COPD Flashcards
what is COPD
long-term, progressive condition involving airway obstruction, chronic bronchitis and emphysema
presentation of COPD
cough (productive, dyspnoea, wheeze, right sided heart failure
investigation in COPD
post-bronchodilator spirometry (FEV1/FVC ratio <70%)
Chest x-ray: hyperinflation, bullae, flat hemidiaphragm
FBC
general management of COPD
smoking cessation
annual influenza vaccine
one-off pneumococcal vaccine
pulmonary rehab
first line bronchodilator management in COPD
SABA or SAMA
how to determine if the patient has asthmatic features/features suggesting steroid responsiveness
any previous diagnosis of asthma or atopy
higher blood eosinophil count
substantial variation in FEV1 over time
substantial diurnal variation in peak expiratory flow
second line management of COPD in patients with no asthmatic features/features suggesting steroid responsiveness
add LABA + LAMA
(if patient already taking SAMA switch to SABA)
still no improvement consider trial of adding ICS
exacerbations: consider LABA + LAMA + ICS
second line management for a patient with COPD with asthmatic features or features suggesting steroid responsiveness
add LABA + ICS
-> person still has day-day symptoms or 1 severe or 2 moderate exacerbations -> offer LABA + LAMA + ICS
when to use oral theophylline in COPD
only after trials of short and long-acting bronchodilators or people who cannot use inhaled therapy
dose reduced if macrolide or fluoroquinolone abx are prescribed
when to use oral prophylactic abx therapy in COPD
azithromycin recommended in select patients
- patients should not smoke
- CT thorax (to exclude bronchiectasis) and sputum culture
- LFTs and ECG to exclude QT prolongation
features of cor pulmonale
peripheral oedema
raised JVP
systolic parasternal heave
loud P2
management of cor pulmonale
loop diuretic for oedema
consider long-term oxygen therapy
ACEi, CCB and alpha blockers not recommended
most common infective causes of COPD exacerbation
haemophilus influenzae (most common)
streptococcus pneumoniae
moraxella catarrhalis
respiratory viruses
management of an acute exacerbation of COPD in patient who does not require admission
increase dose of short-acting bronchodilator
30mg oral prednisolone once daily for 5 days
consider abx (first line choice: amoxicillin, doxycycline, clarithromycin)
send sputum sample
O2 saturation target in patients with COPD
88-92%
94-98% if CO2 is normal on ABG
management of severe exacerbations of COPD that require secondary care
oxygen therapy
nebulise bronchodilator (SABA: salbutamol, SAMA: ipratropium)
steroid therapy (oral prednisolone or sometimes IV hydrocortisone)
IV theophylline
management if COPD patient develops type 2 respiratory failure
non-invasive ventilation
- used for patients with resp acidosis pH 7.25-7.35
bilevel positive airway pressure typically used
when to offer long term oxygen therapy in patients with COPD
pO2 <7.3
or those with a pO2 of 7.3-8 plus
- secondary polycythaemia
- peripheral oedema
- pulmonary hypertension
NICE guidelines for when to give antibiotics with exacerbation of COPD
sputum is purulent or clinical signs of pneumonia
