COPD facts

Question 1

risk factors

Answer 1

-smoking
-occupation
-air pollution
-alpha 2 antitrypsin deficiency

Question 2

Who to screen

Answer 2

> 40
-any dyspnea, chronic cough or sputum production
-lots of URTI
-risk factor exposure

Question 3

diagnosis

Answer 3

Spirometry FEV1/FVC <0.7

Question 4

mMRC grade 0

Answer 4

SOB only with exercise

Question 5

mMRC grade 1

Answer 5

SOB only when hurrying or walking up slight hill

Question 6

mMRC grade 2

Answer 6

-Walk slower than other people of same age
-Stop to catch their breath when walking

Question 7

mMRC grade 3

Answer 7

Have to stop walking every 100m or every few minutes

Question 8

mMRC grade 4

Answer 8

too breathless to leave the house, or while doing regular life things (getting dressed)

Question 9

CAT scores

Answer 9

Low impact <10
medium impact 11-20
high impact 21-30
very high impact 31-40

Question 10

N-acetylcysteine

Answer 10

mucolytic 600mg BID
Has a small reduction in exacerbations and few side effects (nausea, vomiting, rhinorrhea)

Question 11

azithromycin

Answer 11

macrolide 250 QD or 500mg three times a week, reduce exacerbations, monitor QT wave and GI upset

Question 12

roflumilast

Answer 12

PDE 4 inhibitor 500mg QD
reduces inflammation and improves FEV1 and reduces exacerbations
A/E, upset, headache, insomnia (avoid in patients with mental health issues)

Question 13

Theophylline

Answer 13

can relax SMC but has narrow therapeutic level A/E tachycardia, tremor, nervousness, headache

Question 14

CTS Mild

Answer 14

CAT ≤10 mMRC ≤1 FEV1 ≥80%
Just LAMA or LABA

Question 15

CTS moderate

Answer 15

CAT >10, mMRC >2, FEV1 <80%, Low risk (one moderate exacerbation in last year)
LAMA and LABA (if also asthma ICS + LABA preferred)
———
-LAMA, LABA and ICS

Question 16

CTS severe

Answer 16

CAT >10, mMRC >2, FEV1 <80%, high risk (2 moderate exacerbation or one severe in last year)
LAMA/LABA/ICS
——
Triple + macrolide, PDE 4 inhibitor, mucolytic

Question 17

Gold 1

Answer 17

Mild FEV1 >80

Question 18

Gold 2

Answer 18

moderate FEV1 >50 <80

Question 19

Gold 3

Answer 19

severe FEV1 >30 <50

Question 20

Gold 4

Answer 20

very severe FEV1 <30

Question 21

Group A

Answer 21

mMRC 0-1, CAT <10, 0-1 moderate exacerbation in last year
Needs a bronchodilator (LAMA or LABA)

Question 22

Group B

Answer 22

mMRC >=2 CAT >10, 0-1 moderate exacerbations in last year
Needs LAMA + LABA (ICS+LABA if asthma)

Question 23

Group E

Answer 23

Any mMRC and CAT score if >=2 moderate or 1 severe exacerbation in last year
LAMA + LABA
consider ICS too if eos >300
also consider other therapy (mucolytics)

Question 24

Sx of COPD exacerbation

Answer 24

Increased dyspnea, purulent sputum, increased sputum