AECOPD

Question 1

AECOPD: Acute Exacerbation of Chronic Obstructive Pulmonary Disease:

Answer 1

Actue exacerbation of COPD is a sudden worsening of COPD symptoms (dyspnea, quantity and colour of phlegm) that typically lasts for several days. It may be triggered by an infection with bacteria or viruses or by environmental pollutants.
The frequency of AECOPD increases as severity of underlying COPD increases.

Question 2

AECOPD:
Most common bacterial organism:
Most common viral organism:

Answer 2

Bacterial: 
H. Influenza
Strep. Pneumoniae, 
Morax Catarrhalis
Viral: 30%
HSV

Question 3

AECOPD: Symptoms:

Answer 3

Wheeze
Increasing Dyspnea
Sputum 
Struggling to sleep
Oedema 
Cough 
Chest Tightness

Question 4

AECOPD: Signs:

Answer 4

Cyanosis
Confusion
Flapping Tremor
Pyrexia

Question 5

AECOPD: Investigations:

Answer 5

Bloods - FBC, U&ES, Blood Culture
Sputum Culture
Theophylline Concentration
ABGs
ECG

Question 6

AECOPD: Treatments:

Answer 6

Steroids - Corticosteroids, Prednisilone 30mg daily (for 7-14 days)
Antibiotics (only give antibiotics if the exacerbation is due to an infection)
Diuretics (RHF)
Inhalers - increase dose for SABA (Salbutamol, Ipratropium)
NIV (Non-invasive ventilation) - use if persistent respiratory acidosis.
Hopsital Admission - if hypotension, tachypneoa, or low oxygen saturation.
Prior to availability of blood gases, use a 28% Venturi mask at 4 L/min and aim for an oxygen saturation of 88%-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis. Adjust target range to 94-98% if the pCO2 is normal.
*In the 2010 NICE guidelines, there is a recommendation that patients who have frequent exacerbations of COPD should be given a home supply of corticosteroids and antibiotics.