COPD

Question 1

When taking a history what sort of questions should you ask to differentiate COPD from other conditions?

Answer 1

Ask red flags to make sure the SOB is not malignancy (weight loss, fatigue)
Ask about occupation
Ask about chest pain
orthopnoea
PND
Ankle swelling

Question 2

How do you differentiate asthma from COPD?

Answer 2

Smoker COPD
Symptoms under 35 asthma
Chronic productive cough COPD
Nighttime breathlessness/waking Asthma
Diurnal/day to day variability Asthma

Question 3

What specific tests can you do to exclude asthma as a dianosis?

Answer 3

Reveribility testing of FEV1 response to bronchodilator <400ml increase
Peak flow <20% diurnal variation
Steroid trial <400ml improvement with 2 week trial
Exhaled NO negative

Question 4

What is the management steps of COPD?

Answer 4

First line SABA (salbutamol) or SAMA (ipratropiu bromide)
Second line add LABA (salmeterol) or LAMA
Then add a corticosteroid
Then add the other long acting agent LABA or LAMA

Question 5

What are the indications for non invasive ventilation?

Answer 5

COPD exacerbation with acidosis
Type 2 resp failure secondary to chest wall deformity or neuromusculer
pulmonary oedema not responding to CPAP

Question 6

How do you manage an acute exacerbation of COPD?

Answer 6

• steroids - pred of IV hydrocortisone
• Nebulised bronchodilators - salbutamol (SABA) and ipratropium bromide (SAMA)
• Antibiotics if evidence of infection

Question 7

What is the difference between CPAP and Bilevel ventilation?

Answer 7

CPAP is continous to keep airways open
Bipap adjusts to lower positive pressure when breathing out and increases when breathing it, this assits breathing and can trigger breaths if they are not brething adequately

Question 8

What are the absolute contraindications to noninvasive ventilation?

Answer 8

Severe facial deformity
Facial burns
Fixed upper airway obstruction