Acute Exacerbation of COPD

Question 1

What is the presentation of acute exacerbations of COPD?

Answer 1

• Worsening breathlessness
• Worsening cough
• Increased sputum production
• Change in sputum colour

Question 2

What causes aeCOPD?

Answer 2

• virus
• bacteria

Question 3

What are the differentials for aeCOPD?

Answer 3

• asthma
• pulmonary oedema
• upper respiratory tract obstruction
• PE
• anaphylaxis

Question 4

What ix would you order for aeCOPD?

Answer 4

• Bedside
  
  • ECG
  • sputum culture
• Bloods
  
  • FBC, U&E, CRP
  • ABG
  • Blood culture
  • Theophylline levels
• Imaging
  
  • CXR

Question 5

How would you Mx aeCOPD?

Answer 5

1. Oxygen

• Venturi mask, target 88-92%

2. Salbutamol

• 2.5mg nebulised. every 15-30mins
• 4 times/day once stabilised

3. SAMA (Ipratropium)

• 500mcg nebulised
• 4times/day once stabilised

4. Corticosteroid

• Pred 30mg OD for 5 days

5. ABX (if sputum purulent or signs of pneumonia)

• Amoxicillin or clarithromycin or doxycycline

Question 6

What factors support hospital admission?

Answer 6

• Inability to cope at home
• Severe clinical symptoms: severe breathlessness, cyanosis, evidence of heart failure, acute confusion or low saturations (<90%)
• Severe co-morbiditity (e.g. diabetes on insulin or cardiac disease)
• Poor level of activity (i.e. confined to bed)
• Already receiving LTOT
• Chest radiograph changes

Question 7

Pt with aeCOPD are at risk of T2RF and would require BiPAP. What are the indications for BiPAP?

Answer 7

• Acute or acute on chronic T2RF
  
  • pH < 7.35
  • PCO2 > 6
  • Increased RR despite optimisation of oxygen therapy
• Cardiogenic pulmonary oedema
• Type 1 respiratory failure and clinically tiring
• Weaning from mechanical ventilation

Question 8

What are the two settings for BiPAP and what would a normal setting be like?

Answer 8

• IPAP: Inspiratory PAP (10-15cmH2O)
• EPAP: Expiratory PAP (4-5cm H2O)

Normal setting: 12/5