COPD or Asthma

Question 1

Smoker/ex smoker

Answer 1

COPD = nearly all
Asthma = Possibly

Question 2

Symptoms under 35yo

Answer 2

COPD=Rare

Asthma=Often

Question 3

Chronic productive cough

Answer 3

COPD=Common

ASthma=uncommon

Question 4

Breathlessness

Answer 4

COPD = Persistant and progressive
Asthma = Variable

Question 5

Night time waking with breathlessness and/or wheeze

Answer 5

Uncommon= COPD

Common =Asthma

Question 6

Significant diurnal or day to day variablility of symptoms

Answer 6

COPD=Uncommon

Asthma =Common

Question 7

What are common causes of exacerbations in COPD seen at Primary Care? How can these be managed?

Answer 7

Viral - URTI/cold/influenza
Bacterial LRTI/pneumonia
Pollutants
Weather

Change in inhalers (technique, device, add bronchodilator, increase or add inhaled steroid)
Oral steroids (Prednisolone tablets)
Antibiotics

Question 8

What can be the common causes for COPD exacerbation in secondary care environments?
What would be symptoms and treatment?

Answer 8

Viral/bacterial(most common), sedative drugs, pneumothorax, trauma.
Symptoms: Confusion, cyanosis, severe breathless, flapping tremor, drowsy, pyrexial, wheeze, “tripod” position

Treatment: Oxygen, Nebulised bronchodilator, (2 & anti-muscarinic) ,Oral/IV corticosteroid +/- antibiotic (IV aminophylline, respiratory stimulant, NIV)

Question 9

What is key (as well as symptoms) t diagnosing COPD?

Answer 9

FEV1/FVC ratio of less that 0.7

Question 10

What is the no. 1 thing patients can do to slow progression?

Answer 10

Stop smoking

Question 11

Why can cor pulmonare lead to swelling in legs/feet etc?

Answer 11

Because increased right side of heart, increased pressure through left side of heart. Puts up jugular venous pressure. As left ventricle is then impaired, can lead to less circulating volume, activates another compensatory system (kidneys) leading to fluid retention.