Respiratory Disorders
Asthma and COPD
Know asthma (variable airflow obstruction, reversibility, GINA stepwise management, inhaler technique, adherence) and COPD (post-bronchodilator FEV₁/FVC <0.70, GOLD groups ABE, smoking cessation, vaccination, LAMA/LABA, pulmonary rehabilitation). Distinguish asthma–COPD overlap and the role of eosinophils.
Spirometry interpretation
A low FEV₁/FVC = obstructive; low FVC with normal ratio = restrictive. Post-bronchodilator reversibility (≥12% and ≥200 mL FEV₁) supports asthma. Traps arise when candidates interpret pre-bronchodilator values or ignore the ratio.
Infections and emergencies
- CAP: CURB-65 for severity, antibiotics per local guidelines, atypical cover considerations.
- Tuberculosis: symptoms, sputum AFB/GeneXpert, contact tracing, DOT, and drug interactions (rifampicin induces CYP450).
- PE and pneumothorax: Wells score, D-dimer, CTPA; tension pneumothorax is a clinical diagnosis - needle decompression before imaging.
Traps
- Using antibiotics for an asthma exacerbation without evidence of infection.
- Missing COPD diagnosis because the patient is a non-smoker (biomass exposure in the Arab region).
- Ordering imaging before treating tension pneumothorax.
- Ignoring occupational or environmental triggers.
Worked rule
A young patient with episodic wheeze, nocturnal symptoms, and normal spirometry: consider bronchial challenge or peak-flow variability; a normal spirometry does not exclude asthma.