COPD Flashcards
What would be the first line treatment for a patient who has low SpO2 in COPD?
Venturi mask 28%
What SpO2 do you aim to achieve in someone with COPD?
88-92%
If someone with COPD has type 2 respiratory failure, and is on oxygen, what would you do next?
Know that range is 88-92%
Start NIV if acidotic
If not acidotic repeat ABG in 30-60 minutes
How is the severity of COPD assessed?
FEV1 (% predicted)
What is used to diagnose obstructive lung disease?
FEV1/FVC <0.7
What is FVC (% predicted) used to diagnose?
The severity and diagnosis of restrictive lung diseases
What are the features of an acute exacerbation of COPD?
Increase in dyspnoea, cough or wheeze
Increase in sputum suggestive of infective cause
Hypoxia and in some cases acute confusion
What are the most common bacterial causes of infective exacerbations of COPD?
What is the most common viral cause?
Haemophilus influenzae
Streptococcus pneumoniae
Moraxella cattarrhalis
Rhinovirus
What is the recommended treatment of acute exacerbation of COPD?
Increase freq. bronchodilator, consider nebuliser
Prednisolone 30 mg daily for 7-14 days
Give oral abx: amoxicillin or clarithromycin or doxycycline if sputum is purulent or there are clinical signs of pneumonia.
What antibiotics are recommended first line for infective exacerbations of COPD?
Amoxicillin
Clarithromycin
Doxycycline
What are the causes of COPD?
Smoking (Vast majority)
Alpha-1-antitrypsin deficiency
Cadmium (smelting) Coal Cotton Cement Grain
What two older terms are encompassed in COPD?
Chronic Bronchitis
Emphysema
What are the features of COPD?
Cough: often productive
Dyspnoea
Wheeze
Right-sided heart failure (may develop in severe cases, resulting in peripheral oedema)
What are the investigations of COPD?
Post-bronchodilator spirometry: Obstructive pattern: FEV1/FVC < 70%
Chest x-ray
FBC: exclude secondary polycythaemia
BMI
What changes may be seen on a chest x-ray in COPD?
Hyperinflation
Bullae: can mimic pneumothorax
Flat hemidiaphragm
How is the severity of COPD categorised?
Using the FEV1
How is stage 1 (mild) COPD defined?
FEV1 >80% predicted
Post-bronchodilator FEV1/FVC < 0.7 (same in all)
- symptoms should be present to diagnose COPD in these patients
How is stage 2 (moderate) COPD defined?
FEV1 50-79% predicted
Post-bronchodilator FEV1/FVC < 0.7 (same in all)
How is stage 3 (severe) COPD defined?
FEV1 30-49% predicted
Post-bronchodilator FEV1/FVC < 0.7 (same in all)
How is stage 4 (very severe) COPD defined?
FEV1 <30% predicted
Post-bronchodilator FEV1/FVC < 0.7 (same in all)
What patients should be considered for long-term oxygen therapy?
Very severe or severe disease Cyanosis Polycythaemia Peripheral oedema Raised JVP Oxygen sats < or = 92% on room air
How is assessment for long-term oxygen therapy done?
By measuring arterial blood eases on 2 occasions, 3 weeks apart in patients with stable COPD on optimal management
Which patients should long-term oxygen therapy be offered to?
pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
Who should long-term oxygen therapy not be offered to?
People who continue to smoke despite being offered smoking cessation advice and treatment.
What should be considered in the risk assessment for long-term oxygen therapy?
RIsk of falls from tripping over equipment
Risk of burns and fires
What are general management recommendations of COPD?
Smoking cessation
Annual influenza vaccine
One-off pneumococcal vaccine
Pulmonary rehabilitation (if view themselves as functionally disabled)
What drugs are used for the management of stable COPD?
SABA or SAMA Bronchodilator therapy
Then, if the patient ‘has asthmatic features/features suggesting steroid responsiveness’:
LABA + ICS
then: LAMA + LABA + ICS
If no asthmatic features/features suggesting steroid responsiveness:
LABA + LAMA
Theophylline (specialist)
Mucolytics - in patients with a chronic productive cough
What features would be suggestive of ‘has asthmatic features/features suggesting steroid responsive’?
Any previous, secure diagnosis of asthma or of atopy
A higher blood eosinophil count
Substantial variation in FEV1 over time (at least 400 ml)
Substantial diurnal variation in peak expiratory flow (at least 20%)
What oral prophylactic antibiotic therapy is recommended?
Azithromycin prophylaxis
no smoking and otherwise optimised treatments
What investigations are required before giving prophylactic antibiotics?
CT thorax - to exclude bronchiectasis
Sputum culture - to exclude atypical infections and TB
LFTs and ECG to exclude QT prolongation
What are the features of cor pulmonale which can be seen in COPD?
Peripheral oedema
Raised JVP
Systolic parasternal heave
Loud P2
How should cor pulmonale resulting from COPD be treated?
Loop diuretic for oedema
Consider long-term O2
What factors improve survival in patients with stable COPD?
Smoking cessation
Long term O2 therapy - if fit criteria
Lung volume reduction surgery - if fit criteria
