COPD

Question 1

What is the non-pharm management of COPD that should be offered to all patients?

Answer 1

Pulmonary rehab

Question 2

What methods can be used to encourage smoking cessation?

Answer 2

Nicotine replacement therapy- increases chances of quitting. Dose relates to amount they smoke.

Varenicline- nicotinic receptor partial agonist. Reduces cravings and withdrawal. Start taking 2 weeks before quitting. Ass with depressed mood and suicide

Question 3

What is the management of mild- moderate COPD?

Answer 3

SABAs and short acting anti muscarinic antagonist (ipatroprium) PRN

Question 4

How does ipratropium work?

Answer 4

Blocks mACh receptors in SM –> inhibits bronchoconstriction and mucous production.

Short term relief

Question 5

What preparation of ipratroprium are available?

Answer 5

MDI or neb

Question 6

How long does ipratropium’s effects last?

Answer 6

3-6 hours

Question 7

What are the adverse effects of ipratropium?

Answer 7

Dry mouth
Constipation
Urinary retention 
Mydriasis
Angle-closure
Glaucoma
Blurred vision
Cough
Headache

Question 8

What is the management of moderate-severe COPD with FEV1 >50% predicted?

Answer 8

Long acting anti-muscarinic or LABA

LABA with steroid inhaler can be used in those remaining symptomatic

Question 9

What is the management of moderate-severe COPD with FEV1 less than 50% predicted?

Answer 9

Either long acting anti-muscarinic or LABA with steroid combo inhaler

Question 10

What is the management of patients with COPD who remain breathless?

Answer 10

Triple therapy- LABA and steroid combo inhaler plus long acting anti-muscarinic bronchodilator

Question 11

What are examples of LAMAs used in COPD?

Answer 11

Tiotropium most common. Not useful in acute exacerbations

Question 12

What are the SEs of LAMAs?

Answer 12

Similar to ipratropium

Question 13

What should not be prescribed with tiotropium?

Answer 13

Ipatropium

Question 14

What mucolytics are prescribed for COPD?

Answer 14

Carbocisteine

Reduces sputum viscosity. Trial for 4 weeks to check response

Question 15

What PDE4 inhibitors are prescribed in COPD?

Answer 15

Roflumilast. Adjunct to bronchodilators. Used in severe disease with frequent exacerbations

Question 16

What vaccinations should patients with COPD have?

Answer 16

Flu- annual

Pneumococcus (5-10 years)

Question 17

What is LTOT?

Answer 17

Long term oxygen therapy.

At least 15 hours a day

Question 18

Who is eligible for LTOT?

Answer 18

PaO2 less than 7.3kPa when breathing air and clinically stable

PaO2 7.3-8kPa in the presence of secondary polycythaemia, nocturnal hyperaemia, peripheral oedema or evidence of pulmonary HTN.

Severe chronic asthma with PaO2 less than 7.3 kPa or persistent disabling breathlessness

Question 19

What must all patients on LTOT have?

Answer 19

Oxygen card

Question 20

How is suitability for LTOT determined?

Answer 20

2 ABGs 4 weeks apart in a patient with no recent exacerbations

Question 21

How do you mx COPD acute exacerbations?

Answer 21

Nebulised bronchodilators- normally 24-48 hours

Corticosteroids0 short course 30mg pred 7-14 days. IV if very severe

Abx- if signs infection. Typically doxy or clari

Question 22

How do you mx severe COPD acute exacerbations?

Answer 22

AMinophylline (theophylline) if response to nebulised bronchodilators very poor

Consider NIV/BiPAP if severe T2 respiratory failure