COPD Lecture

Question 1

what are the three hallmarks of a COPD exacerbation?

Answer 1

increase cough
increased sputum
worsening dyspnea

Question 2

what are our four options for giving O2 to our patient with a COPD exacerbation?

Answer 2

1) nasal cannula w/ pendant: up to 6 L
2) vapotherm (high flow nasal O2 + positive pressure)
3) positive pressure vent system (BIPAP/CPAP)
4) intubation/mehanical ventilation

Question 3

we have decided a nasal cannula won’t suffice for our patient’s COPD exacerbation. what must we do before moving towards the other 3 options?

Answer 3

get pulmonoloy consult

Question 4

what are the two inhalants we use during a COPD exacerbation?

Answer 4

1) beta adrenergic agonist–albuterol nebulizer q2 hours
2) anticholinergic agent – ipratropium (duoneb) q4-6 hours or tiotroprium (spiriva) once daily

no benefit to using duoneb and spiriva together; choose one or the other

Question 5

during an acute COPD exacerbation, what form of steroids should we give? when can we switch to the other form?

Answer 5

initiate IV methylprednisolone

PO prednisone after 2-3 days, tapered over 2 weeks

Question 6

what are the 3 criteria for determining whether or not you should prescribe your COPD patient ABX?

Answer 6

increased dyspnea, increased sputum volume, increase sputum purulence

need at least 2 of 3

Question 7

what ABX do we use for uncomplicated COPD with no risk factors?

Answer 7

macrolide OR cephalosporin OR doxycycline OR bactrim

Question 8

what ABX do we use for complicated COPD with 1+ risk factor?

Answer 8

fluroquinolone OR augmentin

Question 9

what are considered risk factors for severe COPD exacerbation? (4)

Answer 9

over 65 yo
FEV1 less than 50 percent predicted
3+ exacerbations.year
cardiac disease

Question 10

average length of stay for COPD exacerbation?

Answer 10

5 days

Question 11

when should you begin to wean patients O2 and encourage patient to ambulate in their exacerbation recovery?

Answer 11

2-3 days (midway)

Question 12

what should you be sure to do the day before discharge in terms of patient’s medications for their exacerbation?

Answer 12

all IV meds should be converted to PO

Question 13

when should you perform a formal overnight O2 desaturation study and hallways ambulatory study in your patient’s recovery?

Answer 13

day before discharge

Question 14

who doesn’t need a formal overnight O2 desaturation or ambulatory study?

Answer 14

patients already qualified and receiving chronic home O2

Question 15

should you continue inhalants throughout patients entire stay?

Answer 15

yes