Respiratory

What is the definition of COPD? (1)

Post-bronchodilator airflow obstruction, not fully reversible (FEV1/FVC < 0.7). FEV1% >80 (mild), 50-79% (moderate), 30-49% (severe), <30% (very severe)

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What is the definition of COPD? (2)

Umbrella term for emphysema (permanent enlargement of the alveoli, with the destruction of their walls without obvious fibrosis) and chronic bronchitis (chronic productive cough for 3/12 over 2 successive years (after other causes excluded). Inflammation,

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What is the definition of COPD? (3)

Destruction/loss of elasticity, becomes less springy, unable to keep airways open, a lot of air remains in sac, takes more energy for air to go out, less flexible, not able to collapse, difficult to exhale. COPD has heterogeneity. Ideal world – group by p

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What are the symptoms of COPD?

Breathlessness, particularly on exertion. Persistent cough, often with phlegm. Frequent chest infections, particularly in winter.

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What are the red flag symptoms?

Weight loss, chest pain, haemoptysis (cancer, cardiac functions, coughing up blood)

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What are exacerbations?

An acute sustained worsening of symptoms from the patient's usual stable state (beyond the normal day-to-day variations). Can be infective or non-infective. Can worsen symptoms of COPD and reduce FEV1%. Patient doesn’t recover/return to baseline with more

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How is COPD diagnosed?

Using (FEV1/FVC <0.7). LFTs. Breathing exercises – exhale full content of lungs (FVC) – forced vital capacity. Air exhaled in one second (FEV1) – forced exhale volume in one second. Varies with gender, weight, age – factors to consider. Seversity classifi

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Which scale is used to assess symptoms of COPD?

MRC dyspnoea scale

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State features of the COPD symptoms assessment

Completed by patient, how the patient perceives their condition, 8 questions, score above 10 (significant symptom burden)

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What are the aims of COPD management?

Reduce symptoms. Improve exercise tolerance. Improve health status. Reduce severity and frequency of exacerbations. Slow disease progression. Reduce mortality

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Outline the NICE guidelines for COPD

SABA (salbutamol – common, rescue medication) or SAMA. Long-term management. COPD patients can have asthmatic features – airways behave like asthmatics (patients need to start on ICS and LABA). Evidence of airway inflammation/reversibility

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Which other guidelines can be used for the management of COPD?

GOLD (focuses on exacerbation and symptom burden). Local guidelines (South-East London - type of device)

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Outline the cost-effectiveness of interventions for COPD

From most effective to least effective in terms of cost: flu vaccination, smoking cessation, pulmonary rehabilitations, tiotropium, LABA, triple therapy, telehealth for chronic disease (more money spent on drug therapy rather than preventative measures).

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State features of ICS in COPD

Pneumonia risk in COPD patients (ICS increases this risk). Beclomethasone has the lowest risk of pneumonia

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What is COPD good practice?

Symptoms assessment, exacerbations (DH), SH, vaccinations. Inhaled treatment (device type). Assess adherence. Ask patients to demonstrate how they use their inhaler. Spacer with MDIs to improve lung deposition, reduce risk of oral thrush, less dexterity r

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What are the differences between COPD and asthma?

Smoking (COPD patients). Asthmatic symptoms more common in patients under 35 years. Chronic productive cough is more common in COPD. Breathlessness is persistent/progressive in COPD but variable in asthma. Night-time taking with SOB/wheeze (asthma)

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Outline asthma pathophysiology

Smooth muscle contraction, airway hyper-responsiveness

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What are the clinical features of asthma?

Wheeze, breathlessness, chest tightness, cough, worse at night, exercise and by triggers

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What are the signs and symptoms of the diagnosis of asthma?

Symptoms (6 questions, more Ys, more likely to have asthma), lung function tests (reversibility testing), peak flow diary, raised eosinophils, FeNO, ICS trial, mannitol test. Asthma control test

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Why does asthma still kill people?

Excessive prescribing of reliever therapy, under-prescribing of preventer therapy, inappropriate LABA monotherapy, low number of personal asthma action plans, many deaths were preventable

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What are the features of good asthma control?

No daytime symptoms, no night time, no need for rescue medication, no asthma attacks, no limitations on exercise, use SABA less than 3 times a week

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What is the first therapy for patients with asthma according to the BTS/SIGN asthma guidelines?

ICS (local guidelines can also be used e.g. South-East London)

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Why is it better to start with a low dose of ICS?

Dose-response curve for ICS – low dose (more clinical benefit, little S/E), high dose (no increase in clinical benefit, more S/E) – better to have low dose. But ICS is less effective in smokers

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What are the issues with SABA overuse?

Worsen asthma control, enhance exercise-bronchoconstriction, promote airway inflammation, increases asthma mortality (asthma it not acute and can be severe)

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What are the features of good asthma practice?

Symptoms assessment, exacerbations, SH, asthma management plan, vaccinations. Inhaled treatment – adherence, review SABA use, how to use inhaler, spacer with MDIs, prescribe by brand, same type of advice (MDI or DPI). Inhalers and the environment - MDIs/p

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Respiratory

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