COPD - Management Flashcards
What is COPD?
Airflow ________
_________ reversible
obstruction
not fully
Symptoms of COPD.
Breathlessness
Recurrent cough and chest infection
COPD is not a respiratory disease alone.
It also can incur…
4 points
Loss of muscle mass
CVS disease
Weight loss
Depression, anxiety etc.
When treating a patient with COPD, what exactly are the aims?
8 points
- Improve exercise tolerance
- Prevent exacerbations
- Improve nutrition/weight loss
- Complications (e.g. cor pulmonale, respiratory failure)
- Anxiety/depression
- Co-morbidities
- Dysfunctional breathing
- Palliative care
What are some non pharmacological methods of managing COPD?
5 points
• Smoking Cessation
• Vaccinations
– Annual Flu vaccine
– Pneumococcal vaccine
- Pulmonary Rehabilitation
- Nutritional assessment
- Psychological support
What does pulmonary rehabilitation involve?
4 points
- Exercise prescription
- Education
- Nutritional support
- Psychological support and therapy
What are the benefits to pharmacological management of COPD?
3 points
– Relieve symptoms
– Prevent exacerbations
– Improve quality of life
What are the three broad categories of inhaled therapies for COPD?
- Short acting Bronchodilators
- Long acting bronchodilators
- High dose inhaled corticosteroids (ICS) and LABA
What are examples of short acting bronchodilators?
2 points
SABA, short acting B2 agonist (salbutamol)
SAMA, short acting muscarinic antagonist (ipratropium)
What is an example of a short acting B2 agonist (SABA)?
Salbutamol
What is an example of a short acting muscarinic antagonist (SAMA)?
Ipratropium
What are examples of long acting bronchodilators?
2 points
LAMA, long acting muscarinic antagonist (umeclidinium and tiotropium)
LABA, long acting B2 agonist (salmeterol)
What are examples of long acting muscarinic antagonists?
Umeclidinium and tiotropium
What are examples of long acting B2 agonists (LABA)?
Salmeterol
What are examples of high dose inhaled corticosteroids (ICS) and LABA?
2 points
Relvar (fluticasone/vilanterol)
Fostair MDI
When can long term oxygen be used for COPD?
PaO2 < 7.2kPa
or PaCO2 7.3-8kPa if polycythaemia, nocturnal hypoxia, peripheral oedema or pulmonary hypertension)
What symptoms would warrent using long term oxygen?
Polycythaemia
Nocturnal hypoxia
Peripheral oedema
Pulmonary hypertension
What is polycythaemia?
Abnormally increased concentration of haemoglobin in the blood.
What is the progression of clinical presentation of COPD?
4 points
At risk
Symptomatic
Exacerbations
Respiratory failure
What happens during COPD exacerbations?
6 points
Increasing breathlessness Cough Sputum volume Sputum purulence Wheeze Chest tightness
What does the management of acute exacerbations of chronic obstructive pulmonary disease involve in PRIMARY CARE?
- Short acting bronchodilators
- Steroids
- Antibiotics
- Consider hospital admission if unwell
What short acting bronchodilators are used during exacerbations of COPD in PRIMARY CARE?
Salbutamol and/or ipratropium
What steroids are used during exacerbations of COPD?
Prednisolone 40 mg per day for 5-7 days
What should occur during exacerbations of COPD for you to consider hospital admission?
– Tachypneoa
– Low Oxygen saturation (< 90-92%)
– Hypotension etc
What investigations could be done if a patient with AECOPD is admitted into hospital?
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
What is involved in AECOPD ward based management?
- Oxygen target saturation 88-92%
- Nebulised bronchodilators
- Corticosteroids
- Antibiotics (oral vs IV)
- Assess for evidence of repiratory failure
What is oxygen saturation target for AECOPD ward management?
88-92%
What is used to assess for evidence of respiratory failure?
- Clinical
- Arterial blood gas (ABG)
What does acute respiratory failure require?
Non-invasive ventilation (NIV)
What is involved in COPD palliative care?
2 points
Management of Breathlessness & Dysfunctional
breathing
Anticipatory Care Plan
What methods are used to manage breathlessness and dysfunctional breathing in palliative patients?
3 points
– Pharmacological - Morphine
– Psychological support
– Palliative care referral
What does an anticipatory care plan include?
3 points
– Hospital Admission
– Ceiling of Treatment – ward based, HDU,
Ventilation
– DNR
