COPD therapies

Question 1

What are the long-term management options for patients with COPD

Answer 1

Stop smoking, pneumococcal and annual influenza vaccine, pulmonary rehabilitation

Question 2

What is the first step in COPD medical management?

Answer 2

SABA or SAMA

Question 3

What is an example of a SABA

Answer 3

Salbutamol

Question 4

What is an example of a SAMA

Answer 4

ipratroprium bromide

Question 5

What is the 2nd step in COPD medical management if they are not asthmatic or have any other steroid-responsive features?

Answer 5

LABA and a LAMA combination inhaler

Question 6

What is an example of a LABA and LAMA combination inhaler?

Answer 6

“Anoro Ellipta”

Question 7

What is the 2nd step in COPD medical management if they are asthmatic or have any other steroid-responsive features?

Answer 7

Combined LABA plus an ICS

Question 8

What is an example of a combined LABA plus ICS?

Answer 8

“Fostair”

Question 9

What would you prescribe if both the 2-compartment combination inhalers don’t work?

Answer 9

LABA, LAMA and ICS

Question 10

What are the additional options in more severe cases of COPD?

Answer 10

Nebulisers, oral theophylline, and oral mucolytic therapy to break down sputum, long term prophylactic antibiotics, long term oxygen therapy at home

Question 11

What are the symptoms of an exacerbation of COPD?

Answer 11

worsening cough, shortness of breath, sputum production and wheeze.

Question 12

What is an exacerbation of COPD usually triggered by?

Answer 12

viral or bacterial infection

Question 13

What is the treatment for exacerbation of COPD if they are well enough to remain at home?

Answer 13

Prednisolone 30mg once daily for 7-14 days
Regular inhalers or home nebulisers
Antibiotics if there is evidence of infection

Question 14

What is the treatment for exacerbation of COPD if they have to go to hospital?

Answer 14

Nebulised bronchodilators (eg salbutamol 5mg/4h)
Steroids (200mg hydrocortisone)
Antibiotics if evidence of infection
Physiotherapy can help clear sputum

Question 15

What is the next step of treatment in severe cases of COPD exacerbation who aren’t responding to first-line treatment?

Answer 15

IV aminophylline
Non-invasive ventillation
Intubation and ventilation with admission to intensive care
Doxapram can be used as a respiratory stimulant where NIV or intubation is not appropriate.

Question 16

What does a SABA do?

Answer 16

short-acting adrenoreceptor acts as a bronchodilator in obstructive resp diseases.

Question 17

What are the side effects of a SABA?

Answer 17

tremor, tachycardia, headache, palpitations, hypokalaemia

Question 18

What is a SAMA?

Answer 18

short-acting muscarinic agonist, acts as a bronchodilator, in asthma and often in COPD

Question 19

What are the side effects of a SAMA?

Answer 19

Arrhythmias, constipation, cough, dizziness, dry mouth, headache, nausea, GIT motility disorder.

Question 20

What is a LABA?

Answer 20

long-acting beta agonist acts as a bronchodilator, often used un patients requiring long term therapy.

Question 21

What are the side effects of LABA?

Answer 21

muscle cramps, dizziness, nausea, tremor, tachycardia, headache, palpitations, hypokalemia

Question 22

What is a LAMA?

Answer 22

long-acting muscarinic antagonist acts as a bronchodilator, often used as a maintenance treatment of chronic obstructive pulmonary disease.

Question 23

What are the limitations of a LAMA?

Answer 23

dry mouth, difficulties passing urine in men, arrhythmias, constipation, cough, dizziness, headache, nausea.

Question 24

What is a prednisolone orally hydrocortisone IV beclometasone?

Answer 24

it is corticosteroids, used in exacerbation of COPD

Question 25

What are the side effects of ICS?

Answer 25

oral candidiasis, dysphonia (hoarseness) and pneumonia

Question 26

What oxygen sats should you be aiming for in a patient with COPD on long term oxygen therapy?

Answer 26

88-92%