COPD

Question 1

a ‘common, preventable and treatable disease characterised by non-fully reversible persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the
airways and the lung to noxious particles or gases.

Answer 1

Chronic obstructive pulmonary disease (COPD)

Question 2

COPD

It is the_______leading cause of death and the
______leading burden of disease in Australia, affecting
12.4% of Australians between 45 and 70 years.

Answer 2

fourth

third

Question 3

________ is undoubtedly the major cause
of both chronic bronchitis and emphysema, although
only 10–15% of smokers develop the diseases

Answer 3

Cigarette smoking

Question 4

Occupation at risk for COPD

Answer 4

Occupation: related to cadmium, silica, dusts

Question 5

Other factors asstd with COPD

Answer 5

• Familial factors: genetic predisposition
• Alpha 1 -antitrypsin deficiency (emphysema)
• Bronchial hyper-responsiveness

Question 6

Reco for MX of COPD

Answer 6

Confirm diagnosis, Optimise
function, Prevent deterioration, Develop a selfmanagement
plan and manage eXacerbations

Question 7

Main Sx of COPD

Answer 7

• Breathlessness
• Cough
• Sputum production

Question 8

Sx with advanced disease

Answer 8

• Fatigue
• Anorexia
• Weight loss

Question 9

T or F

The sensitivity of the physical examination for
detecting mild to moderate COPD is poor.

Answer 9

T

Question 10

COPD signs

• __________—always breathless
_________—oedematous and central cyanosis

Answer 10

‘pink puffer’

• ‘blue bloater’

Question 11

It is
unwise to make a diagnosis of chronic bronchitis
and emphysema in the absence of cigarette smoking
unless there is a family history suggestive of ______

Answer 11

alpha 1 -

antitrypsin deficiency

Question 12

________ remains the gold standard for diagnosing,
assessing and monitoring COPD. The PEFR is not a
sensitive measure.

Answer 12

Spirometry

Question 13

Definition of COPD based on PFT

Answer 13

Post-bronchodilator FEV 1 /FVC of <0.70 (<70%)

and FEV 1 <80% predicted

Question 14

The Australian stages of severity of COPD is based on FEV 1 % predicted

mild
moderate
severe

Answer 14

are mild (60–80%) moderate (40–50%) and
severe (<40%),

Question 15

GOLD staging of severity of COPD is based on FEV 1 % predicted:

Answer 15

1. mild ( ≥ 80%),
2. moderate (50–80%),
3. severe (30–50%),
4. very severe (<30%)

Question 16

ABG of advanced COPD

Answer 16

• PaCO 2 ↑; PaO 2 ↓ (advanced disease)

Question 17

ECG of COPD

Answer 17

• This may show evidence of cor pulmonale

Question 18

The only treatment proven to slow the progression of COPD is________

Answer 18

smoking cessation.

Question 19

In the long-term treatment of COPD, _________
are recommended for the relief of wheezing and
shortness of breath

Answer 19

bronchodilators

Question 20

Examples of short acting bronchodilators

Answer 20

These include short-acting β 2 -
agonists (SA β As e.g. salbutamol, terbutaline) and
short-acting anticholinergic drugs (ipratropium
bromide);

Question 21

Examples of LABA

Answer 21

long-acting β 2 -agonists (LA β As e.g.
eformoterol, salmeterol); long-acting anticholinergic
drugs with muscarinic antagonist action (LAMAs e.g.
tiotropium, glycopyrronium)

Question 22

The evidence suggests that an _______ and _______ are as effective as a nebuliser, but the appropriate method depends on patient needs and preference

Answer 22

MDI and space

Question 23

____________ can be used in patients
who remain symptomatic despite treatment with
combinations of short-acting bronchodilators and
those with frequent exacerbations.

