Acute exacerbation of COPD

Question 1

What is an acute exacerbation of COPD?

Answer 1

Change in baseline symptoms of a patients cough, breathlessness and/or sputum production that is beyond their normal variation and is of acute in onset.

Question 2

What are the signs and symptoms of an Exacerbation of COPD?

Answer 2

-Symptoms:
Breathlessness
Cough
Wheeze
Sputum production –> if infective
Fever –> if infective

-Signs:
Desaturating
Increased RR or HR
Reduced breath sounds

Question 3

What features may be suggestive of a severe exacerbation of COPD?

Answer 3

Marked breathlessness and tachypnoea.
Pursed-lip breathing and/or use of accessory muscles at rest.
New-onset cyanosis or peripheral oedema.
Acute confusion or drowsiness.
Marked reduction in activities of daily living.

Question 4

What is the initial management of an acute exacerbation?

What investigations would you order?

Answer 4

ABCDE
-Sit up-right and give oxygen

Initial management:
1. Oxygen (target sats of 88-92%)
2. ABG
3. Bloods - FBC, UEs
4. Blood cultures - if pyrexial
5. Sputum cultures - if pyrexial and production

Investigations:
-CXR

Question 5

What would you prescribe for the management of an acute exacerbation of COPD?

Answer 5

Salbutamol 5mg nebuliser, back to back. Then QDS.

Ipatropium Bromide 500mcg nebuliser QDS, every 4-6 hours.

Prednisolone 30mg Stat dose then OD for 5 days.

Abx as per local policy

Question 6

What values should you be wary of on the ABG which dictates management?

Answer 6

pH 7.25-7.35 or PaCO2 <6kPa = NIV

pH <7.25 = Invasive ventilation

Question 7

Explain respiratory drive in CO2 retainers

Answer 7

Typically, normal people will rely on elevated CO2 levels to drive respiration. However, in COPD retainers, they lose this ability and rely on hypoxic drive to drive respiration. Hence, when you give a CO2 retainer too much oxygen, they lose their oxygen drive and so go into respiratory failure.

Question 8

What are the target saturations for patients who’s PCO2 are normal and PCO2 is high?

Answer 8

Normal PCO2 = 94-98%

High PCO2 (CO2 retainer) = 88-92%

Question 9

What is a CO2 retainer?

Answer 9

Being a carbon dioxide (CO2) retainer means that too little CO2 is removed from the blood by the lungs. The resulting condition is called hypercapnia.

Question 10

What happens if you give a CO2 retainer too much oxygen on a blood gas?

Answer 10

If you give a CO2 retainer too much oxygen:

-Oxygen levels would be: Normal
-Carbon dioxide: High as the patient loses respiratory drive
-Bicarbonate: high to try and compensate