COPD Exacerbations****

Question 1

What time of yr are they more common in?

Answer 1

Wintertime

Question 2

List some causes of exacerbations - 4

Answer 2

U/LRTI due to viruses or bacteria
Pollution
Drug changes
Co-morbidities - HF, PE

Question 3

Home Management:

IPAD mneumonic

Answer 3

Increase frequency or double dose of short-acting bronchodilators

Prednisolone PO 1-2 wks

Amoxicillin or Doxycycline PO 5 days

Question 4

Home management:

When should antibiotics be prescribed?

What can be done for those at risk of exacerbations?

Answer 4

If there purulent sputum

Can give them a back-up course of steroids and antibiotics so they can self-manage

Question 5

Hospital management:

Indications for admission?

Answer 5

Severe SOB
SaO2 <90%
Cyanosis 
Generally unwell, reduced activity, altered mental status
Not coping, especially if living alone 
Worsening oedema 
On LTOT

Question 6

Hospital management:

(1) What 2 types of nebulised bronchodilators are administered before investigations are even done?

(2) What investigations are then done?:
- Bedside
- Bloods
- Imaging
- MC+S

Answer 6

SABA - salbutamol + SAMA - ipratropium

Bed - ABG, ECG
Blood - FBC, U+E, CRP
CXR
Sputum culture and blood culture if fever

Question 7

Hospital management:

(3) Oxygen is given after bronchodilators via controlled oxygen therapy.
- What is the concentration of oxygen that is used in a percentage?
- What type of mask is it administered through?
- What are the target SATS?

(4) Steroid:
- What type of steroid is given IV?
- Prednisolone is given PO. How long are they put on this?

(5) What should be started if there is evidence of infection?
(6) What should be started if there is no response to nebulisers and steroids? - A

Answer 7

24-28%

Venturi mask

88-92%
======
Hydrocortisone 
7-14 days 
======
Antibiotics 
====
Aminophylline IV **

Question 8

Hospital management:

(7) If there is still no response, what type of ventilation should be started?
(8) Under what pH is invasive mechanical ventilation needed?

Answer 8

NIV

<7.25

Question 9

Considering the ceiling of care:

Why must the best interests be discussed with the patient?

What are patients with COPD at risk of due to ventilation?

Answer 9

Invasive ventilation may not be appropriate, it can be difficult to wean patients off ventilatory support.

Ventilator-associated pneumonias and pneumothoraces from ruptured bullae

READ 812 - IN CLINICAL MEDICINE BOOK