COPD (chronic)

Question 1

Complications of COPD

Answer 1

Anxiety
Depression
Cor Pulomanle
Secondary polycythemia
T2RF

Question 2

Genetic risk factor for COPD

Answer 2

Deficiency in alpha-1 antitrypsin

Question 3

What vaccines should patients with COPD recieve?

Answer 3

Pnumococcal and influenza vaccine

Question 4

What treatment should be offered if a patient has experienced no exacerbations and has an mMRC of 0 and a CAT of <10, according to GOLD?

Answer 4

Group A- Bronchodilator

Question 5

What treatment should be offered if a patient has experienced 2 moderate exacerbations and has an mMRC of 1 and a CAT of <10, according to GOLD?

Answer 5

A LABA + LAMA

Question 6

What treatment should be offered if a patient has experienced 1 exacerbation leading to hospitalisation and whose eosiniphils >300, according to GOLD?

Answer 6

LABA + LAMA + ICS (Triple therapy)

Question 7

What does the mMRC score mean in GOLD guidelines?

Answer 7

Measurement of dyspnoea

Question 8

What risk is increased with ICS use in COPD?

Answer 8

Pneumonia

Question 9

Treatment step-up if a patient is on a LAMA/LABA and is experiencing day-to-day symptoms of COPD according to NICE guidelines?

Answer 9

3-month trial of ICS + LABA + LAMA.

Question 10

Treatment step-up if a patient is on a LAMA/LABA and experiences a severe exacerbation according to NICE guidelines?

Answer 10

Consider LABA + LAMA + ICS

Question 11

Treatment step-up if a patient is on a LAMA/LABA and experiences two moderate exacerbations within 1 year according to NICE guidelines?

Answer 11

Consider LABA + LAMA + ICS

Question 12

1st line treatment in COPD

Answer 12

SABA/SAMA

Question 13

Treatment step-up if a patient is on a SAMA and presents with Eosinophilia and signs of atopy according to NICE guidelines?

Answer 13

LABA + ICS

Question 14

Asthmatic features as defined by NICE?

Answer 14

• Diurnal variation
• Atopy e.g., hayfever, eczema
• Eosinophilia
• FEV1 >400ml and PEF variation >20%

Question 15

Cautions with SAMA/LAMA use?

Answer 15

Risk of bladder outflow obstruction
Paradoxical bronchospasm
Angle-closure gluacoma with nebulised Ipratropium
Prostatic hyperplasia

Question 16

Examples of LAMAs

Answer 16

Glycopyronium
Umeclidnium
Aclidnium
Tiotropium

Question 17

Example of SAMA

Answer 17

Ipratropium

Question 18

SAMA/LAMA side effects

Answer 18

Antimuscarinic side effects: Dry mouth, headache, dizziness, nausea, arrythmias, constipation, cough

Question 19

According to GOLD, what therapy should be considered in additional to LAMA + LABA if Eosinophils 100-300?

Answer 19

A trial of ICS