COPD Flashcards

Question

What are the surgical options?

Answer 1

o Bullectomy if single large bulla present on CT scan | o Lung transplant if remain breathless despite maximal medical therapy

Answer 2

o For people with end-stage COPD unresponsive to other medical therapy o Opioids should be used as pain relief o Use benzodiazepines, tricyclic antidepressants, major tranquillisers and oxygen to treat breathlessness

Answer 3

e.g. salbutamol, turbutaline – as needed, mild COPD

Answer 4

e.g. ipratropium – as needed

Answer 5

e.g. salmeterol, formoterol – more severe COPD, maintenance therapy

Answer 6

e.g. tiotropium – equally as effective as LABA

Answer 7

– if LABA/LAMA insufficient in severe COPD

Answer 8

acute exacerbations and sometimes long-term

Answer 9

to decrease acute exacerbations in moderate to severe COPD

Answer 10

use not encouraged; used only when corticosteroids and other medication have not helped

Answer 11

e.g. carbocisteine – chronic productive cough | Oral

Answer 12

o SaO2 aim 88-92% o ABGs required to monitor changes to PaO2 and O2 o If PaO2 rises and PaCO2 drops then continue to give o If pH drops and PaCO2 rises then consider non-invasive ventilation (NIV) instead – in hypercapnia patients lose their respiratory drive from low CO2 and so require hypoxia to keep them breathing

Answer 13

o At least 15 hours a day o Given at night if arterial hypoxaemia worsens overnight o Considered for patients with FEV1 <30% predicted, cyanosis, polycythaemia, peripheral oedema, raised JVP, sats <92% on air o Ambulatory oxygen can also be given to those already o LTOT who want to use it outside the house o Hypercapnic patients should be considered for long-term NIV

Answer 14

o Should be considered for patients not eligible for LTOT but who remain breathless after minimal exertion

Answer 15

Antimuscuarinic eg ipratropium or B2 agonist inhaled PRN

Answer 16

Regular anticholinergic eg ipratropium or tiotropium or long acting B 2 agonist eg salmetrol + inhaled corticosteroid eg beclomethasone esp if FEV1 <50% and >2 exacerbations/yr eg seretide. May consider oral theophylline

Answer 17

Long acting B2 agonist + inhaled steroid + anticholinergic Refer to specialist Consider steroid trial or home nebs

Answer 18

Assess need for long term O2 therapy UK DoH guidelines suggest LTOT for: 1.) Clinically stable non smokers with PaO2 <7.3kPa despite max Rx 2.) If PaO2 7.3-8.0 AND pul HTN (eg RHV; loud S2) + cor pulmonale 3.) Terminally ill patients Treat oedema with diuretics

Answer 19

Recurrent pneumothoraces Isolated bullous disease Lung vol reducing surgery (selected pts)

Answer 20

Increasing cough, breathlessness, wheeze. Decr exercise capacity Look for cause eg infection, pneumothorax Controlled O2 therapy (start 24-48%; vary according to ABG. Aim for PaO2 >8.0kPa with prise in PaCO2 <1.5kPa Nebulised bronchodilators – salbutamol 5mg/4hr and ipratropium 500mcg/6hr Steroids – IV hydrocortisone (200mg) and oral prednisolone 30-40mg for 7-14d Antibiotics – if evidence of infection – amoxicillin 500mg/8hr PO or clarithromycin or doxycycline Physio to aid sputum expectoration If no response – repeat nebs and consider IV aminophylline If still no response, consider NIPPV if RR >30 or pH <7.35 Consider intubation and ventilation if pH <7.26 and PaCO2 is rising Consider a resp stimulant drug eg doxapram 1.5-4mg/min IV. SE: agitation, confusion, tachycardia, nausea. In pt who not suitable for mechanical ventilation. Short term measure and rarely sued now NIPPV available.

Answer 21

Common | White/clear/grey sputum

Answer 22

Asthma – does not usually coincide with COPD; no sputum; presents earlier; reversible airway obstruction

Answer 23

Bronchiectasis – purulent sputum; presents earlier; absence of smoking Hx

Answer 24

Congestive heart failure – no cough;

Answer 25

Pneumonia - acute; consolidation on CXR

Answer 26

Five-year survival from diagnosis is 78% in men and 72% in women with clinically mild disease (defined as not requiring continuous drug therapy), but falls to 30% in men and 24% in women with severe disease defined as requiring oxygen or nebulised therapy.

Answer 27

* Acute exacerbations/infections * Respiratory failure * Secondary polycythaemia – hypoxia stimulates erythropoietin increasing number of red blood cells * Cor pulmonale – hypoxia leads to vasoconstriction of lulmonary vessels in order to improve ventilation-perfusion; leads to right-heart strain resulting in right-sided hypertrophy * Pneumothorax – bullae; thin, brittle alveolar walls; prone to rupture