COPD treatment Flashcards
How do you calculate pack years?
Number of cigarettes a day/20 multiplied by the number of years smoked
What can you offer to people who want to stop smoking?
- Appropriate support group
- Niccotine replacement therapy
- Varenicline
- Bupropion
What is the first line therapy for someone with COPD?
- Short acting beta 2 agonist and short acting muscarinic agonists
- short acting bronchodilators to relieve breathlessness and exercise limitation
- Inhaled combination therapy = LAMA and LABA and ICS
Treatment of someone with spirometrically confirmed COPD with no asthmatic features using a short acting bronchodilator, had relevant vaccinations and optimised non pharmacological management
LAMA and LABA
Treatment of someone with spirometrically confirmed COPD with asthmatic features using a short acting bronchodilator, had relevant vaccinations and optimised non pharmacological management
• LABA + ICS
What is the next step after being prescribed LABA and ICS? When?
- Add LAMA if their
- day to day symptoms continue to adversely impact their quality of life or they have a severe exacerbation (requiring hospitalisation) or they have 2 moderate exacerbations a year
What is the next step after LAMA and LABA? When should this be introduced?
- add ICS
* Severe exacerbation or 2 moderate exacerbations a year
What are the types of inhalers?
- Metered dose inhlaers
- Breath activated
- Dry powder
What are the pros of spacers
- Need less coordination
- Give better drug deposition
- Cut down on the risk of sore throat, husky voice and oral thrush
When should oral theophylline be used in COPD?
- After a trial of short acting bronchodilators and long acting bronchodilators
- For people who are unable to used inhaled therapy, as plasma levels and interactions need to be closely monitored
What should you do if someone on theophylline is prescribed a macrolide of fluoroquinolone antibiotic
Reduce the dose
When should you consider mucolytic therapy in someone with COPD?
If they have a chronic cough productive of sputum, should only be continued if there is symptomatic improvement
What is the mechanism of action of mucolytic therapies?
- Increase concentrations of sialomucins
- Reduces concentrations of fucomucins
- results in reduced sputum viscosity
When should you consider opioids in COPD?
To relieve breathlessness in people with end stage COPD that is unresponsive to other therapies
What can you use in patients with end stage COPD who are unresponsive to other medical therapy
- Opioids
- Benzodiazipine
- Tricyclic antidepressants
- Major tranquillisers
- Oxygen
Which antibiotic is used for prophylaxis in COPD?
• Azithromycin 250mg 3 times a week
When is prophylactic antibiotic therapy indicated in COPD?
•If they don’t smoke and have optimal non-pharmacological management and continue to have one or more of:
- Frequent (≥4 a year) exacerbations with sputum production
- Prolonged exacerbations with sputum production
- Exacerbations resulting in hospitalisation
What should you do before prescribing prophylactic antibiotics?
- Sputum culture
- Training in airway clearance techniques to optimise sputum clearance
- CT scan of the thorax to rule out bronchiectasis and other lung pathologies
- ECG to rule out prolonged QT interval and baseline LFTs
What is roflumilast?
Selective inhibitor of phosphodiesterase-4, reduces exacerbations of COPD
What is the mechanism of action of roflumilast?
- Inhibits the hydrolysis of cAMP in inflammatory cells
- Increases intracellular cAMP
- Reduces the release of pro-inflammatory mediators and cytokines
What is the management of an acute presentation of COPD exacerbation
•Nebulise:
- salbutamol 5mg
- ipratropium 500mcg
•Steroids - prednisolone 30/40mg for five days
•Antibiotics: amoxicillin or doxycycline
