COPD Management Flashcards
What are differential diagnoses here?
(breathlessness, wheeze, cough)
asthma
lung cancer
tuberculosis
bronchiectasis
left heart failure
interstitial lung disease
cystic fibrosis
idiopathic cough
What do you do when dealing with differential diagnosis?
take history
CT scans
echo
sputum culture
-remember NTM
What’s the best marker for the likelihood of ICS giving benefit?
Blood eosinophil count
What are the surgical options for COPD?
bullectomy
lung volume reduction surgery
endobronchial valves and coils
lung transplant
What other options are there in secondary care?
lung transplantation
long term O2 therapy
What’s the process when diagnosing COPD?
history - symptoms, risk factors
examination
chest x-ray
spirometry
What are the symptoms of COPD?
breathlessness
cough
sputum
frequent chest infections
wheeze
What are most patients when they get to secondary care for their COPD?
most are elderly, frail, have significant co-morbidities
outcome is poor
What does palliation of breathlessness involve?
not same as hypoxaemia
fan - v useful
anxiolytics
lorazepam - 0.5 mg PRN
oral liquid morphine - 1mg PRN
pulmonary rehabilitation
What’s the definition of exacerbation of COPD?
an acute worsening of respiratory symptoms that results in additional therapy
What are the differential diagnosis of COPD exacerbation?
pneumonia
pneumothorax
pleural effusion
pulmonary embolism
pulmonary oedema
cardiac arrythmias
What’s the investigations of COPD exacerbation differential diagnosis?
history
always
- chest x-ray
- ECG
sometimes
- CTPA
- echo
What’s the exacerbation management?
increase short acting bronchodilators
systemic steroids improves lung function, oxygenation, shorten recovery time
- no more than 5-7 days
antibiotics, if infection, shorten recovery time, decrease risk of early relapse, treatment failure
- therapy 5-7 days
What are the features of hypercapnic respiratory failure?
acute on chronic type 2 respiratory failure
low pO2
v high pCO2
high HCO3
What does the NIV expiratory positive airways pressure do?
lowers work of breathing
overcomes intrinsic PEEP
reduces pCO2
