COPD

Question 0

What investigations should be done to investigate COPD?

Answer 0

CXR to exclude other diagnoses
FBC - anaemia, polycythaemia
BMI
Spirometry - post bronchodilator!!!!

Question 1

What are risk factors for COPD?

Answer 1

Tobacco smoking
Occupational - mining, textiles
Age - at least 35
Genetics - alpha1antitrypsin deficiency
Urban - air pollution
Childhood respiratory infections

Question 2

What is the fev1 of mild COPD?

Answer 2

fev1 >80% predicted

Only diagnosed in the presence of symptoms

Question 3

What is the fev1 of moderate COPD?

Answer 3

Fev1 between 50-79% of predicted

Symptoms usually progress, with SOBOE

Question 4

What is the fev1 of severe COPD?

Answer 4

Fev1 between 30-49% of predicted

SOB limits patients daily activities, with exacerbations present

Question 5

What is the fev1 of very severe COPD?

Answer 5

Fev1

Question 6

What is the MRC dyspnoea scale?

Answer 6

1 - no SOB except on hard exercise

2 - SOB on slight gradient

3 - walks slowly on flat ground due to SOB, or has to stop to catch breath

4 - stops for breath after 100m on flat

5- too breathless to leave house or when dressing or undressing

Question 7

What is the first step of management of COPD?

Answer 7

Short acting B2 agonist inhaler
(Use before breathless activity)

Or

Short acting muscarinic antagonist inhaler

• ipratropium
• SE- dry mouth, increased cardiovascular risk

Question 8

What is the second step in COPD management if feV >50%

Answer 8

Long acting B2 agonist

• salmeterol
• taken every day!

Or

Long acting muscarinic antagonist

• stop SAMA!
• tiotropium

Question 9

What is the second step of management of COPD if fev1 <50%?

Answer 9

Long acting B2 agonist and ICS in a combination inhaler

• ICS must always be given with lama!
• eg fluticasone

Or

Long acting muscarinic antagonist
- stop SAMA

Question 10

What is the third step in COPD management?

Answer 10

LAMA + LABA + ICS

Question 11

When is theophylline used in COPD management?

Answer 11

For those who cannot use inhaled therapy

Can be used with B2 agonists and muscarinic antagonists

Requires monitoring - three days after starting, three days after dose adjustment

Question 12

When should oxygen therapy be considered in COPD?

Answer 12

Assess for LTOT need if:

FEV1

Question 13

How is LTOT need assessed?

Answer 13

Measure ABG on two occasions, at least three weeks apart

Consider if PaO2 is <7.3 KPa when stable

Or

If PaO2 is between 7.4 and 8 KPa when stable and secondary polycythaemia, nocturnal hypoxaemia or oedema and pulmonary hypertension

Question 14

How many hours of supplementary oxygen is recommended for LTOT?

Answer 14

15 hours at least

If hypercapnoeic or acidosis on LTOT, refer to specialist care on NIV

Question 15

What is involved in pulmonary rehabilitation?

Answer 15

Community based programme
8 week rolling programme
Patients bussed to and from sessions

May prevent need for LTOT

Combines education, breathing training, cheat physio, respiratory muscle training, nutrition counselling and psychological support

Offer to all who consider themselves disabled - MRC grade three and above

NOT offered if cannot walk, unstable angina, and recent MI

Question 16

How often are patients with COPD reviewed, and what is covered?

Answer 16

At least once a year - twice if severe

Vaccinations - pneumococcal and flu jab

Smoking status
Symptom control
Medication review
Inhaler technique
Spirometry
BMI
MRC dyspnoea score
Review complications
Review need for LTOT

Question 17

What lifestyle advice an be given to people with COPD?

Answer 17

Smoking cessation
Exercise and weight reduction
Learning breathing exercises
Adherence to medication - prevents flare ups
Flu and pneumococcal jab
Avoid exposure to dust, irritants, aerosols
Check weather - avoid going out in cold/humid weather

Question 18

How does acute exacerbation of COPD present?

Answer 18

Worsening breathlessness
Cough
Increased sputum
Change in sputum colour
Fatigue
Fluid retention
Confusion
Tachpnoea

Question 19

What investigations should be considers in acute exacerbation of COPD?

Answer 19

FBC 
UandEs
Sputum culture
CXR
ECG

Question 20

How is acute exacerbation of COPD managed?

Answer 20

Oral prednisolone 30mg daily for 7-14 days
High dose short acting bronchodilator
Antibiotics only if sputum is pure lent or signs of infection- send for sputum culture

Reduce frequency of exacerbation by improving management
Oxygen therapy or positive pressure ventilation may be necessary