COPD

Question 1

What is COPD?

Answer 1

Combination of chronic bronchitis and emphysema in varying proportions
Smoking related
FEV1 is reduced
Little variation in PEF

Question 2

What is chronic bronchitis and emphysema?

Answer 2

Chronic bronchitis- increased mucuc, airway obstruction, intercurrent infections
Emphysema- involves destruction of alveoli

Question 3

What is mild COPD?

Answer 3

FEV1: 60-80% predicted, smoker’s cough, with little or no breathlessness

Question 4

What is moderate COPD?

Answer 4

FEV1: 40-59% predicted, breathless on mild exertion, possibly with wheezing and a cough

Question 5

What is severe COPD?

Answer 5

FEV1< 40% predicted, breathless on mild exertion or at rest with a wheeze and cough

Question 6

What is the mainstay of therapy?

Answer 6

Smoking cessation
Regular bronchodilators (B2-agonist and short acting muscarinic (ipratropium)

Question 7

What is the staged management for COPD if FEV1 >50%?

Answer 7

Step 1: Short acting B2-agonist or short-acting antimuscarinic
Step 2: Add long acting B2-agonist or long acting antimuscarinic
Step 3: Step 2 + inhaled steroid

Question 8

What is the staged management for COPD if FEV1<50%?

Answer 8

Step 1: Short acting B2-agonist or short acting antimuscarinic
Step 2: Add long-acting beta2-agonist and inhaled steroid
Replace SA with a LA antimuscarinic
Step 3: LA antomuscarinic + LA B2-agonist + inhaled steroid

Question 9

What other treatments are needed for COPD?

Answer 9

Antibiotics:
Frequent chest infections (2 of purulent sputum, increased sputum and breathlessness)
Oxygen therapy:
Used in severe disease at 24-28% oxygen for 15 hours a day