COPD Flashcards
What is the non-pharm management of COPD that should be offered to all patients?
Pulmonary rehab
What methods can be used to encourage smoking cessation?
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
What is the management of mild- moderate COPD?
SABAs and short acting anti muscarinic antagonist (ipatroprium) PRN
How does ipratropium work?
Blocks mACh receptors in SM –> inhibits bronchoconstriction and mucous production.
Short term relief
What preparation of ipratroprium are available?
MDI or neb
How long does ipratropium’s effects last?
3-6 hours
What are the adverse effects of ipratropium?
Dry mouth Constipation Urinary retention Mydriasis Angle-closure Glaucoma Blurred vision Cough Headache
What is the management of moderate-severe COPD with FEV1 >50% predicted?
Long acting anti-muscarinic or LABA
LABA with steroid inhaler can be used in those remaining symptomatic
What is the management of moderate-severe COPD with FEV1 less than 50% predicted?
Either long acting anti-muscarinic or LABA with steroid combo inhaler
What is the management of patients with COPD who remain breathless?
Triple therapy- LABA and steroid combo inhaler plus long acting anti-muscarinic bronchodilator
What are examples of LAMAs used in COPD?
Tiotropium most common. Not useful in acute exacerbations
What are the SEs of LAMAs?
Similar to ipratropium
What should not be prescribed with tiotropium?
Ipatropium
What mucolytics are prescribed for COPD?
Carbocisteine
Reduces sputum viscosity. Trial for 4 weeks to check response
What PDE4 inhibitors are prescribed in COPD?
Roflumilast. Adjunct to bronchodilators. Used in severe disease with frequent exacerbations
What vaccinations should patients with COPD have?
Flu- annual
Pneumococcus (5-10 years)
What is LTOT?
Long term oxygen therapy.
At least 15 hours a day
Who is eligible for LTOT?
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
What must all patients on LTOT have?
Oxygen card
How is suitability for LTOT determined?
2 ABGs 4 weeks apart in a patient with no recent exacerbations
How do you mx COPD acute exacerbations?
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
How do you mx severe COPD acute exacerbations?
AMinophylline (theophylline) if response to nebulised bronchodilators very poor
Consider NIV/BiPAP if severe T2 respiratory failure
