COPD DIAGNOSIS AND TREATMENT Flashcards
COPD diagnosis
Spirometry - measure FEV1/FVC ratio. If <0.7, give salbutamol, still unchanged = COPD
Persistent and progressive SOB, often associated with cough and sputum production
Assess severity
how can the severity of COPD be assessed?
GOLD = based on FEV1
mMRC, CAT, CCQ = symptoms based
the higher the value the more severe
Management of COPD
SAMA / SABA
without asthma features: Add LABA then LAMA
without asthma features: Add LABA then ICS
If hospitalized / uncontrolled Add either ICS or LAMA - whichever missing + antibiotics if needed
In COPD management, what must be considered when stepping up from SAMA to 2nd line therapy?
If LAMA is initiated, SAMA must be stopped due to risk of CVD side effects eg. arrythmias, palpitations (as well as muscarinic dife effects). Switch to SABA if this is the case.
Why must ICS be used with caution in people with COPD (hence why mainly initiated if COPD patients have asthmatic symptoms)?
ICS, especially fluticasone has increased risk of pneumonia
How can you tell if COPD patient has asthmatic symptoms?
Likely if they have a previous diagnosis of asthma, increases eosinophil count, big variation in FEV1 overtime (at least 400ml and peak expiratory flow (at least 20%)
signs of COPD exacerbation?
SaO2 < 90%
Breathlessness
increased heart rate
increased respiratory rate
increased temp
possible loss of consiouc ness, confusion
- the worse, the more likely hospital administration is required
5 main fundamental care in COPD
- help / offer stop smoking
- pneumococcal and flu vaccines
- pulmonary rehabilitation if needed
- personalized care plan
- optimize treatment for comorbidities
When to step up treatment in COPD?
Person has day-to-day symptoms
that adversely impact quality of life,
or has 1 severe or 2 moderate
exacerbations within a year
Management of COPD exacerbation
- increase dose of SABA - inhaler or nebulizer (which back to inhaler when stable
- Oral steroids 30mg prednisolone for 5 days
- Antibiotics if necessary
- IV theophylline if inadequate response to inhaler
- doxapram if non-invasive ventilation unavailable
- monitor O2 therapy - keep at 88-92%
why must O2 be between 88-92% (lower than asthma patients)
due to risk of hypercapnic respiratory failure
5 different oxygen therapies: Chronic COPD management with oxygen
High conc: uncomplicated conditions eg. pneumonia and pulmonary fibrosis
Low conc: patients at high risk of hypercapnia respiratory failure eg. COPD, advanced cystic fibrosis, drug included respiratory depression
Long-term therapy (LTOT): patients with advanced COPD
Short-bursts: PRN use if symptoms not relieved by inhaler
Ambulatory: patient with LTOT but need to move around
Antibiotic therapy in COPD exacerbation
- Amox 500mg - 1g TDS / clarith 500mg BD / doxy 200mg 1st day then 100mg daily (can increase to 200mg if serious) for 5 days
- Co-amoxiclav / levofloxacin / co-trimoxazole
