Acute exacerbation of COPD

Question 1

What is the most common cause of an acute exacerbation of COPD?

Answer 1

Bacteria

Question 2

What is the most common bacterial cause of COPD?

Answer 2

Haemophilus influenzae

Question 3

What percentage of acute exacerbations of COPD are due to viruses?

Answer 3

30%

Question 4

What is the most common viral cause of an acute exacerbation of COPD?

Answer 4

Human rhinovirus

Question 5

How does an acute exacerbation of COPD present?

Answer 5

• increase in dyspnoea, cough, wheeze
• Increase in sputum
• Hypoxia and acute confusion

Question 6

What does an increase in sputum suggest?

Answer 6

An infective cause

Question 7

What is the management of an acute exacerbation of COPD?

Answer 7

5 days of 30mg prednisolone

Question 8

What would you increase the frequency of in an acute exacerbation of COPD?

Answer 8

Bronchodilator use - consider giving via a nebuliser

Question 9

Why might you consider giving antibiotics for someone with an acute exacerbation of COPD?

Answer 9

Purulent sputum
Or clinical signs of pneumonia

Question 10

What antibiotics might you give for someone with an acute exacerbation of COPD?

Answer 10

amoxicillin
(or clarithromycin or doxycycline)

Question 11

What is the management of an acute exacerbation of COPD in hospital?

Answer 11

• Nebulised bronchodilators
• Steroids
• Antibiotics- if infection
• Physiotherapy- clear sputum

Question 12

What is the management of an acute exacerbation of COPD if not responding to first line treatment?

Answer 12

• IV aminophylline
• Non-invasive ventilation (NIV)
• Intubation and ventilation with admission to intensive care
• Doxapram can be used as a respiratory stimulant where NIV or intubation is not appropriate

Question 13

What are the main three things used in the management of a severe acute exacerbation of COPD?

Answer 13

Oxygen
Nebulised bronchodilator
Steroids

Question 14

Why would you give oxygen to someone having a severe acute exacerbation of COPD?

Answer 14

They are at risk of hypercapnia

Question 15

How should oxygen be administered to someone having a severe acute exacerbation of COPD?

Answer 15

28% Venturi mask at 4 l/min

Question 16

What oxygen saturations should you aim for in someone having a severe acute exacerbation of COPD in patients with risk factors for hypercapnia?

Answer 16

88-92%

Question 17

What oxygen saturations should you aim for in someone having a sever acute exacerbation of COPD in patients with normal pC02?

Answer 17

94-98%

Question 18

What nebulised bronchodilators can be used in the management of an acute exacerbation of COPD?

Answer 18

beta adrenergic agonist- salbutamol
muscarinic antagonists-ipratropium

Question 19

What steroids can be administered to someone having an acute exacerbation of COPD?

Answer 19

IV hydrocortisone may sometimes be considered instead of oral prednisolone

Question 20

What can be considered for patients not responding to nebulised bronchodilators in a severe acute exacerbation of COPD?

Answer 20

IV theophylline

Question 21

What are patients with COPD prone to developing?

Answer 21

Type 2 respiratory failure

Question 22

When would non-invasive ventilation be considered in someone having an acute exacerbation of COPD?

Answer 22

Respiratory acidosis pH 7.25-7.35