COPD Flashcards
What does the rescue pack for COPD contain?
Amoxicillin
Corticosteroid like prednisolone
What is given for prophylaxis fo COPD exacerbation?
For exacerbations of 4 or more in a year, azithromycin is given 3 x a week
What is Grade 1 COPD?
Over 80%
What is Grade 2 COPD?
50-79%
What is Grade 3 COPD?
30-49%
What is Grade V COPD?
Less than 30%
Which investigations to perform for COPD?
Spirometry: FEV1/FVC ratio should be less than 0.7
Sputum culture
FBC for polycythaemia fromc chronic hypoxaemia or anaemia of chronic disease
ECG findings correlating with RHF
CXR
What are the CXR findings?
Flattening of diaphragm
Bullae
What is first line for patients who are limited by breathlessness?
SABA or SAMA
What is given for patients with features of asthma and steroid responsiveness?
LABA and ICS
What is third line?
LABA + LAMA + ICS
What can be given additionally if not stabilised with 3rd line therapy and asthma features/steroid responsive?
Oral steroid
Oral theophylline
Oral phosphodiesterase-4 inhibitor like roflumilast
What is given for a COPD patient with significant symptoms but no exacerbation?
LAMA or LABA
-> if symptoms persist, escalate to dual therapy
What is given for patients with 2 exacerbations OR 1 hospitalisation?
LAMA is first line unless asthmatic features then LABA + ICS
What is given for patients with 2 exacerbations OR 1 hospitalisation and LAMA is ineffective?
Dual therapy
What is the surgical managmeent for COPD?
Lung volume reduction
Which patients should be referred for LTOT?
Oxygen saturations <92% in air or cyanosis
FEV1 <30% predicted (consider referring if <49%)
Polycythaemia
Peripheral oedema or raised jugular venous pressure (suggesting cor pulmonale)
What should the ABG values be for LTOT?
PaO2 below 7.3kPa
PaO2 7.3-8kPa with any of secondary polycythaemia, peripheral oedema or pulmonary hypertension
When is non-invasive ventilation given?
I level positive airway pressure for uncompensated Type 2 respiratory failure, where CO2 is more than 6 and PaO2 is less than 8
How to determine between infective exacerbation and infection?
CXR findings will show pacification for infection
There will be an absence of a wheeze
When is non-invasive ventilation used in COPD?
Hypercapnic respiratory failure for respiratory acidosis
When should non-invasive ventilation be avoided?
When patients lose their hypoxia respiratory drive due to overoxygenation
How is overoxygenation of patients in COPD present?
Reduced work of breathing, looking a calmer from CO2 narcosis with hypoxia but oxygen saturation of 93% or higher. Therefore they should be switched onto a lower oxygen mask to achieve a target saturation of 88-92%.
