COPD

Question 1

acute exacerbation of COPD

Answer 1

1) 24% oxygen initially - while monitoring RR, consciousness, sats, ABG. give in increasing amts, aiming for pao2 > 8
2) salbutamol + ipratropium air-driven nebs (can put O2 on prongs during)
3) steroids - IV severe, oral less severe
4) repeat nebs
5) ?IV aminophylline if not improving + not on oral theophyllines

?ventilation if acidosis/rising CO2
IV fluids + abx if severe

Question 2

infective exacerbation of COPD - management (non-acute)

Answer 2

1) increase frequency bronchodilator use and consider giving via a nebuliser
2) prednisolone 30 mg daily for 7-14 days
3) oral abx if sputum is purulent or clinical signs of pneumonia - amoxicillin or tetracycline or clarithromycin

Question 3

commonest pathogens of infective exacerbations of COPD

Answer 3

haemophilus influenzae (most common cause)
streptococcus pneumoniae
moraxella catarrhalis

respiratory viruses - 30% (human rhinovirus commonest)

Question 4

what is ipratropium? diff between ipratropium + tiotropium? what drug type are they?

Answer 4

muscarinic ANtagonists

blocks muscarinic Ach receptors -> relaxes bronchial smooth muscle

tiotropium - long-acting (T for Time) (LAMA)
ipratropium - short acting (SAMA)

Question 5

COPD - investigations

Answer 5

post-bronchodilator spirometry to demonstrate obstruction - FEV1/FVC < 70%

CXR - hyperinflation, bullae, exclude lung ca

FBC - exclude 2° polycythaemia

BMI

Question 6

COPD - severity

Answer 6

based on FEV1% of predicted

1, mild - >80%
2, mod - 50-80%
3, sev - 30-50%
4, v sev - <30%

Question 7

COPD - management

Answer 7

stop smoking
annual flu + one pneumococcal
bronchodilators

Question 8

COPD - bronchodilator

Answer 8

1° - SABA or SAMA (ipra)

2° - depends on FEV1:

> 50% - LABA (salmeterol) or LAMA (tio)

<50% - LABA/ICS combo or LAMA

3°:
if on LABA - switch to LABA/ICS combo

if not - LAMA + LABA/ICS combo

4° - theophylline - reduce dose w some abx

Question 9

cor pulmonale - management

Answer 9

loop diuretic
?LTOT

ACEis, ccbs + alpha blockers not recommended

Question 10

COPD - LTOT criteria

Answer 10

15h/d oxygen

pO2 < 7.3 on 2 occ 3wk apart

or, pO2 7.3-8 and:
peripheral oedema
pulmonary HTN
2° polycythaemia
nocturnal hypoxaemia

Question 11

what is polycythaemia?

Answer 11

raised hematocrit (% of RBC in blood)

due to an increase in RBC or decrease in the vol of plasma