Respiratory: COPD

Question 1

First line management COPD

Answer 1

SABA or SAMA

Question 2

What do you need to determine before moving to second line management?

Answer 2

Asthmatic features/features suggesting steroid responsiveness

Question 3

What suggests asthmatic features/steroid responsiveness?

Answer 3

Prev diagnosis of asthma or of atopy
High blood eosinophil count
Variation in FEV1 over time (at least 400 ml)
Diurnal variation in peak expiratory flow (at least 20%)

Question 4

Second line treatment with no asthma features/steroid responsiveness?

Answer 4

SABA PRN
Add LABA + LAMA

Question 5

Second line treatment with asthma features/steroids responsiveness?

Answer 5

SABA/SAMA PRN
Add LABA + ICS

Question 6

Third line treatment

Answer 6

SABA PRN
LABA + LAMA + ICS

Question 7

When should oral theophylline be added?

Answer 7

After trials of short and long-acting bronchodilators or to people who cannot used inhaled therapy

Question 8

When should patients be assessed for LTOT?

Answer 8

• very severe airflow obstruction (FEV1 < 30% predicted)
• cyanosis
• polycythaemia
• peripheral oedema
• raised jugular venous pressure
• oxygen saturations less than or equal to 92% on room air

Question 9

How is LTOT assessed?

Answer 9

ABG on 2 occasions at least 3 weeks apart in patients with stable COPD on optimal management.

Question 10

When to offer LTOT?

Answer 10

pO2 of < 7.3 kPa
or
those with a pO2 of 7.3 - 8 kPa and one of the following:
- secondary polycythaemia
- peripheral oedema
- pulmonary hypertension