Respiratory Chronic Conditions

Question 1

How is mild/moderate COPD classified?

Answer 1

FEV1 >50%

Question 2

How is severe COPD classified?

Answer 2

FEV1 <50%

Question 3

How is mild/moderate COPD managed?

Answer 3

ALL SABA (Salbutamol) or SAMA (Ipratropium)
Path1: 1) LABA (Salmeterol), 2) LABA + ICS/ LABA + LAMA, 3) LAMA + LABA + ICS
Path2: 1) LAMA (Tiotropium) + discontinue SAMA, 2) LAMA + ICS + LABA

Question 4

How is severe COPD managed?

Answer 4

ALL SABA (Salbutamol) or SAMA (Ipratropium)
Path1: LAMA, then add steroid & LABA
Path2: Steroid & LABA, then add LAMA

Question 5

How is asthma managed?

Answer 5

SABA (Salbutamol)
Add: Inhaled Steroid (Beclometasone)
Add: LABA (Salmeterol)
Trial: Medium dose steroid/LAMA/Leukotriene/Theophylline
Trial: High dose steroid/ 4th drug (prevention trial & beta2 agonist tablet)
Add: Daily steroid tablet

Question 6

When should a diagnosis of COPD be considered?

Answer 6

>35 w/RF (e.g smoking) presenting with:
Exertional breathlessness
Chronic cough
Regular sputum production
Frequent winter bronchitis 
Wheeze 
FEV1/FVC < 0.7

Question 7

How is COPD severity indicated?

Answer 7

Mild: FEV1 >80%
Moderate: FEV1 50-79%
Severe: FEV1 <30%

Question 8

How is Cor Pulmonale treated in COPD patients?

Answer 8

Assess need for LT O2 therapy
Diuretics: Oedema
Digoxin: AF
Contraindicated: ACEi, alpha blockers, CCBs

Question 9

How can exacerbations of COPD be managed by the patient?

Answer 9

Abx & Corticosteroids course to keep at home
Start Steroids for inc SOB
Start Abx for purulent sputum
Adjust bronchodilators to control symptoms
Contact HCA if symptoms do not improve

Question 10

What antibiotics & other drugs can be given for an exacerbation of COPD?

Answer 10

Ampicillin
Amoxicillin
Erythromycin
Tetracycline
Prednisolone 30mg daily for 7-14days

Question 11

How often are patients with COPD reviewed?

Answer 11

Mild/moderate: At least once a year

Severe: At least twice a year

Question 12

What are the causes of an exacerbation of COPD?

Answer 12

Viral: Rhinovirus, (para)influenza, coronavirus, adenovirus, RSV, C.Pneumoniae
Bacterial: H.influenza, Strep Pneumoniae, Moraxella, Staph Aureus, Pseudomonas
Pollutants: NO2, ozone, SO2, particulates

Question 13

What are the diagnostic features of COPD on a CXR?

Answer 13

Hyperinflated (extra ribs)
Hyperdense
Lungs look scarred