COPD - Management Flashcards

1
Q

What is COPD?

Airflow ________
_________ reversible

A

obstruction

not fully

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2
Q

Symptoms of COPD.

A

Breathlessness

Recurrent cough and chest infection

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3
Q

COPD is not a respiratory disease alone.

It also can incur…

4 points

A

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

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4
Q

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

8 points

A
  • Improve exercise tolerance
  • Prevent exacerbations
  • Improve nutrition/weight loss
  • Complications (e.g. cor pulmonale, respiratory failure)
  • Anxiety/depression
  • Co-morbidities
  • Dysfunctional breathing
  • Palliative care
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5
Q

What are some non pharmacological methods of managing COPD?

5 points

A

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

  • Pulmonary Rehabilitation
  • Nutritional assessment
  • Psychological support
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6
Q

What does pulmonary rehabilitation involve?

4 points

A
  • Exercise prescription
  • Education
  • Nutritional support
  • Psychological support and therapy
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7
Q

What are the benefits to pharmacological management of COPD?

3 points

A

– Relieve symptoms
– Prevent exacerbations
– Improve quality of life

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8
Q

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

A
  • Short acting Bronchodilators
  • Long acting bronchodilators
  • High dose inhaled corticosteroids (ICS) and LABA
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9
Q

What are examples of short acting bronchodilators?

2 points

A

SABA, short acting B2 agonist (salbutamol)

SAMA, short acting muscarinic antagonist (ipratropium)

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10
Q

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

A

Salbutamol

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11
Q

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

A

Ipratropium

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12
Q

What are examples of long acting bronchodilators?

2 points

A

LAMA, long acting muscarinic antagonist (umeclidinium and tiotropium)

LABA, long acting B2 agonist (salmeterol)

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13
Q

What are examples of long acting muscarinic antagonists?

A

Umeclidinium and tiotropium

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14
Q

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

A

Salmeterol

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15
Q

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

2 points

A

Relvar (fluticasone/vilanterol)

Fostair MDI

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16
Q

When can long term oxygen be used for COPD?

A

PaO2 < 7.2kPa

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

17
Q

What symptoms would warrent using long term oxygen?

A

Polycythaemia
Nocturnal hypoxia
Peripheral oedema
Pulmonary hypertension

18
Q

What is polycythaemia?

A

Abnormally increased concentration of haemoglobin in the blood.

19
Q

What is the progression of clinical presentation of COPD?

4 points

A

At risk
Symptomatic
Exacerbations
Respiratory failure

20
Q

What happens during COPD exacerbations?

6 points

A
Increasing breathlessness
Cough
Sputum volume
Sputum purulence
Wheeze
Chest tightness
21
Q

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

A
  • Short acting bronchodilators
  • Steroids
  • Antibiotics
  • Consider hospital admission if unwell
22
Q

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

A

Salbutamol and/or ipratropium

23
Q

What steroids are used during exacerbations of COPD?

A

Prednisolone 40 mg per day for 5-7 days

24
Q

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

A

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

25
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 ```
26
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
27
What is oxygen saturation target for AECOPD ward management?
88-92%
28
What is used to assess for evidence of respiratory failure?
- Clinical | - Arterial blood gas (ABG)
29
What does acute respiratory failure require?
Non-invasive ventilation (NIV)
30
What is involved in COPD palliative care? 2 points
Management of Breathlessness & Dysfunctional breathing Anticipatory Care Plan
31
What methods are used to manage breathlessness and dysfunctional breathing in palliative patients? 3 points
– Pharmacological - Morphine – Psychological support – Palliative care referral
32
What does an anticipatory care plan include? 3 points
– Hospital Admission – Ceiling of Treatment – ward based, HDU, Ventilation – DNR