COPD

Question 1

What are the 3 key factors to diagnose COPD

Answer 1

1. Airflow limitation
2. Progressive
3. Chronic inflammatory response of airway

Question 2

How do you diagnose COPD

Answer 2

post bronchodilator FEV1/FVC <0.7

Question 3

Explain the GOLD grading

Answer 3

it looks at the FEV1
GOLD 1: >80%
Gold 2: 50-79%
GOLD 3: 30-49%
GOLD 4: <30%

Question 4

Explain the staging of COPD

Answer 4

GROUP A: 0 or 1 moderate exacerbation with no hospitalisation, mmrc 0-1 and CAT <10

GROUP B: 0-1 moderate exacerbation with no hospitalisation, mmrc >2, cat >10

GROUP E: more than 2 exacerbations with more than 1 leading to hospitalisation

Question 5

What are the other tests that you can do for COPD and their purpose

Answer 5

1. Blood eosinophil count (may also predict exacerbation risk)
2. CT in stable COPD (as part of cancer screening)

Question 6

What is the management for Group A

Answer 6

Bronchodilator (could be PRN or regular dose).

Muscarinic agents are preferred (Ipratropium is SABA, Umeclidinium, glycopyrronium and tiotropium are LAMA)

Question 7

What is the management for Group B

Answer 7

LABA + LAMA

Question 8

What is the management of Group E

Answer 8

LABA + LAMA and can consider LABA + LAMA +ICS if eosinophil >300

Question 9

What are the other medications that can be added for Group E patients

Answer 9

Roflumilast and Azithromycin

Question 10

When will you consider prescribing supplemental oxygen to COPD patients

Answer 10

When SPO2 <88% for PaO2 <55 or if PaO2 <60 but with right heart failure. patient needs to be on it for at least 15 hours

Question 11

What does chronic bronchitis result in

Answer 11

1. Gas trapping
2. Airflow limitation
3. Hyperinflation
4. Mucus hypersecretion

Question 12

What does emphysema result in

Answer 12

1. reduced ventilation
2. V/Q mismatch

Question 13

What is a common complication of COPD

Answer 13

Cor pulmonale (right sided heart failure)
Occurs due to pulmonary vasoconstriction, which causes pulmonary hypertension and subsequently right ventricular heart strain and hypertrophy

Question 14

What are some investigations you may consider for patient with COPD exacerbations

Answer 14

1. ECG (for cor pulmonale)
2. Spirometry once stable
3. CXR
   ABG (to determine need for NIV)

Question 15

What are some confounders or contributors in patients with COPD exacerbation

Answer 15

1. Pneumonia
2. Pulmonary embolism
3. Heart failure
4. Pneumothorax/pleural effusion
5. MI or cardiac arrythmias

Question 16

What are some contraindications for ICS use

Answer 16

1. Repeated pneumonia events
2. Blood eosinophil <100
3. History of mycobacterial infection

Question 17

How should systemic corticosteriods be administered

Answer 17

PO, 5-7 days around 40mg without tapering or IV delivery

Question 18

When should antibiotics be considered for AECOPD

Answer 18

when there is increased dyspnoea, increase sputum purulence and volume