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Egyptian Board Thoracic Diseases study materials
Egyptian Board Thoracic Diseases study resources

Egyptian Board Thoracic Diseases: Obstructive Airway Diseases (Asthma, COPD, Bronchiectasis)

Egyptian Board Thoracic Diseases · Work through your exam, one topic at a time.

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Obstructive Airway Diseases (Asthma, COPD, Bronchiectasis)

Domain 3 - Obstructive Airway Diseases

This domain tests diagnosis, severity assessment and long-term management of asthma, COPD and bronchiectasis. Egyptian Board questions often use exacerbation scenarios: decide the treatment setting, choose inhaler therapy, identify when antibiotics or NIV are indicated, and avoid outdated SABA-only asthma care.

Core rules

  • Asthma diagnosis requires variable respiratory symptoms plus variable airflow limitation: positive bronchodilator response, peak-flow variability or positive challenge. GINA no longer recommends SABA-only treatment; every adult and adolescent should receive inhaled corticosteroid-containing therapy.
  • COPD diagnosis requires post-bronchodilator FEV₁/FVC <0.70 in a patient with symptoms and exposure. GOLD ABE groups use exacerbation history and symptoms (CAT or mMRC), not FEV₁ alone for initial pharmacotherapy.
  • COPD initial therapy: group A a bronchodilator; group B LABA + LAMA; group E LABA + LAMA, with ICS added if blood eosinophils ≥300 cells/µL or repeated exacerbations.
  • Exacerbations: controlled oxygen to 88–92% in COPD, short-acting bronchodilators, systemic steroids for 5 days, antibiotics if increased sputum purulence plus volume or dyspnoea, and NIV for persistent hypercapnic acidosis.
  • Bronchiectasis: confirm with CT, screen for underlying causes, use airway clearance, and reserve long-term macrolides for selected frequent exacerbators after excluding non-tuberculous mycobacteria.

Worked example

A 64-year-old with COPD has FEV₁ 38% predicted, CAT 22, and two moderate exacerbations in the past year. This is GOLD 3, group E. Start LABA + LAMA. Because the eosinophil count is 340 cells/µL and exacerbations persist, add ICS, preferably in a single inhaler. Check inhaler technique, offer smoking cessation and influenza/pneumococcal vaccination, and assess for home oxygen if PaO₂ ≤55 mmHg or 56–59 mmHg with cor pulmonale. Do not start chronic oral steroids or routine antibiotics.

Traps that cost marks

  • Prescribing SABA alone for asthma; this increases exacerbation and mortality risk.
  • Giving ICS to every COPD patient regardless of eosinophils or exacerbation history.
  • Using high-flow oxygen in a COPD exacerbation and worsening hypercapnia.
  • Diagnosing bronchiectasis on chest X-ray alone; HRCT is required.
  • Missing allergic bronchopulmonary aspergillosis in asthma with eosinophilia and central bronchiectasis.

Key points

  • Asthma: variable symptoms plus variable airflow limitation; ICS-containing therapy for all.
  • COPD: post-bronchodilator FEV₁/FVC <0.70; GOLD ABE guides initial therapy.
  • Group E COPD: LABA + LAMA; add ICS if eosinophils ≥300 or frequent exacerbations.
  • COPD oxygen target 88–92%; NIV for hypercapnic acidosis.
  • Bronchiectasis needs CT confirmation and airway clearance.