Diagnosis
What confirms COPD on spirometry?
Post-bronchodilator FEV₁/FVC < 0.70
Name one symptom score used to assess COPD burden.
CAT or mMRC
First-line reliever for stable symptoms.
SABA or SAMA PRN
Two core benefits of formal pulmonary rehabilitation.
Relieves dyspnea; improves exercise capacity.
Name four classic X Ray findings of COPD
Rapidly tapering vascular shadows, increased lung radiolucency, flattened diaphragm and long narrow cardiac silhouette.
GOLD airflow grades are based on what?
FEV₁ % predicted
When to add ICS?
Frequent/severe exacerbations with eos ≥300/µL (or ≥100/µL with recurrent exacerbations); avoid with recurrent pneumonias
Starting pulmonary rehab soon after an acute exacerbation improves which outcomes?
Health-related QoL and reduced readmissions.
Do both symptomatic and asymptomatic adults get screened for COPD?
No. COPD is case-finding, not population screening:
YES symptomatic, at-risk adults (dyspnea, chronic cough/sputum, activity decline with smoking/biomass exposure).
NOT asymptomatic adults—asymptomatic mild obstruction usually doesn’t require treatment.
MAY BE if CAPTURE ≥3 can prompt spirometry
Define “high exacerbation risk” for treatment decisions.
≥2 moderate exacerbations/yr or ≥1 hospitalization
Name the three handheld inhaler types.
MDI/HFA, DPI, SMI (Respimat)
In COPD, why should Advance Care Planning be prioritized, and what markers/tools guide when to start the conversation?
Mortality is hard to predict and any exacerbation can be fatal; COPD with FEV₁ <50% plus multiple exacerbations has worse long-term prognosis/QoL than many cancers; use validated prognostic tools—BODE or ADO—to frame risk; and remember the vast majority of patients want prognosis/ACP discussions, so offer them proactively.
Who should be evaluated for alpha-1 antitrypsin deficiency?
COPD; unexplained liver disease; unexplained bronchiectasis; ANCA-positive vasculitis; and first-degree relatives of an affected individual.
Which index predicts COPD prognosis?
BODE index
Two universal steps people most people forget but you should definitely inform pt?
Full exhalation before inhaling; breath-hold after inhalation
Indications for roflumilast or chronic azithromycin.
Roflumilast: chronic bronchitis, FEV₁ <50%, frequent exacerbations. Azithro: former smokers with frequent exacerbations despite optimal inhaled therapy
Which index guides initial pharmacologic treatment at diagnosis?
GOLD ABE grouping (A/B/E) based on symptoms (CAT or mMRC) and exacerbation history
Best inhaler for poor inspiratory force?
MDI/HFA with spacer or SMI (Respimat)