COPD - Management

Question 1

What is COPD?

Airflow ________
_________ reversible

Answer 1

obstruction

not fully

Question 2

Symptoms of COPD.

Answer 2

Breathlessness

Recurrent cough and chest infection

Question 3

COPD is not a respiratory disease alone.

It also can incur…

4 points

Answer 3

Loss of muscle mass
CVS disease
Weight loss
Depression, anxiety etc.

Question 4

When treating a patient with COPD, what exactly are the aims?

8 points

Answer 4

• Improve exercise tolerance
• Prevent exacerbations
• Improve nutrition/weight loss
• Complications (e.g. cor pulmonale, respiratory failure)
• Anxiety/depression
• Co-morbidities
• Dysfunctional breathing
• Palliative care

Question 5

What are some non pharmacological methods of managing COPD?

5 points

Answer 5

• Smoking Cessation
• Vaccinations
– Annual Flu vaccine
– Pneumococcal vaccine

• Pulmonary Rehabilitation
• Nutritional assessment
• Psychological support

Question 6

What does pulmonary rehabilitation involve?

4 points

Answer 6

• Exercise prescription
• Education
• Nutritional support
• Psychological support and therapy

Question 7

What are the benefits to pharmacological management of COPD?

3 points

Answer 7

– Relieve symptoms
– Prevent exacerbations
– Improve quality of life

Question 8

What are the three broad categories of inhaled therapies for COPD?

Answer 8

• Short acting Bronchodilators
• Long acting bronchodilators
• High dose inhaled corticosteroids (ICS) and LABA

Question 9

What are examples of short acting bronchodilators?

2 points

Answer 9

SABA, short acting B2 agonist (salbutamol)

SAMA, short acting muscarinic antagonist (ipratropium)

Question 10

What is an example of a short acting B2 agonist (SABA)?

Answer 10

Salbutamol

Question 11

What is an example of a short acting muscarinic antagonist (SAMA)?

Answer 11

Ipratropium

Question 12

What are examples of long acting bronchodilators?

2 points

Answer 12

LAMA, long acting muscarinic antagonist (umeclidinium and tiotropium)

LABA, long acting B2 agonist (salmeterol)

Question 13

What are examples of long acting muscarinic antagonists?

Answer 13

Umeclidinium and tiotropium

Question 14

What are examples of long acting B2 agonists (LABA)?

Answer 14

Salmeterol

Question 15

What are examples of high dose inhaled corticosteroids (ICS) and LABA?

2 points

Answer 15

Relvar (fluticasone/vilanterol)

Fostair MDI

Question 16

When can long term oxygen be used for COPD?

Answer 16

PaO2 < 7.2kPa

or PaCO2 7.3-8kPa if polycythaemia, nocturnal hypoxia, peripheral oedema or pulmonary hypertension)

Question 17

What symptoms would warrent using long term oxygen?

Answer 17

Polycythaemia
Nocturnal hypoxia
Peripheral oedema
Pulmonary hypertension

Question 18

What is polycythaemia?

Answer 18

Abnormally increased concentration of haemoglobin in the blood.

Question 19

What is the progression of clinical presentation of COPD?

4 points

Answer 19

At risk
Symptomatic
Exacerbations
Respiratory failure

Question 20

What happens during COPD exacerbations?

6 points

Answer 20

Increasing breathlessness
Cough
Sputum volume
Sputum purulence
Wheeze
Chest tightness

Question 21

What does the management of acute exacerbations of chronic obstructive pulmonary disease involve in PRIMARY CARE?

Answer 21

• Short acting bronchodilators
• Steroids
• Antibiotics
• Consider hospital admission if unwell

Question 22

What short acting bronchodilators are used during exacerbations of COPD in PRIMARY CARE?

Answer 22

Salbutamol and/or ipratropium

Question 23

What steroids are used during exacerbations of COPD?

Answer 23

Prednisolone 40 mg per day for 5-7 days

Question 24

What should occur during exacerbations of COPD for you to consider hospital admission?

Answer 24

– Tachypneoa
– Low Oxygen saturation (< 90-92%)
– Hypotension etc

Question 25

What investigations could be done if a patient with AECOPD is admitted into hospital?

Answer 25

Full blood count
Biochemistry and glucose
Theophylline concentration
Arterial blood gas
Electrocardiograph
Chest X-ray
Blood cultures in febile patients
Sputum microscopy, culture and sensitivity

Question 26

What is involved in AECOPD ward based management?

Answer 26

• Oxygen target saturation 88-92%
• Nebulised bronchodilators
• Corticosteroids
• Antibiotics (oral vs IV)
• Assess for evidence of repiratory failure

Question 27

What is oxygen saturation target for AECOPD ward management?

Answer 27

88-92%

Question 28

What is used to assess for evidence of respiratory failure?

Answer 28

• Clinical

- Arterial blood gas (ABG)

Question 29

What does acute respiratory failure require?

Answer 29

Non-invasive ventilation (NIV)

Question 30

What is involved in COPD palliative care?

2 points

Answer 30

Management of Breathlessness & Dysfunctional
breathing

Anticipatory Care Plan

Question 31

What methods are used to manage breathlessness and dysfunctional breathing in palliative patients?

3 points

Answer 31

– Pharmacological - Morphine
– Psychological support
– Palliative care referral

Question 32

What does an anticipatory care plan include?

3 points

Answer 32

– Hospital Admission
– Ceiling of Treatment – ward based, HDU,
Ventilation
– DNR