COPD

Question 1

GOLD staging

COPD Staging

Answer 1

Stage 1: Mild FEV1 >80%
Stage 2: Moderate FEV1 50–80%
Stage 3: Severe FEV1 = 30–50%
Stage 4: V. severe FEV1 <30%

Question 2

COPD 1st line Mx

Answer 2

SABA (Salbutamol) OR SAMA (Ipratropium)

Question 3

COPD 2nd line Mx w/ asthma features*

*Hx of asthma, Atopy, >eosinophils

Answer 3

**LABA + ICS **
e.g. Fostairs (Formeterol + Beclometasone), Symbicort (Formeterol + Budesonide)

Question 4

COPD 2nd line w/out asthma features

Answer 4

LABA (salmeterol) + LAMA (Tiotropium)

Question 5

Triple therapy

COPD 3rd line MX w/ asthma features

Answer 5

LABA + LAMA +ICS e.g. Trimbow

Question 6

4 steps

Acute COPD exacerbation Mx

Answer 6

1. SABA + SAMA nebs
2. PO prednisolone 30mg 5/7
3. O2: 88-92% Ventruri mask
4. Abx

Question 7

When to prescribe rescue pack

Answer 7

multiple exacerbations of COPD within one year

Question 8

What is in the rescue pack for COPD exacerbation

Answer 8

PO corticosteroids + PO Abx

Question 9

2 criterias

Long-term O2 indications

Answer 9

1. Sp O2 <88%
2. Pa O2 <7.3 kPa readings 3/52 apart
3. Pa O2 pO2 7.3 - 8 kPa AND ONE of the following:
   - Secondary polycythaemia (increase RBCs)
   - Peripheral oedema
   - Pulmonary hypertension (Pulmonary Artery Pa more 25mmHg)

Question 10

long-term O2 therapy contraindications

Answer 10

Current smokers

Question 11

Acute COPD exacerbation ABG features

Answer 11

Low pH
High CO2
High HCO3

Acute on chronic Resp acidosis

Question 12

When to prescribe a ‘Rescue’ pack for COPD?

Answer 12

Patients w/ two or more exacerbations (or one exacerbation requiring hospital admission) withing a year

Question 13

MRC Dyspnoea Scale

Medical Research Council dyspnoea scale

Answer 13

1: Only breathless during strenuous exercise
2: Short of breath when hurrying or walking up a slight hill
3: Walks slower than others of the same age or has to stop for breath when walking at their own pace
4: Stops for breath after walking 100 yards or after a few minutes on level ground
5: Too breathless to leave the house or breathless when dressing

Question 14

COPD lung physological features

Answer 14

• Increase Total lung capacity
• Increase Lung Residual Volume (Hyperinflated lungs)
• Decrease diffusing capacity of the lungs for CO (DLCO)
• Decrease in KCO (carbon monoxide transfer coefficient)

Question 15

Indications for lung reduction surgery

Answer 15

• Predominant upper lobe emphysema
• PaCO2 <7
• Transfer capacity of the lung for carbon monoxide (TlCO) >20%
• FEV1>20% predicted

Question 16

Pneumothorax with COPD + Hypoxia MX

Answer 16

Initially provide high flow oxygen via non-rebreathe mask aiming for saturations of 94-98%, prioritising the treatment of hypoxemia over hypercapnia

until pCO2 is established, then titrating down O2: sat. 88-92%

Question 17

When to refer COPD pt to pulmonary rehab?

Answer 17

• MRC dyspnoea sclae 4
• Recent admission for an acute exacerbation
• GOLD 2

Question 18

Indications for NIV in COPD

Answer 18

• T2RF
• Respiratry Acidosis (pH < 7.5 / pCO2 >6)

despite MAx. medical Tx

Question 19

Initial O2 Mx in COPD

Answer 19

• Venturi 24% at 2-4 L/min (BLUE)
• Venturi 28% at 4 L/min (WHITE)
• Nasal Cannulae at 1-2 L/min (24-28%)

Sats. 88-92%