COPD

Question 1

What are common symptoms of COPD?

Answer 1

• Exertional breathlessness or wheeze
• Chronic cough
• Regular sputum production
• Frequent ‘winter bronchitis’

Question 2

What features may suggest other diseases co-exist with COPD?

Answer 2

• Haemoptysis
• Chest pain
• Weight loss/fatigue
• Breathless at night
• Ankle swelling
• Occupational risk (e.g. asbestos exposure)

Question 3

What is the primary investigation to confirm COPD diagnosis?

Answer 3

Post-bronchodilator spirometry: FEV1/FVC <0.7

Question 4

Which investigation is used to assess eosinophil count and anemia in COPD patients?

Answer 4

FBC (Full Blood Count)

Question 5

What is the significance of a BMI assessment in COPD?

Answer 5

To evaluate obesity or cachexia

Question 6

What are the classifications of COPD severity based on FEV1 percentage?

Answer 6

• Mild/stage 1: ≥80%
• Moderate/stage 2: 50-79%
• Severe/stage 3: 30-49%
• Very severe/stage 4: <30%

Question 7

What scale is used to assess subjective severity of dyspnea in COPD?

Answer 7

MRC dyspnoea score

Question 8

What is the maximum score on the CAT score for assessing symptom burden?

Answer 8

40

Question 9

What is the recommended oral steroid treatment for COPD exacerbations?

Answer 9

30mg prednisolone for FIVE days

Question 10

Are blood tests and CXR routinely needed for treating acute exacerbations of COPD?

Answer 10

No, they are NOT routinely needed

Question 11

What is the first-line oral antibiotic for treating COPD exacerbations?

Answer 11

Amoxicillin

Question 12

What is the usual dose of Amoxicillin for severe infections in COPD

Answer 12

1g 3x daily (usual dose 500mg 3x daily)

Question 13

What should be done if a patient has a risk of exacerbations?

Answer 13

Implement home rescue therapy

Question 14

Home rescue pack- advise What should a patient do if breathlessness interferes with daily activities?

Answer 14

Start steroids

Question 15

Home rescue pack- advise What should a patient do if sputum changes color or increases in volume?

Answer 15

Start antibiotics

Question 16

True or False: Home rescue therapy can reduce admissions for COPD exacerbations.

Answer 16

True

Question 17

Does COPD show reversibility with bronchodilator

Answer 17

No (asthma does - this is how to distinguish)

Question 18

If repeated antibiotic courses, nigh risk fo complications or based on sputum culture what else can be used in COPD

Answer 18

Co-amox (levofloxacin and co-trim also options)

Question 19

If on prophylactic azithromyacin should this be continued in exacerbations?

Answer 19

Yea but treat exacerbation with non-macrolide

Question 20

Who should get pulmonary rehab?

Answer 20

If admission with exacerbations or MRC >_3

Question 21

What is the first line in COPD

Answer 21

Short acting agent for PRN relief- SABA preferred

Question 22

For most patients which long acting drugs do we opt for in COPD

Answer 22

LABA + LAMA

Question 23

Who should have ICS in COPD?

Answer 23

Asthmatics
NICE- PMH asthma/atopy, symptom variability, higher blood eosinophils
GOLD- Asthmatics and those with frequent exacerbations (>2 a year or admission) and blood eosinophils GOLD>0.3)

Question 24

Options for adding ICS to LABA+LAMA

Answer 24

Nice: ICS + LABA ( I.e. switching the LAMA for ICS)
GOLD: ICS + LAMA + LABA

Question 25

What should be considered if initial long-acting therapies for COPD are insufficient?

Answer 25

Comorbidities contributing to symptoms ## Footnote Check adherence and ability to use the device, including understanding, manual dexterity, and inspiratory effort.

Question 26

What non-pharmaceutical interventions should be considered in COPD management?

Answer 26

Smoking cessation, pulmonary rehab ## Footnote These interventions can significantly improve patient outcomes.

Question 27

What is the recommendation for patients on LABA/LAMA monotherapy with ongoing symptoms?

Answer 27

Swap to LABA+LAMA

Question 28

What treatment is suggested if eosinophils are less than 0.1?

Answer 28

* Azithromycin if ex-smoker * Roflumilast if FEV1 <50% predicted AND chronic bronchitis ## Footnote Roflumilast is specialist-only in NICE, azithromycin requires significant work-up.

Question 29

When should ICS be considered in COPD management if the patient is having frequent exacerbations

Answer 29

If eosinophils are 0.1 or higher, especially with eosinophils 0.3 ## Footnote Exacerbations and eosinophil counts are key indicators.

Question 30

When should prophylactic antibiotics be considered in COPD patients?

Answer 30

In non-smokers with significant daily sputum and: * Hospitalized by exacerbation * Prolonged exacerbations * ≥4 exacerbations/year ## Footnote Azithromycin 250mg 3x a week is a common choice.

Question 31

What are the criteria for referring a COPD patient for specialist assessment?

Answer 31

* Diagnostic uncertainty or symptoms disproportionate to spirometry * Suspected alpha-1-antitrypsin deficiency * Signs of other disease (e.g., haemoptysis, frequent infections) * Rapid decline in FEV1 ## Footnote Referral may also be necessary for nebulizers, maintenance oral steroids, oxygen, or surgery.

Question 32

What conditions warrant consideration for long-term oxygen therapy?

Answer 32

kPA <7.3 * FEV1 <30% (consider if FEV1 30-49%) * Oxygen saturation ≤92% * Cyanosis/polycythaemia *Peripheral Oedema *Raised JVP ## Footnote Oxygen must be used for ≥15 hours a day.

Question 33

Why are corticosteroids used in COPD exacerbation?

Answer 33

Reduce risk of clinical deterioration

Question 34

What test would you consider in patients with COPD who are early onset, minimal smoking or family history?

Answer 34

A 1 antitrypsin deficiency