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Monday, November 18, 2019
Home Specialties Allergy & Asthma Dyspnea? Cough? Sputum? Pop Quiz on COPD

Dyspnea? Cough? Sputum? Pop Quiz on COPD

COPD: it is currently the world’s fourth leading cause of death and a major cause of chronic morbidity. And things are projected to get worse: as the population ages and as exposure to environmental risk factors continues, the COPD burden is expected to increase.

In its 2018 report, the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) reviews the evidence for the assessment, diagnosis, and management of people with this disease. You can access the GOLD Pocket Guide here.

The following quiz questions about spirometry are culled from that report and are meant to whet your appetite for a more thorough review of the information.

1. Spirometry is the most reproducible and objective measure of airflow limitation when you suspect a diagnosis of COPD. Which of the following values confirms the diagnosis of persistent airflow limitation and thus of COPD in patients with appropriate symptoms and significant exposures to noxious stimuli?

A. post-bronchodilator FEV1/FVC of < 0.70 confirms persistent airflow limitation

B. post-bronchodilator FEV1/FVC of < 0.60 confirms persistent airflow limitation

C. post-bronchodilator FEV1/FVC of < 0.50 confirms persistent airflow limitation

2. If the post-bronchodilator FEV1/FVC is between 0.60 and 0.80 based on a single measurement, then:

A. repeat spirometry test is indicated at a separate interval

B. a single test is usually diagnostic of persistent airflow obstruction

C. An initial ratio of < 0.60 is unlikely to rise above 0.70 spontaneously
 

3. According to the Pocket Guide, possible dosing protocols for bronchodilation for spirometry include which of the following?

A. 400 ug short-acting beta2-agonist

B. 160 ug of a short-acting anticholinergic

C. A combination of A and B

D. Any of the above protocols is acceptable

ANSWERS: 

1. Spirometry is the most reproducible and objective measure of airflow limitation when you suspect a diagnosis of COPD. Which of the following values confirms the diagnosis of persistent airflow limitation and thus of COPD in patients with appropriate symptoms and significant exposures to noxious stimuli?

Answer: A: A post-bronchodilator FEV1/FVC of < 0.70 confirms a diagnosis of persistent airflow limitation

More details can be found on page 4 of the Pocket Guide

2. If the post-bronchodilator FEV1/FVC is between 0.60 and 0.80 based on a single measurement, then: 

Answer:  A and C: A single reading that falls between 0.60 and 0.80 should be followed up by a subsequent spirometric test, but an initial value below 0.60 is unlikely to rise spontaneously. 

More details can be found on page X (in the preface) of the Pocket Guide. 

3. According to the Pocket Guide, possible dosing protocols for bronchodilation for spirometry include which of the following?

 Answer: D. The GOLD guidelines recommend a dosing protocol of 400 ug of a short-acting beta2-agonst or 160 ug of a short-acting anticholinergic — or a combination of the two agents. Measure FEV1 10-15 minutes after administering the beta2-agonist or wait 30-45 minutes after giving the short-acting anticholinergic or combination of the beta2-agonist and the anticholinergic.

More details can be found on page 26 of the Pocket Guide.

References:

GOLD Pocket Guide, Global Initiative for Chronic Obstructive Lung Disease.

Last updated on 9/14/19.

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