Chronic obstructive pulmonary disease: diagnosis and management

What conditions sit under the umbrella term chronic obstructive pulmonary disease (COPD)?

Which of the following are common symptoms of COPD?

Which of the following new symptoms would require urgent referral in a patient with diagnosed COPD?

Which of the following features would suggest that the patient may have asthma instead of, or in addition to, COPD?

Which of the following is not a risk factor for COPD?

A patient is described as having “moderate” COPD. What is their FEV1 percent predicted?

You are reviewing a patient with known COPD in clinic. They tell you that they are very short of breath. They describe having difficulty walking up hills and need to stop every 100m when they are walking on the flat. What is their Medical Research Council dyspnoea grade?

A patient aged 40 years presents to his GP with a 6-month history of dyspnoea, cough and recurrent chest infections. He has a modest smoking history of 5 cigarettes per day for approximately 5 years in his early 20s. His GP referred him for a chest X-ray, which showed hyperinflated lungs, and he was subsequently referred to his local chest clinic, which ordered a CT scan of his chest. This showed lower lobe emphysema. What condition would be suspected based on this information?

Mr AB has recently been diagnosed with COPD. He is still smoking 12 cigarettes per day, with a 20-pack year history but he informs you he is determined to quit. What advice or help should he be given?

Mrs YZ has severe COPD and has just been treated for her first exacerbation in more than 12 months. She has stopped smoking and has had both her influenza and pneumococcal vaccinations. She finds her triple therapy (Trimbow) inhaler very effective but, despite this, is still very breathless, even when walking short distances. What else can be done to optimise her treatment?

Mr CD has a diagnosis of COPD and sees his GP practice pharmacist for his annual COPD review. He is prescribed an Incruse Ellipta (GlaxoSmithKline UK) inhaler — one puff inhaled every morning. He has had one recent exacerbation and, when reviewing his bloods, the GP practice pharmacist notes that he has an eosinophil count of 0.6 x 109/L. What would be the most appropriate action?

You are a GP practice pharmacist and you review Mrs OC’s COPD management as part of her COPD annual review. During the review you note she has required four courses of prednisolone for exacerbation of COPD in the last 12 months. Which of the following should be avoided where possible?

Which of the following is not required before commencing treatment with prophylactic azithromycin (250–500 mg orally, three times per week)?

You are counselling Ms AC on her medications before she is discharged from hospital. When you ask her to demonstrate her inhaler technique, she says she had this done a few months ago at her respiratory review. What should you do?

Mr CPD, a COPD patient, was commenced on carbocisteine capsules 750mg, 3 times daily, 8 weeks ago by his GP, as he had chronic sputum production which was particularly bothersome. He tells you today that he has not noticed any difference since starting the medication. What would you advise?