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[MB] Respiratory > (C) 8 - COPD > Flashcards

(C) 8 - COPD Flashcards

1
Q

What are the most common infective causes of COPD exacerbations?

A

Bacteria:
* Haemophilus influenzae (most common)
* Streptococcus pneumoniae
* Moraxella catarrhalis

Respiratory viruses:
* Human rhinovirus

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2
Q

What are the key features of an acute exacerbation of COPD?

A
  • Dyspnoea, cough, and wheeze
  • Sputum production
  • Hypoxia and possible acute confusion
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3
Q

What does NICE recommend for managing COPD exacerbations?

A
  • Increase frequency bronchodilator (neb)
  • Prednisolone 30 mg daily for 5 days
  • Antibiotics - if sputum purulent / signs of pneumonia
  • First-line oral antibiotics: amoxicillin, clarithromycin, or doxycycline
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4
Q

What are the admission criteria for COPD exacerbations according to NICE?

A
  1. Severe breathlessness
  2. Acute confusion or impaired consciousness
  3. Cyanosis
  4. Oxygen saturation < 90%
  5. Social reasons (e.g., inability to cope at home)
  6. Significant comorbidity (e.g., cardiac disease)
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5
Q

What is the target oxygen saturation for COPD patients?

A
  • Initial target: 88-92% to avoid hypercapnia
  • Use a** 28% Venturi mask at 4 L/min** before blood gases
  • Adjust target to 94-98% if pCO2 is normal
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6
Q

What are the recommended treatments for severe COPD exacerbations?

A

1. Nebulised bronchodilators:
Beta-adrenergic agonist (e.g., salbutamol)
Muscarinic antagonists (e.g., ipratropium)
.
2. Steroid therapy:
IV hydrocortisone may be considered if needed
.
3. IV theophylline:
For patients not responding to nebulised bronchodilators

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7
Q

When should non-invasive ventilation (NIV) be considered for COPD patients?

A
  • In type 2 respiratory failure
  • Typically for respiratory acidosis (pH 7.25-7.35)
  • For more acidotic patients (pH < 7.25), increased monitoring is required
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8
Q

List causes of COPD

A
  1. Smoking
  2. alpha-1 antitrypsin deficiency
  3. Occupational exposure: cadmium, coal, cotton
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9
Q

What is Chronic Obstructive Pulmonary Disease (COPD)?

A
  • Umbrella term for chronic bronchitis and emphysema
  • Most commonly caused by smoking
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10
Q

What is the variability in severity among COPD patients?

A
  • Mild cases: may only require occasional bronchodilator use
  • Severe cases: may experience frequent hospital admissions due to infective exacerbations
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11
Q

What are the common features of COPD?

A
  • Productive cough
  • Dyspnoea (shortness of breath)
  • Wheezing
  • Right-sided heart failure may develop in severe cases, leading to peripheral oedema
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12
Q

Investigations for suspected COPD

A
  1. Post-bronchodilator spirometry
  2. CXR
  3. FBC
  4. BMI
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13
Q

Findings from Post-bronchodilator spirometry in COPD

A

FEV1/FVC ratio < 70% indicates airflow obstruction

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14
Q

COPD CXR findings

A
  1. Hyperinflation
  2. Bullae
  3. flat hemidiaphragm
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15
Q

COPD FBC finding

A

secondary polycythaemia = complication

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16
Q

How is the severity of COPD categorized?

A
17
Q

What is the minimum duration for long-term oxygen therapy (LTOT) use?

A

use supplementary oxygen for at least 15 hours a day.

18
Q

What criteria indicate a patient should be assessed for LTOT?

A
  1. Very severe airflow obstruction (FEV1 < 30% predicted)
  2. Severe airflow obstruction (FEV1 30-49% predicted, assessment considered)
  3. Cyanosis
  4. Polycythaemia
  5. Peripheral oedema
  6. Raised jugular venous pressure
  7. Oxygen saturation ≤ 92% on room air
19
Q

How is the assessment for LTOT conducted?

A

Measure arterial blood gases on 2 occasions at least 3 weeks apart in stable COPD patients on optimal management.

20
Q

When should LTOT be offered?

A
  • pO2 < 7.3 kPa
  • pO2 7.3 - 8 kPa with one of the following:
    Secondary polycythaemia
    Peripheral oedema
    Pulmonary hypertension
21
Q

What does NICE recommend regarding smoking and LTOT?

A

Do not offer LTOT to individuals who continue to smoke despite receiving cessation advice and treatment, including referral to specialist services.

22
Q

Conservative management of COPD

A
  1. Smoking cessation
  2. Annual influennza vaccine
  3. Pneumococcal vaccine
  4. Pulmonary rehabilitation
23
Q

What is the first-line treatment for bronchodilator therapy in COPD?

A

SABA = salbutamol
SAMA = ipatropium bromide

24
Q

How do you determine if a COPD patient has asthmatic features/steroid responsiveness?

A
  1. Diagnosis of asthma / atopy
  2. Higher blood eosinophil count
  3. Substantial variation in FEV1 (at least 400 ml)
  4. Substantial diurnal variation in peak expiratory flow (at least 20%)
25
Q

What should be done if a COPD patient has no asthmatic features/steroid responsiveness?

A

LABA = salmeterol
&
LAMA = tiotropium

switch SAMA to SABA

26
Q

What is the treatment approach for COPD patients with asthmatic features/steroid responsiveness?

A

LABA & ICS

still breathless/exacerbation = triple therapy = LAMA + LABA + ICS

Switch SAMA to SABA

27
Q

When is oral theophylline recommended in COPD management?

A
  • unresponsive to previous steps
  • cannot use inhaled therapy
28
Q

What are the prerequisites for azithromycin prophylaxis in COPD patients?

A
  • Must not smoke
  • Optimised standard treatments
  • History of frequent exacerbations
  • CT thorax to exclude bronchiectasis
  • Sputum culture to exclude atypical infections and TB
  • LFTs and ECG to exclude QT prolongation
29
Q

What is the recommendation for standby medication in COPD patients?

A

Offer a short course of oral corticosteroids and antibiotics for patients who:

  • Had an exacerbation in the last year
  • Understand how to take the medication and its risks
  • Know when to seek help or request replacements
30
Q

What are the features of cor pulmonale in COPD patients?

A
  • Peripheral oedema
  • Raised jugular venous pressure
  • Systolic parasternal heave
  • Loud P2
31
Q

What are the recommendations for treating cor pulmonale in COPD patients?

A
  • Use loop diuretics for oedema
  • consider long-term oxygen therapy

[MB] Respiratory (2 decks)

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