulisers if cannot use inhalers

Question 64

What steroids are used during exacerbations of COPD?

Answer 64

Prednisolone 40mg per day for 5-7 days

Question 65

What should occur during exacerbations of COPD for you to consider hospital admission?

Answer 65

Tachypneoa Low oxygen saturation (\<92%) Hypotension

Question 66

What investigations could be done if a patient with AECOPD is admitted into hospital?

Answer 66

Full blood count Biochemistry and glucose Theophylline concentration Arterial blood gas Electrocardiograph Chest X-ray Blood cultures in febile patients Sputum microscopy, culture and sensitivity

Question 67

What is involved in AECOPD ward based management?

Answer 67

Oxygen target saturation 88-92% Nebulised bronchodilators Corticosteroids Antibiotics (oral vs IV) Assess for evidence of repiratory failure

Question 68

What is oxygen saturation target for AECOPD ward management?

Answer 68

88-92%

Question 69

What is used to assess for evidence of respiratory failure?

Answer 69

Clinical Arterial blood gas

Question 70

What does acute respiratory failure require?

Answer 70

Ventilation