COPD - Management Flashcards
What are the non-pharmacological ways to manage COPD?
smoking cessation, vaccinations, pulmonary rehabilitation, nutritional assessment and psychological support.
What are the benefits of non-pharmacological management methods?
Relieve symptoms, prevent exacerbations and improve the quality of life.
What do short acting inhalers do?
They open up the airways, and cats between 1 to 4 hours. eg. SABA - Short Acting Beta Agonist (Salbutamol) and SAMA - Short acting anti-muscarinic agent(Ipratropium)
What are long acting muscarinic receptors?
LAMA (Long acting anti-muscarinic agents, eg. Umeclidinium, Tioptropium) and LABA (Long acting beta agonist eg. Salmeterol)
What are inhaled corticosteroids used alongside?
They are normally used alongside a LABA, (eg. Relvar
What are the strict criteria for offering a patient long term oxygen?
They must have stopped smoking for at least six months and they must be hypoxic.
What can a patient use of they cant use an inhaler?
Nebuliser
What are the doses and how long does a patient use prednisolone for?
It is 40mg per day for 5-7 days
When are antiobiotics used during COPD treatment?
If there is any evidence of the exacerbation being secondary to a viral infection.
What are the criteria to consider a hospital admission?
- Tachypnea, if they have a low oxygen saturation (<90-92%), hypotension is present.
What ways are COPD patients managed in the ward?
- Their oxygen saturation must be kept between 88-92%, they are given nebulised bronchodilators, corticosteroids, antibiotics (orally or intravenously), and the assess for evidence of respiratory failure.
What ways are patients managed in palliative care?
They are given morphine for anxiety, psychological support, palliative care referral.
They should also have a anticipatory care plan made for them discussing whether they would like to be in hospital or not, and if they are in hospital what kind of treatment would they like to receive, ward based, HDU etc. Also asking them if them when they are well if they would like CPR.
Why do people develop COPD?
Reactive oxygen species Cause tissue damage and deactivate antiproteases (increase in neutrophil elastase) more tissue damage
What are other health affects of COPD?
Loss of muscle mass - TNF interleukin affected - less drive to eat food Exercise ability is very poor Weight Loss Cardiac disease Depression, anxiety etc
How do you diagnose COPD?
Relevant History (Symptoms), Look for clinical signs, Confirmation of diagnosis and assessment of severity, Other relevant tests
What are the examinations for COPD?
No diagnostic tests, May be normal in early stages, Reduced chest expansion, Prolonged expiration/Wheeze, Hyperinflated chest, Respiratory failure
What are the different ways you can witness respiratory failure?
Tachypneoa, Cyanosis, Use of accessory muscles, Pursed lip breathing, Peripheral Oedema
What is the use of spirometry in COPD?
Confirms diagnosis and assesses severity
What are the COPD baseline tests?
Anaemia can present itslef as breathlessness, HIgh blood cell count can be a sign of COPD, Polycthaemic means lots of RBC’s, AIAT is antitrypsin
What are the ways you can manage COPD?
Prevention of disease progression (smoking cessations), Releive breathlessness (inhalers), Prevention of exacerbation (inhalers, vaccines, pulmonary rehabilitation), Management of complications (long term oxygen therapy)
What vaccines can help prevent exacerbation?
Annual flu vaccine, pneumococcal vaccine
What are examples of high dose inhaled corticosteroids?
Relvar (Fluticasone/vilanterol), Fostair MDI
What are symptoms of a COPD exacerbation?
Increasing breathlessness, cough, sputum volume, sputum purulence, wheeze and chest tightness.
What is the effect of AECOPD on alveoli and mucus glands (including goblet cells)?
Alveolar wall destruction and mucus hypersecretion
What does management of AECOPD involve?
Short acting bronchodilators (salbutamol/ipratropium/nebulisers), Steroids (Prednisolone 40mg per day for 5-7 days), Antibiotics (only if there is evidence of infection: Fever, increase in volume/purulence of sputum), Hospital admission if unwell (tachypnea, low oxygen saturation (below 90-92 %)Hypotension.
What are the relevant AECOPD investigations?
Full blood count? Biochemistry of glucose
Theophyline concentration (in patients using theophyline concentration)
Arterial blood gas
Electrocardiograph
Chest X-Ray
Blood cultures in febrile patients
Sputum Microscopy, culture and sensitivity
