Complications

Question 1

What is Type I respiratory failure?

Answer 1

PaO2 < 8kPa, normal PaCO2 (<6 kPa)

Question 2

What can cause Type I respiratory failure?

Answer 2

Infection
Oedema
A shunt

Question 3

What is Type II respiratory failure?

Answer 3

PaO2 < 8kPa, PaCO2 >6 kPa

Question 4

What can cause Type II respiratory failure?

Answer 4

Gas trapping
Chest wall deformities
Muscle weakness
Central causes of respiratory depression

Question 5

What are the signs of hypercapnia?

Answer 5

• Dilated pupils
• Bounding pulse
• Hand flap
• Myoclonus
• Confusion
• Drowsiness
• Coma

Question 6

How does COPD cause Type II respiratory failure?

Answer 6

Loss of elastic recoil of the lungs causes gas trapping and reduced excretion of CO2

Question 7

What complications can occur due to COPD?

Answer 7

•	Exacerbations 
•	Pneumonia
•	Pneumothorax
             Alveolar destruction can rupture through pleural surface 
•	RV failure
•	Peripheral neuropathy 
•	Cachexia

Question 8

What are the symptoms of a COPD exacerbation?

Answer 8

• Preceding coryzal (cold) symptoms
• Worsening breathlessness
• Increased cough
• Increased sputum
• Sputum purulence
• Ankle swelling

Question 9

What are the most common infective causes of a COPD exacerbation?

Answer 9

1. Haemophilus influenzas
2. Streptococcus pneumoniae
3. Moraxella catarrhalis
4. Viruses
5. Pseudomonas aeruginosa

Question 10

If hospitalisation is not required for an exacerbation, how would you treat a patient?

Answer 10

o Increase dose or frequency of SABA
o 30 mg prednisolone o.d. for 5 days
o Antibiotics if there is an infection (broad spectrum)

Question 11

If hospital admission is required for an exacerbation, how would you treat a patient?

Answer 11

o Give O2 to raise saO2, not more than 92%
o High dose SABAs, usually nebulised
o High dose corticosteroids (usually prednisolone 40mg/day – 7 days)
o Antibiotics -> broad spectrum
o Physiotherapy -> help clear sputum
o Reassess after 1 hour

Question 12

What would you give for an exacerbation that is not responding to 1st line treatment?

Answer 12

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

Question 13

What would you do with a patient with Type II respiratory failure and respiratory acidosis?

Answer 13

• IV bronchodilator (salbutamol or theophylline)
• Urgent intensive care opinion
• Non-invasive ventilation
• Intubation and assisted ventilation

Question 14

What are the extrapulmonary effects of COPD?

Answer 14

• Weight loss
• Skeletal muscle dysfunction
• CV disease
• Cerebrovascular disease
• Metabolic syndrome
• Osteoporosis
• Depression
• Pitting oedema
• Secondary polycythaemia

Question 15

What are the indications for antibiotics?

Answer 15

• Purulent and increased sputum production
• Raised inflammatory markers
• Temperature >38 degrees Celsius

AND

• SOB
• Fairly severe COPD
• OR consolidation on X-ray

Question 16

What are the indications for NIV?

Answer 16

• Respiratory acidosis (pH <7.35, pCO2 >6.5) despite controlled oxygen therapy and optimum medical treatment
• Moderate to severe breathlessness with accessory muscle use and paradoxical abdominal motion
• RR >25

Question 17

What are the contraindications for NIV?

Answer 17

•	pH >7.25
•	confusion
•	Somnolence, agitation, lack of cooperation
•	High risk of gastric aspiration
•	GCS <8
•	Facial trauma/deformity
o	As mask needs a good seal
•	Recent gastro-oesophageal surgery
•	Untreated pneumothorax