COPD

Question 0

Treatment of an acute exacerbation of COPD

Answer 0

1 - controlled O2, salbutamol+ipratropium nebs, IV hydrocortisone, CXR to exclude pneumothorax + ABG
2 - Venturi mask O2 therapy –> –> 3 - repeat nebs –> –> 4 - magnesium/aminophylline IV –> 5 - NIV + Doxopram
6 - Mechanical ventilation on ITU

Question 1

Chronic obstructive pulmonary disease (COPD)

Answer 1

A combination of chronic bronchitis and emphysema which causes progressive airway narrowing over time.
This causes a obstructive spirometry (FEV1 < 80%, FEV1/FVC t reversible with salbutamol
Suffers are at increased risk of infection and may retain CO2

Question 2

Causes of acute exacerbations of COPD

Answer 2

Bacterial or viral infection (50%)
Environmental pollutants
Pulmonary embolism
Failing to comply to a treatment plan

Question 3

NIV

Answer 3

Non-invasive ventilation

Consider when pH is 7.25-7.35 and oxygen and medical therapies have failed

Question 4

Doxopram

Answer 4

A respiratory stimulant which works by activating the chemoreceptors in the carotid bodies, which work on the respiratory centres in the brain
Used in patients in respiratory failure

Question 5

“Pink puffers”

Answer 5

Increased alveolar ventilation
Normal PaO2, normal/low PaCO2
Progress to type 1 resp failure

Question 6

“Blue bloaters”

Answer 6

Decreased alveolar ventilation
Low PaO2 and high PaCO2
Reliant in hypoxic drive
May develop cor pulmonale

Question 7

Tests in COPD

Answer 7

FBC (^PVC)
CXR (hyperinflation) 
ECG
ABG
Lung function

Question 8

Treatment of stable COPD

Answer 8

Stop smoking, public health, PRN ipratropium
Mild: long acting antimuscarinic (tiotropium) or b2 agonist
Severe: add steroids
Then: add everything
Treat pulmonary oedema with diuretics

Question 9

Definition of steroid responsive COPD

Answer 9

30mg pred PO/day/2 weeks

FEV1 rises by >15%

Question 10

Antibiotic treatment of acute COPD

Answer 10

Amoxicillin or tetracycline or clarithromycin