Answer 23

Long-acting β 2 -agonists

Question 24

___________ has been proven to
reduce the frequency of exacerbations with COPD
compared with short-acting anticholinergic drugs

Answer 24

Long-acting anticholinergic therapy with tiotropium

bromide (taken by inhalation)

Question 25

Only 10% of patients with stable COPD benefit in the

short term from _______

Answer 25

inhaled corticosteroids (ICS)

Question 26

When to give ICS in COPD

1
2
3

Answer 26

•documented evidence of responsiveness to inhaled
corticosteroids, including functional status
• those with an FEV 1 ≤50% predicted
• two or more exacerbations requiring oral steroids
in 12 months

Question 27

T or F,

OCS can be used as maintenance for COPD

Answer 27

False

Oral corticosteroids are not recommended for
maintenance therapy in COPD, although they may
be needed in patients with severe COPD where
corticosteroids cannot be withdrawn following
an acute exacerbation.

Question 28

____________ reduces the risk of
exacerbations, hospitalisation and death. It should be
given in early autumn to all patients, especially those
with moderate to severe COPD

Answer 28

Influenza vaccination

Question 29

In COPD pts, Vaccination to prevent invasive ___________ is recommended. It should
be given at 5-yearly intervals

Answer 29

bacteraemic

pneumococcal pneumonia

Question 30

_________ reduces mortality

in COPD.

Answer 30

Long-term oxygen therapy (LTOT)

Question 31

Long-term continuous therapy given for at
least ______ a day (as close as possible to 24 hours a
day) prolongs life in hypoxaemic patients—those who
have PaO 2 consistently <55 mm Hg (7.3 KPa; SpO 2
88%) when breathing air

Answer 31

15 hours

Question 32

Flow rate for O2 LTOT

Answer 32

A flow rate of 0.5–2.0 L/min is usually sufficient

Question 33

T or F

No medication has yet been shown to prevent
the long-term decline in lung function

Answer 33

T

Question 34

___________may reduce the frequency and

duration of exacerbations (evidence level I

Answer 34

Mucolytic agents

Question 35

Mucolytic therapy should be considered for patients

with a _______

Answer 35

chronic cough productive of sputum.

Question 36

Regular use of _______ in stable COPD is

contraindicated

Answer 36

antitussives

Question 37

What are the lung surgery options?

Answer 37

The options are bullectomy, lung volume reduction

surgery and transplantation

Question 38

Patients should be referred for consideration for __________ if they have a single large bulla on CT scan associated with breathlessness and an FEV 1 <50% predicted

Answer 38

bullectomy

Question 39

Note that patients with severe COPD are
prone to _________ if they breathe high oxygen
concentrations

Answer 39

hypercapnia

Question 40

The duration of oral corticosteroid therapy for
exacerbations of COPD is not well established;
however, courses of _______ days are commonly used

Answer 40

7 to 14

Question 41

The indication for antibiotic treatment in COPD is:

1
2

Answer 41

• increased cough and dyspnoea together with

* increased sputum volume and/or purulence

Question 42

Abx for bacterial infection in COPD

Answer 42

amoxycillin 500 mg (o), 8 hourly for 5 days
or
doxycycline 200 mg (o) as 1 dose on day 1, then
100 mg (o) daily for a further 5 days
or
azithromycin 500 mg (o) daily for 5 days

Question 43

Mx of COPD Stage 0

Answer 43

Avoidance of risk factors, esp. smoking

Influenza and pneumococcal
vaccination ? Haemophilus influenza
vaccination

Question 44

Mx of COPD Stage 1

Answer 44

Avoidance of risk factors, esp. smoking

Influenza and pneumococcal
vaccination ? Haemophilus influenza
vaccination

Add short-acting bronchodilator

Question 45

Mx of COPD Stage 2 Moderate

Answer 45

Avoidance of risk factors, esp. smoking

Influenza and pneumococcal
vaccination ? Haemophilus influenza
vaccination

Add short-acting bronchodilator

Add long-acting bronchodilators
LAMA + LAβA
Consider LAβA/ICS and referral
Add pulmonary rehabilitation

Question 46

Mx of COPD Stage 3 Severe

Answer 46

Moderate + Add inhaled corticosteroids

LAβA/ICS + LAMA

Question 47

Mx of COPD Stage 4 Very severe

Answer 47

Add long-term oxygen (if chronic
respiratory failure)
Consider theophylline (o) or roflumilast
Consider surgical referral