COPD — KFP-style written assessment

KFP 1 (10 marks)

A 59-year-old painter who has smoked 25 cigarettes daily for 35 years presents with two years of worsening exertional breathlessness and morning sputum. Spirometry: post-bronchodilator FEV1/FVC 0.58; FEV1 58% predicted. He wants 'something to fix my lungs'. ^{[1] [3] [5]}

1. State the diagnostic criterion he meets and grade his airflow limitation. (3) ^[1]
2. What can and cannot be achieved by smoking cessation at this stage? Quantify the pharmacotherapy you would offer. (5) ^{[3] [6] [7]}
3. His brother asks whether he should have a 'breathing test' too — he feels well. What is the correct screening position? (2) ^[2]

Model answers

1. Post-bronchodilator FEV1/FVC below 0.70 confirms COPD — no reversibility requirement. FEV1 58% predicted = GOLD grade 2 (moderate). ^[1]
2. Cessation cannot restore lost lung function — irreversible obstructive changes are established — but it reverts the rate of further FEV1 loss toward normal, and in established COPD improves FEV1% predicted (+6.72%), symptoms, walk distance and may reduce mortality. Offer varenicline first-line (RR 2.24 versus placebo; superior to patch RR 1.25 and bupropion), or combination NRT which performs comparably; bupropion equals single-form NRT. Neuropsychiatric safety of varenicline is confirmed (EAGLES). ^{[3] [6] [7] [9]}
3. The USPSTF recommends against screening asymptomatic adults for COPD — no net benefit. Case-finding applies only to those with respiratory symptoms plus risk factors. ^[2]