305.2 🩺 國考版

305.2.1 高頻考點

305.2.1.1 COPD vs Asthma

  • COPD: smoker, irreversible obstruction
  • Asthma: variable, reversible (> 12%), atopy

305.2.1.2 GOLD ABE 2023 (Updated)

  • A: low symptoms + 0-1 exac
  • B: high symptoms + 0-1 exac
  • E: ≥ 2 exac OR ≥ 1 hosp

305.2.1.3 GOLD Severity by FEV1

  • GOLD 1: ≥ 80%
  • GOLD 2: 50-79%
  • GOLD 3: 30-49%
  • GOLD 4: < 30%

305.2.1.4 Treatment Algorithm

  • A: SABA/SAMA or LABA/LAMA
  • B: LABA + LAMA combo
  • E: LABA + LAMA → triple if eosinophilic; add roflumilast/azithromycin

305.2.1.5 α1-Antitrypsin Deficiency

  • Genetic; PiZZ phenotype
  • Early-onset emphysema (< 50 yo)
  • Basilar, panacinar (vs centrilobular in smoking COPD)
  • Augmentation therapy (IV α1-antitrypsin)
  • Screen all COPD with FEV1 < 80% (USPSTF + GOLD)

305.2.1.6 Key Trials

  • ETHOS, IMPACT, KRONOS, TRINITY, TRELEGY: triple therapy reduces exacerbations
  • BOREAS (2023) + NOTUS (2024): dupilumab for eosinophilic COPD
  • MATINEE (2024): mepolizumab for eosinophilic COPD
  • HOT-HMV: home NIV reduces exacerbations + admissions
  • NETT: LVRS for upper lobe emphysema

305.2.1.7 Acute Exacerbation Antibiotic Indications

  • Cardinal symptoms (≥ 2 of 3: dyspnea, sputum, purulence)
  • Severe (mech vent)
  • Common: amoxicillin-clavulanate, azithromycin, doxycycline
  • Pseudomonas coverage in severe / repeat: cefepime, pip-tazo

305.2.1.8 LTOT Criteria

  • PaO2 ≀ 55 OR SpO2 ≀ 88% at rest
  • OR PaO2 56-59 + cor pulmonale / polycythemia
  • ≥ 15 hr/d
  • Improves survival

305.2.2 易混淆比范

Feature Asthma COPD
Onset Childhood often Adult
Reversibility Yes No (or partial)
Smoking Variable Strong link
Eosinophils Yes Variable
DLCO Normal/↑ ↓
Atopy Common Rare
Treatment ICS-LABA + biologic LABA-LAMA ± ICS
Exacerbations Variable Worse

305.2.2.1 α1-Antitrypsin vs Smoking COPD

  • α1-AT: basilar, panacinar, early onset
  • Smoking: apical, centrilobular, later onset

305.2.3 Special Topics

305.2.3.1 Pulmonary Rehabilitation

  • Class I in symptomatic COPD
  • 6-12 week program
  • Reduces dyspnea + improves QOL
  • Improves exercise tolerance
  • Reduces hospitalizations

305.2.3.2 COPD + Comorbidities

  • Cardiovascular disease (top cause of mortality in COPD)
  • Lung cancer
  • Osteoporosis
  • Depression / anxiety
  • Diabetes
  • Metabolic syndrome

305.2.3.3 COPD-OSA Overlap

  • ~ 1% prevalence
  • Worse outcomes
  • CPAP for OSA + LTOT if needed