COPD Flashcards
Criteria for diagnosis of COPD?
Age >35
Presence of risk factors (smoking, age, genetics, occupational exposure)
Typical symptoms - SoB, chronic cough, wheeze, ^sputum, ^chest infections)
Investigations required to make COPD diagnosis
Post-bronchodilator spirometry - FEV1/FVC <0.7
CXR exclusion
FBC - anaemia, polycythaemia
BMI - obesity, cachexia
What are the grades on the MRC dyspnoea scale?
Grade 1 - breathless on strenuous exertion
2 - breathless hurrying/uphill
3 - can’t keep up with peers on level ground
4 - SoB after walking 100m
5 - SoB when dressing / housebound
Stages of COPD according to FEV1
1) Mild - FEV1 >80%
2) Moderate - FEV1 50-79%
3) Severe - FEV1 30-49%
4) Very severe - FEV1 <30%
What health promotion advice is offered after diagnosis of COPD?
Smoking cessation advice
Depression screen
Offer pneumococcal/flu vaccination
mucolytics if chronic, productive cough
When do you refer to pulmonary rehab?
After recent exacerbation
If MRC grade 3 or above
1st line therapy in COPD?
SABA or SAMA
SABA - Salbutamol, 100-200mcg inhaler, 2.5-5mg Neb
SAMA - Ipratropium - 40mcg inhaler, 250-500mcg Neb
Escalation of Inhaler therapy in COPD?
Depends on likelihood of steroid responsiveness AND whether there are asthma features
Inhalers if symptoms of asthma/steroid responsiveness
LABA + ICS
Salmeterol (50mcg BD) , formoterol, indacaterol
Beclomethasone (50/100 mcg INH), fluticasone, budesonide
Inhalers if NO symptoms of asthma / steroid responsiveness
LABA + LABA
Salmeterol, formoterol, indacaterol
Tiotropium, glycopyrronium bromide
Indications for oxygen therapy?
If FEV1 <30%
Sats <92%
Cyanosis, polycythaemia
Management of acute exacerbation of COPD
Assess need for admission - acute onset, confusion, cyanosis
Bloods/CXR/Sputum culture - NOT routinely required
Oral Steroids - Prednisolone 30mg, 7-14 days
Oral Abx - 5 day course
Oral Abx used in infective exacerbation of COPD?
Amoxicillin - 500mg TDS
Doxycycline - 200mg first day, 100mg OD
Clarithromycin - 500mg BD
Rescue therapies for home management of exacerbation of COPD
Start steroids if SoB interferes with ADL
Start Abx if sputum changes colour or increases in volume/thickness
Advise patient to book review appointment, call for help if deteriorating on treatment
