COPD Quiz Answer

1. COPD involves a combination of which characteristics:
a airway inflammation
b. eosinophilia
c. bronchoconstriction that is fully reversible
d. bronchoconstriction that is not fully reversible
e. increased mucus production

Discussion: COPD is a chronic inflammatory condition that involves obstruction of airflow that is not fully reversible. The definition encompasses two distinct types, chronic bronchitis and emphysema. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines define COPD as a disease state characterized by airflow limitation that is not fully reversible, is usually progressive, and is associated with an abnormal inflammatory response of the lungs to inhaled noxious particles or gases. The associated airway inflammation typically involves PMNs and macrophages, as opposed to asthma which includes an eosinophilia. The key component is that the obstructive bronchoconstriction is NOT fully reversible, even with appropriate medication regimens, as opposed to asthma which is fully reversible.

2. What percentage of patients with COPD have a clinically significant history of tobacco use:
a. 100%
b. 85%
c. 70%
d. 50%

Discussion: While most everyone who is diagnosed with COPD has some degree of tobacco use in their history, up to 15% of those diagnosed do not have a significant tobacco abuse history. Causes of COPD in these patients include air pollution, alpha-1 antitrypsin deficiency, chemical exposures, second-hand smoke.

3. What percentage of patients who smoke have clinically significant COPD:
a. 0%
b. 7%
c. 15%
d. 30%
e. 50%

Discussion: Surprisingly only 15% of people who smoke tobacco are diagnosed with COPD based on Pulmonary Function Testing. With that said there is suspicion of a much higher percentage of smokers who go undiagnosed due to mild symptoms or failure to pursue testing.

4. One component of COPD is chronic bronchitis. Chronic bronchitis is defined as:
a. productive cough for 6 consecutive months
b. intermittent episodes of cough and dyspnea over 1 year
c. productive cough for 3 months over 2 consecutive years
d. evidence of inflammatory cells on > 2 sputum cultures

Discussion: Chronic bronchitis is defined by a chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded. This definition has been used in many studies, despite the arbitrarily selected symptom duration and lack of biologic rationale.

5. Spirometry to diagnose COPD is recommended for which of the following groups of patients:
a. all adults with respiratory symptoms
b. all persons who smoke
c. all persons 45 years and older who smoke
d. all persons 60 years and older with a history of smoking

Discussion: The GOLD Guidelines recommend clinicians should suspect COPD whenever significant history of risk factors are present or typical clinical symptoms are present in anyone over 40 years of age. Significant clinical features include: chronic cough, typically daily and productive; breathlessness on exertion, initially intermittent and becoming persistent; chronic sputum production; frequent exacerbations of bronchitis. Significant risk factor exposure includes abuse or excessive exposure to tobacco smoke, occupational dusts, and certain cooking fuels.

6. Diagnosis of severe COPD based on spirometry is made by:
a. FEV1/FVC < 0.7, FVC < 30%
b. FEV1/FVC > 0.7, FVC < 30%
c. FEV1/FVC < 0.7, FEV1 <30%
d. FEV1/FVC > 0.7, FEV1 <30%

Discussion: Based on GOLD Criteria for evaluating severity of disease. An FEV1/FVC of less than 0.7 is used to diagnose COPD. The post-bronchodilator FEV1 value is then used to assess the severity of the disease. FEV1 values > 80% signify mild disease. FEV1 50-80% signifies moderate disease. FEV1 values 30-50% signifies severe disease. And FEV1 values < 30% signify very severe disease.

7. Long term oxygen therapy improves survival, exercise, and cognitive performance
a. true
b. false

8. Which medication(s) have been shown to improve the long-term rate of decline (FEV1) in lung function:
a. short-acting bronchodilators (albuterol)
b. long-acting bronchodilators (salmeterol)
c. glucocorticoids (prednisone)
d. anticholinergics (tiotropium)
e. all of the above
f. none of the above

Discussion: The only official therapies and interventions with significant mortality benefits over the long term in patients with officially diagnosed COPD based on pulmonary function testing includes oxygen therapy and cessation of tobacco abuse. There has been equivocal data on the effectiveness in preventing the long-term rate of decline of FEV1 and mortality with use of anticholinergic medications (specifically tiotropium) or combination therapy with long acting B-agonists with inhaled steroids (Advair).