COPD management Flashcards
what does COPD management aim to treat
improve exercise tolerance prevent exacerbations nutrition/weight loss complications anxiety/depression co-morbidities dysfunctional breathing palliative care
what are non pharmacological managements
smoking cessation vaccinations - annual flu and pneumococcal pulmonary rehabilitation nutritional assessment physiological support
what are the benefits of pharmacological management
relieve symptoms
prevent exacerbations
improve quality of life
what are some inhaled therapies
short acting bronchodilators - SABA (salbutamol)
- SAMA (ipratropium)
long acting bronchodilators - LAMA (long acting anti-muscarinic agents)
- LABA (king acting beta 2 agonist)
high dose inhaled corticosteroids (ICS) and LABA - relvar
- fostair MDI
when would a patient be eligible for long term oxygen (LTOT)
when paO2 <7.4kPa OR paO2 7.3-8kPa if they also have polycythaemia nocturnal hypoxia peripheral hypoxia peripheral oedema pulmonary hypertension
what are copd exacerbations (AECOPD)
increasing breathlessness cough sputum volume sputum purulence wheeze chest tightness m
what treatment is used in primary care management
short acting bronchodilators - nebulisers if cannot use inhalers
steroids - prednisone 40mg a day 5-7 days
antibiotics - most exacerbations are secondary to viral infection
consider hospital admission if unwell - tachypnea
- low o2 sat (<90-92%)
- hypotension
what investigations are done in hospital
full blood count biochem and glucose theophylline concentration arterial blood gas electrocardiograph chest x-ray blood cultures in febrile patients sputum mivroscopy, culture and sensitivity
what are examples of ward based management
oxygen target sat 88-92% nebulised bronchodilators corticosteroids antibiotics assess for evidence of resp failure - clinical abs arterial blood gas
what treatment would be used in palliative care
management of breathlessness and dysfunctional breathing - pharmacological - morphine
psychological support
palliative care referral
anticipatory care plan - hospital admission - ceiling of fragment - DNACPR
