Quick quiz: Management of COPD

Our quick quizzes aim to test your knowledge through a series of illustrative cases and scenarios. Work your way through the questions to enhance your understanding of management of key conditions. Press ‘start’ below to begin the quiz on COPD management.

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Dr Toni Hazell is a GP in north London

<div id="article_leaderboard2" class="article-lb mb-4 widget_text widget adbanner mpu d-none d-md-none d-lg-block "> <div class="textwidget custom-html-widget">  <div id="article-lb"><script> googletag.cmd.push(function() { googletag.display("article_leaderboard2"); }); </script></div> </div> </div> <section data-block="SingleChoice"> <h3>You have a particular interest in COPD and do all the COPD clinics at your surgery. As a result of this, you have been invited to be the nurse representative on an ICB committee looking at where they should put some extra funding for COPD, in order for it to have the greatest effect. Which one of the options below gives the greatest value per pound spent in improving COPD care?</h3> <ul> <li>Long-acting muscarinic antagonist (LAMA) inhalers.</li> <li>Flu vaccination.</li> <li>Stop smoking support.</li> <li>Inhaled corticosteroids (ICS).</li> </ul> </section> <section data-block="SingleChoice"> <h3>You are seeing a patient who is newly diagnosed with COPD. He has had an annual flu vaccination and is in the process of stopping smoking. He has not had any exacerbations in the last year and has a low symptom score, putting him in group A of the GOLD guidelines. What is your first-line treatment, and would it vary depending on whether you were following NICE or GOLD guidelines?</h3> <ul> <li>NICE recommends a short-acting bronchodilator and GOLD recommends a long-acting bronchodilator.</li> <li>Both guidelines recommend a LAMA inhaler as first-line management.</li> <li>Both recommend a combined LAMA and long-acting beta agonist (LABA) combination to start with, stepping down once good control is attained.</li> <li>Both recommend an ICS first-line.</li> </ul> </section> <section data-block="SingleChoice"> <h3>You review your patient a year later. He continues to smoke and to use his LAMA/LABA inhaler, and has had one exacerbation of COPD, discharged a few weeks ago. A friend of his has recently been offered pulmonary rehabilitation, and he wonders if he should also do this. Since you last saw him, he has developed stable angina but has no other medical conditions. Which of the following are correct about pulmonary rehabilitation.</h3> <ul> <li>Pulmonary rehabilitation is only offered to patients who no longer smoke.</li> <li>NICE says that pulmonary rehabilitation should only be offered to those who have a Medical Research Council (MRC) score of ≥4 or have had ≥2 admissions in the last year.</li> <li>Patients who have any form of angina cannot attend pulmonary rehabilitation.</li> <li>NICE suggests offering pulmonary rehabilitation to those who are functionally disabled by COPD or have had a recent exacerbation which needed admission.</li> </ul> </section> <section data-block="SingleChoice"> <h3>You are reviewing the COPD of a patient who is new to your surgery. He has been taking a combined LAMA/LABA/ICS inhaler for several years and tells you that, in his online COPD support group, quite a few people have been taken off their ICS and stepped down to a LAMA/LABA alone. He wonders if he should do the same. Which of the following is correct about the stepping down of COPD therapies?</h3> <ul> <li>One of the reasons for considering stepping down is that those using LAMA/LABA/ICS are more likely to have pneumonia than those using just LAMA/LABA.</li> <li>If a person on triple therapy has one or more exacerbations per year they should not be considered for stepping down therapy.</li> <li>Raised blood eosinophils would be a reason to discontinue the ICS part of his therapy.</li> <li>If an ICS is discontinued, this should always be done in one go – there isn’t a reason to gradually step down the dose of the ICS.</li> </ul> </section> <section data-block="SingleChoice"> <h3>Your patient would prefer, if possible, not to take something every day and so you start him on a short acting beta-agonist (SABA). You next see him one year later when he has come for review. Unfortunately he hasn’t yet been able to give up the cigarettes, and he’s had one exacerbation which required oral antibiotics in the community. Whilst the inhaler makes him feel better when he takes it, on balance his symptoms have worsened; he now has to stop for breath when walking to the supermarket, which is about half a kilometre away. You encourage him to go back to the smoking cessation clinic; what would be your next step in terms of medication? Reviewing his notes there has never been any suggestion that he has asthma, and he had a recent full blood count showing a normal eosinophil count.</h3> <ul> <li>A combined LABA/ICS inhaler.</li> <li>Keep his SABA and add an ICS.</li> <li>A combined LAMA/LABA inhaler.</li> <li>Start him on oral theophylline.</li> </ul> </section> <p>  <p><strong>Related Article: </strong> <a id="related_article_link_2" href="https://www.nursinginpractice.com/clinical/respiratory/quick-quiz-diagnosis-of-copd/">Quick quiz: Diagnosis of COPD</a> <p>  <p>  <p>

Quick quiz: Management of COPD

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