Which one of the following interventions is most likely to increase survival in patients with COPD?
Correct Answer D: Whilst long-term oxygen therapy may increase survival in hypoxic patients, smoking cessation is the single most important intervention in patients with COPD.
COPD: stable management: NICE updated it's guidelines on the management of chronic obstructive pulmonary disease (COPD) in 2010.
General management:
Bronchodilator therapy:
FEV1 > 50%:
FEV1 < 50%:
For patients with persistent exacerbations or breathlessness:
Oral theophylline:
Mucolytics:
Cor pulmonale:
Factors which may improve survival in patients with stable COPD:
A 67-year-old man is referred to the respiratory clinic. He has a past history of tuberculosis as a child but is otherwise normally fit and well. Over the past two months he has had a cough, lost one stone in weight and had four episodes of haemoptysis. A chest x-ray shows a solid mass occupying the right upper zone. Investigation results include the following:
What is the most likely diagnosis?
Correct Answer C:
Aspergilloma:
An aspergilloma is a fungus ball which often colonizes an existing lung cavity (e.g. secondary to TB, lung cancer or cystic fibrosis).
Usually asymptomatic but features may include:
Investigations:
Which one of the following is the most common type of lung cancer in the UK?
Correct Answer B: Tricky question. It is well known that the incidence of adenocarcinoma is rising in comparison to the other types of non-small cell lung cancer. Indeed, adenocarcinoma is now the most common type of lung cancer in the USA.
In the UK however squamous cell cancer remains the most common subtype Reference: Janssen-Heijnen, M.L. and J.W. Coebergh, The changing epidemiology of lung cancer in Europe. Lung Cancer, 2003. 41(3).
Lung cancer: types: Lung cancer:
Other tumours:
A 19-year-old male with no past medical history presents to the Emergency Department with anterior chest pain and shortness of breath. Blood pressure is 110/80 mmHg and his pulse is 84 bpm. The chest x-ray is reported as showing a 50% pneumothorax with no mid-line shift.
What is the most appropriate management?
Correct Answer E: Questions may occasionally quote a percentage figure rather than 'rim size'. A 50% pneumothorax is likely to have a rim of > 3cm. Please see the American Journal of Radiology link for more information on the relationship between rim size and percentage.
Pneumothorax:
The British Thoracic Society (BTS) published updated guidelines for the management of spontaneous pneumothorax in 2010. A pneumothorax is termed primary if there is no underlying lung disease and secondary if there is.
1- Primary pneumothorax:
Recommendations include:
2- Secondary pneumothorax: Recommendations include:
3- Iatrogenic pneumothorax:
A 54-year-old woman with a 30-pack-year history of smoking presents due to increasing breathlessness. A diagnosis of chronic obstructive pulmonary disease (COPD) is suspected.
Which of the following diagnostic criteria should be used when assessing a patient with suspected COPD?
Correct Answer B: Please see the 2010 NICE guidelines for further details. Patients can now be diagnosed with 'mild' COPD if their FEV1 predicted is > 80% if they have symptoms suggestive of COPD.
COPD: investigation and diagnosis:
NICE recommend considering a diagnosis of COPD in patients over 35 years of age who are smokers or ex-smokers and have symptoms such as exertional breathlessness, chronic cough or regular sputum production.
The following investigations are recommended in patients with suspected COPD:
The severity of COPD is categorized using the FEV1*:
Measuring peak expiratory flow is of limited value in COPD, as it may underestimate the degree of airflow obstruction.
*Note that the grading system has changed following the 2010 NICE guidelines. If the FEV1 is greater than 80% predicted but the post-bronchodilator FEV1/FVC is < 0.7 then this is classified as Stage 1 - mild.
**Symptoms should be present to diagnose COPD in these patients.
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