COPD

Question 1

Presentation of COPD

Answer 1

Long term smoker with chronic SOB, cough, sputum, wheeze and recurrent respiratory infections

Question 2

What is the MRC dyspnoea scale

Answer 2

5 point scale that NICE recommend for assessing the impact of their breathlessness

Question 3

Two criteria to diagnose

Answer 3

Clinical presentation and spirometry

Question 4

Results of spirometry

Answer 4

Obstructive picture - FEV1/FVC ratio <0.7

Question 5

How can the severity of the airflow obstruction be graded

Answer 5

Using the FEV1 score

Question 6

Investigations that may be necessary to help with diagnosis and management

Answer 6

Chest XR, FBC, BMI, sputum culture, ECG, ECHO, CT thorax, Serum alpha-1 antitrypsin, transfer factor for CO2

Question 7

Step one of COPD management

Answer 7

Short acting bronchodilators - beta-2 agonists or short acting antimuscarinics

Question 8

Eg of beta-2 agonist

Answer 8

Salbutamol or terbutaline

Question 9

Eg of short acting antimuscarinics

Answer 9

Ipatropium bromide

Question 10

Step two of COPD management if they do not have asthmatic or steroid responsive features

Answer 10

Combined long acting beta agonist and long acting muscarinic antagonist (LABA and LAMA)

Question 11

Step two of COPD management if they do have asthmatic or steroid responsive features

Answer 11

Combined long acting beta agonist and inhaled corticosteroid

Question 12

Step three of COPD management

Answer 12

Combination of LAMA, LABA and ICS

Question 13

Eg of combination inhalers with LAMA and LABA

Answer 13

Anoro Ellipta, Ultibro breezhaler and Duakir genuair

Question 14

Eg of combination inhalers with LABA and ICS

Answer 14

Fostair, Symbicort and Seretide

Question 15

Eg of combination inhalers with LABA, LAMA and ICS

Answer 15

Trimbo and Trelegy Ellipta

Question 16

Additional options for more severe COPD

Answer 16

Nebulisers, oral theophylline, oral mucolytic therapy, long term prophylactic ABx, long term O2 therapy

Question 17

When is LTOT used

Answer 17

Severe COPD that is causing problems such as chronic hypoxia, polycythaemia, cyanosis or HF secondary to pulmonary hypertension

Question 18

Presentation of exacerbation of COPD

Answer 18

Acute worsening of symptoms such as cough, SOB, sputum production, wheeze

Question 19

What aid is used to deliver oxygen

Answer 19

Venturi mask

Question 20

Medical treatments for exacerbations if they are well enough to be at home

Answer 20

Prednisolone, regular inhalers and home nebulisers and Abx

Question 21

Where is the damage in COPD

Answer 21

Damage to the lung tissues causes an obstruction to the flow of air through the airways making it more difficult to ventilate the lungs

Question 22

Management of acute exaccerbation of COPD

Answer 22

Airway, O2 sats, nebulisers, steroids and antibiotics if infection

Question 23

\Indications for LTOT

Answer 23

Patients having PaO2 <7.3kPa on 2 readings 3 weeks apart and non-smokers. Or PaO2 7.3 - 8kPa and hypoxia, peripheral oedema and pulmonary HTN

Question 24

What is stage 2 COPD

Answer 24

50-79% FEV1 predicted

Question 25

What is stage 3 COPD

Answer 25

30-49% FEV1 predicted

Question 26

What is stafe 4 COPD

Answer 26

<30% FEV1 predicted