COPD

Question 1

Mild COPD

Answer 1

Fev1 - predicted 60-80%
Breathlessness on moderate exertion
Recurrent chest infections
Little or no daily activities

Question 2

Moderate COPD

Answer 2

Fev1- 40-59%
Increased dyspnoea
Breathless walking on level ground
Increasing limitations on daily activities
Cough and sputum production
Exacerbations requiring SABA and corticosteroids

Question 3

Severe COPD

Answer 3

Fev1 <40%
Dyspnoea on minimal exertion 
Daily activities severely curtailed 
Regular sputum production 
Chronic cough

Question 4

Dominant characteristics of COPD and risk factors

Answer 4

Chronic bronchitis & emphysema
Risk factors: Tobacco smoke, occupational dusts and chemicals
Air pollution, factors that affect lung development during gestation and childhood.
Genetics

Question 5

Cardinal symptoms of COPD

Answer 5

Dyspnoea, chronic cough, sputum production.

Less common symptoms: wheezing, chest tightness

Question 6

Management for a COPD exacerbation

Answer 6

Increased dose of bronchodilators (salbutamol 4-8puffs 3-4/24, titrated to response)
Oral corticosteroids
If Clincal features of infection- amoxicillin or doxycycline
Oxygen therapy- Aim for Sats 88-92%
NIPPV if PaCO2 >45mmhg and pH <7.35
Refer to pulmonary rehabilitation

Question 7

When is NIV effective in COPD

Answer 7

With acute respiratory acidosis- Elevated paCO2 >45mmHg and pH <7.35

Question 8

When should a person with COPD be hospitalised

Answer 8

Marked increase of sx
Exacerbation characterised by increased SOB, cough or sputum production plus..
Inadequate response to appropriate community based management
Inability to walk between rooms when previously mobile
Inability to eat or drink because of SOB
Cannot manage at home even with home care help
Altered mental state

Question 9

Preventing exacerbations is important in COPD - identify PC care prior to leaving hospital with rationales

Answer 9

Vaccinations - decrease risk of infection
Cease smoking- slow lung function decline, improves prognosis and quality of life
Pulmonary rehab- with in 4 weeks of exacerbation; improves sx; improves exercise tolerance; improves quality of life
Encourage self management- action plan, check inhaler technique, support services

Question 10

Antibiotics in treating an exacerbation of COPD

Answer 10

Exacerbation with clinical features of infection (increased volume and change in colour of sputum and or fever) benefit form antibiotic therapy.
Amoxicillin 500mg 8hrly or 1g 12 holy
Or doxycycline 100mg for 5 days

Question 11

When is NIV effective in COPD?

Answer 11

For pts with acute respiratory acidosis indicated by elevated PaCO2 >45mmHg and pH<7.35