Matt Wong + Sheila MurphyDec 13th 2011

AKT MINI EXAMNICE COPD GUIDELINESBTS ASTHMA GUIDELINESINHALER TECHNIQUEQOFSPIROMETRYCSA EXERCISE

Which of the following are used in assessing the severity of COPD? A. Body mass index (BMI)B. AgeC. Medical Research Council (MRC) dyspnoea score D. Smoking pack year historyE. Lung function

Which of the following statements apply to COPD?A. It is more common in those from upper social classesB. It is often seen as a co-morbidity in patients with ischaemic heart disease and lung cancerC. Mortality from COPD is evenly spread across the UK as a wholeD. The estimated prevalence of COPD in patients over 40 years of age is 9-10%

What percentage of patients will die within 3 months of admission for a COPD-related condition?A. 33%B. 50%C. 5%D. 20%

Pulmonary rehabilitation should be offered to:A. All patients with moderate or severe COPDB. All patients with COPD irrespective of their MRC scoreC. Patients who are poorly motivatedD. All patients who meet the referral criteria regardless of their inhaled drug therapyE. Patients with an MRC dyspnoea score of 3 or more unless they are on long-term oxygen therapy (LTOT)

Which of the following statements about the role of inhaled corticosteroids in COPD are true?A. In patients with moderate/ severe COPD (FEV1

Which of the following features suggest a patient should be admitted to hospital for management of their COPD exacerbation?A. CyanosisB. Mild peripheral oedemaC. Low oxygen saturation (

Which of the following statements about oxygen therapy in COPD exacerbations are true?A. It should be given to all patientsB. It should be started at 100% until the oxygen saturation is >95%C. It should be monitored by pulse oximetry until access to full arterial or capillary blood gases are availableD. In patients on LTOT it should be given at the same rate as they receive at home

1. A, C, E2. B, D3. E4. B5. C, D6. A, C, E7. C, D8. 39. D

Consider COPD in smokers >35 and with exertional SOB, chronic cough, regular sputum production, winter bronchitis, wheezeNo features of asthma unproductive cough, diurnal variation, night-time waking with wheeze/breathlessnessAsk about: weight loss, fatigue, exercise tolerance, chest pain, night waking, haemoptysis, ankle swelling, occupational hazards

Post-bronchodilator spirometryCXR FBC anaemia/polycythaemiaBMI

FEV1/FVC < 0.7 = COPDStage 1-5 mild to very severe based on FEV1 % >80% is mild 30% - 50% severe People must be symptomatic to make diagnosis!

Grade 1 not troubled by SOB except on exerciseGrade 2 SOB when hurrying/walking up hillGrade 3 walks slower on level ground due to SOB, or has to stop when walking at own paceGrade 4 stops for breath after 100m or a few mins on ground levelGrade 5 too breathless to leave the house or breathless when dressing

Smoking cessation for allStart treatment once diagnosis confirmedPulmonary rehabFor those with disability/recent admission

SABA : short acting B agonist salbutamol

LABA : long acting B agonistsalmeterol

SAMA : short acting muscarinic antagonistipratropium

LAMA : long acting muscarinic antagonist Tiotropium

ICS : inhaled corticosteroidsBeclometasone, fluticasone, budesonide

TheophyllineIf inhaled therapy ineffective/cant be used

Oral steroidsMaintenance steroids not recommended, but if severe COPD may be necessary, aim for low dose and monitor for osteoporosis30mg for 7-14 days in exacerbations

LTOT used for 15 hours/dayAssess need for LTOT if FEV1

Increase frequency of broncholdilator use/consider use of nebuliserPrescribe oral abx if sputum purulent/clinical signs of peumoniaSteroid 30mg 7-14 days

Self-ManagementStart abx/steroid if SOB increases/interferes with ADLsAbx if sputum purulentAdjust bronchodilator to control symptoms

not able to cope at home severe beathlessness, Sats

Salbutamol CFC Free 100mcg/dose 3 / 200 dosesIpratropium 20 mcg5 / 200 dosesSalmeterol 50 mcg29 / 60doses/ 1 monthSalmeterol 50 mcg and fluticasone35 / 60 doses/ 1 monthTiotropium32 / 30 doses/ 1 month

Contains a pressurised inactive gas that propels a dose of drug in each 'puff'

ADVmost widely used inhalerquick to use, small, and convenient to carry

DISADVneeds good co-ordination to press the canister, and breathe in fully at the same time

Used with pressurised MDIs

The spacer between the inhaler and the mouth holds the drug like a reservoir when the inhaler is pressed

Valve at the mouth end ensures that the drug is kept within the spacer until you breathe in. When you breathe out, the valve closes.

Adv No need to have good co-ordination to use a spacer device.

A facemask can be fitted on to some types of spacers, instead of a mouthpiece. This is sometimes done for young children and babies who can then use the inhaler simply by breathing in and out normally through the mask.

Alternatives to the standard MDIDon't require you to press a canister on top

Bottom 3 are dry powder inhalers.Dose is triggered by breathing in at the mouthpiece. You need to breathe in fairly hard to get the powder into your lungs. AccuhalersClickhalersEasyhalersNovolizersTurbohalersdiskhalers Twisthalers

ADV - Require less co-ordination than the standard MDI. DISADV - They tend to be slightly bigger than the standard MDI.Autohaler

Practice register of patients with COPD% with COPD in whom diagnosis has been confirmed by spirometry with reversibility testing % with COPD with record of smoking status in the previous 15m% with COPD who smoke, who have been offered smoking cessation advice or referral to a specialist service, where available in last 15 months% with COPD with a record of FEV1 in the previous 27m% with COPD with record that inhaler technique has been checked in the preceding 27m % with COPD who have had influenza immunisation in the preceding 1 September to 31 March

PROMPTS: MRC Dysponea Score, FEV1, REVIEW EVERY 15mOUR PRACTICE:Inhaler technique, sats, smoking, exacerbations, immunisations, depression

*Answers a,c,e*B, d*e*b*C,d*A,c,e*C,d *******Reduce dose of aminophylline if using macrolides or ciprofloxacin to treat exacerbation***Answers a,c,e***Answers a,c,e*