NAECB COPD Management 4 — Questions and Answers
Question 1: During an acute COPD exacerbation requiring hospitalization, systemic corticosteroids should be given for approximately how many days?
- 5 days (Correct answer)
- 14 days
- 21 days
- 3 days
Correct answer: 5 days
Evidence from the REDUCE trial supports a 5-day course of systemic corticosteroids for COPD exacerbations, which is as effective as longer courses with fewer side effects.
Question 2: A COPD patient uses a metered-dose inhaler (MDI) without a spacer and coordinates poorly. What is the most appropriate intervention?
- Add a valved holding chamber (spacer) to improve lung deposition (Correct answer)
- Switch to a dry powder inhaler requiring less coordination
- Increase the MDI dose to compensate for poor technique
- Prescribe nebulized therapy for all doses
Correct answer: Add a valved holding chamber (spacer) to improve lung deposition
A valved holding chamber eliminates the need for precise actuation-inhalation coordination, significantly improving drug delivery to the lungs.
Question 3: The mMRC Dyspnea Scale score of 2 means a patient experiences breathlessness when:
- Walking on level ground at own pace or climbing a slight hill (Correct answer)
- Only during strenuous exercise
- Too breathless to leave the house
- Getting dressed or undressed
Correct answer: Walking on level ground at own pace or climbing a slight hill
mMRC grade 2 describes breathlessness causing the patient to walk slower than peers on level ground or requiring rest when walking at their own pace.
Question 4: Alpha-1 antitrypsin deficiency (AATD) testing is recommended in which COPD patients?
- All patients with COPD, especially those under age 45 or with early-onset disease (Correct answer)
- Only those with a family history of lung cancer
- Patients with FEV1 above 70% predicted
- Only smokers with severe exacerbations
Correct answer: All patients with COPD, especially those under age 45 or with early-onset disease
GOLD guidelines recommend AATD testing for all COPD patients, with particular emphasis on younger patients or those with early-onset emphysema where genetic deficiency is more likely.
Question 5: Which surgical intervention is most appropriate for a carefully selected COPD patient with predominantly upper-lobe emphysema and low exercise capacity despite maximal medical therapy?
- Lung volume reduction surgery (LVRS) (Correct answer)
- Lung transplantation
- Bullectomy only
- Tracheostomy
Correct answer: Lung volume reduction surgery (LVRS)
The NETT trial showed that LVRS improves survival and exercise capacity in patients with upper-lobe predominant emphysema and low post-rehabilitation exercise capacity.
Question 6: Non-invasive positive pressure ventilation (NIPPV) during a COPD exacerbation is MOST indicated when:
- pH is below 7.35 with hypercapnia despite medical therapy (Correct answer)
- pH is above 7.40 with mild hypoxemia
- The patient is comfortable and SpO2 is 95%
- FEV1 drops below 50% predicted on spirometry
Correct answer: pH is below 7.35 with hypercapnia despite medical therapy
NIPPV is indicated for acute hypercapnic respiratory failure (pH <7.35, elevated PaCO2) that persists despite maximal medical treatment, reducing the need for intubation.
Question 7: When assessing a COPD patient's exacerbation history for GOLD group classification, how many hospitalizations in the past year qualify as 'high risk'?
- One or more hospitalizations for exacerbation (Correct answer)
- Three or more outpatient exacerbations
- Two or more outpatient exacerbations only
- Any emergency department visit regardless of admission
Correct answer: One or more hospitalizations for exacerbation
Under GOLD 2023 grouping, even one hospitalization for a COPD exacerbation in the prior year places the patient in the high-risk (Group E) category.
NAECB COPD Management 4
During an acute COPD exacerbation requiring hospitalization, systemic corticosteroids should be given for approximately how many days?