COPD

Question 1

COPD imp points

Answer 1

progressive and not reversible unlike asthma

persistent respiratory symptoms - whereas asthma - have attacks and moments where you need reliever

airflow limitation due to bronchiolitis and emphysema

symptoms - dyspnoea, wheezing, chronic cough, sputum production

main risk factor - SMOKING

Question 2

drug treatment

Answer 2

step 1 - SABA or SAMA
- continue SABA throughout all stages

step 2 - asthmatic - LABA + ICS

step 2 non-asthmatic - LABA + LAMA

step 3 - if severe exacerbation or 2+ moderate ones in 1 year - LABA + LAMA + ICS

step 4 - can add theophylline, mucolytcis, oxygen therapy

if non asthmatic patients feel no change after 3 months with triple therapy - can revert back to LABA + LAMA

offer pneumococcal or influenza vaccine

azithromycin - as prophylactic 3x a week

Question 3

COPD exacerbation imp points

Answer 3

if patients had exacerbation in last year - rescue pack
- corticosteroid + antibiotic
- pred, amoxicillin or doxy or clarithromycin
- avoid clari if taking prophylactic azithromycin as both macrolides

non drug:
- positive expiratory pressure - helps sputum clearance

Question 4

drug treatment in COPD exacerbation

Answer 4

SABA/SAMA - withhold lama if SAMA given

hospital - short course of pred given

community - short course of pred only if significant breathlessness

pred 30mg OD 5 days

if inadequate response to nebulised bronchodilator - add aminophylline

oxygen