COPD

Question 1

describe the management of an acute exacerbation of COPD.

Answer 1

increase bronchodilator use and consider nebuliser

30mg prednisolone for 5 days

consider oral antibiotics if purulent sputum or signs of pneumonia
- 1st line: Amoxicillin, Clarithromycin or Doxycycline

Question 2

what are the most common causative pathogens of an acute exacerbation of COPD?

Answer 2

most common = Haemophillus influenzae
streptococcus pneumonia
moraxella catarrhalis
viruses (30%) e.g. Rhinovirus

Question 3

what is cor pulmonale?

Answer 3

right heart failure secondary to disorder of the respiratory system such as COPD
usually due to pulmonary hypertension

Question 4

what is the criteria for long term 02 therapy in COPD?

Answer 4

pa02 < 7.3kPa

or Pa02 7.3-8kPa + one of the following;

• polycythaemia
• pulmonary hypertension
• peripheral oedema

Question 5

describe the management of COPD.

Answer 5

bronchodilator therapy
1st line: SABA or SAMA
2nd line: determine if response to steroids/asthma features

if yes
2nd line: SABA + LABA + ICS
3rd line: SABA + LABA + LAMA + ICS

if no
2nd line: SABA + LAMA + LABA

• long term 02 therapy (if meet criteria)
• prophylactic antibiotics i.e. azithromycin (if meet criteria)
• mucolytics if chronic productive cough
• oral theophylline (if meet criteria)

general management

• smoking cessation
• once of pneumococcal vaccine
• annual influenza vaccine

Question 6

when would a patient with COPD receive oral theophylline?

Answer 6

unable to tolerate inhaled therapy

have reach maximum inhaled therapy

NOTE: reduce dose if on fluroquinolone or macrolide therapy

Question 7

when would a patient with COPD receive prophylactic antibiotics?

Answer 7

1st line: Azithromycin

• don’t smoke
• recurrent exacerbations
• optimised standard treatments

Question 8

what prerequests are required prior to starting prophylactic antibiotic therapy?

Answer 8

CT to check for bronchiectasis
sputum culture to exclude atypical infections and TB
LFT
ECG to exclude QT prolongation

Question 9

what criteria does NICE suggest using to determine whether a patient has asthmatic/steroid responsive features ?

Answer 9

previous diagnosis of asthma or atopy
high eosinophil count
variability in FEV1 over time (> 400ml)
diurnal variability in PEFR (> 20%)

Question 10

how is the severity of COPD categorised?

Answer 10

FEV1/FVC < 0.7 (diagnostic for COPD)

spirometry > 80% predicted = stage 1

50-79% predicted = stage 2

30-49% predicted = stage 3

< 30% predicted = stage 4

Question 11

what are features of COPD on CXR?

Answer 11

hyperinflation
bull
flat hemidiaphragm