COPD treatment

Question 1

what is the treatment of COPD?

Answer 1

1. smoking cessation
2. patient education
3. pneumococcal vaccination
4. bronchodilators (ß2-agonist e.g. salbutamol)
5. inhaled corticosteroid - anti-inflammatory
6. pulmonary rehabilitation

Question 2

why would you give a patient inhaled corticosteroid?

Answer 2

loss of ciliary function - mucus buildup, stasis, infection

Question 3

what is pulmonary rehabilitation?

Answer 3

many COPD patients avoid exercise - breathlessness
leads to muscle weakness
vicious cycle of worsening symptoms, social isolation & depression
pulmonary rehab aims to break cycle with MDT

Question 4

how does pulmonary rehab break cycle with MDT?

Answer 4

programme of exercise
disease education
nutritional advice

Question 5

what is long term oxygen treatment administered?

Answer 5

for patients with extended periods of hypoxia, leading to pulmonary hypertension

Question 6

what is long term oxygen treatment?

Answer 6

continuous low dose of oxygen therapy at home, at least 16hrs/day to improve survival

Question 7

what are the criterias for a patient to be put on long term oxygen treatment?

Answer 7

patient must be non-smoker & have fire safety team inspect home
(dangerous, compressed oxygen)

Question 8

when would surgical interventions be used in COPD?

Answer 8

last resort

to improve lung dynamics, exercise adherence & QoL

Question 9

what are the surgical interventions for COPD?

Answer 9

removal of large bullae
lung volume reduction
lung transplant

Question 10

what is an acute exacerbation of COPD?

Answer 10

an event characterised by a change in patient’s baseline dyspnoea, cough, and or sputum
that is beyond normal day-to-day variations
is acute in onset

Question 11

how would acute infectious exerbations present?

Answer 11

acute severe SOB (dyspnoea)
fever
chest pain

Question 12

what is management for acute exacerbations of COPD?

Answer 12

monitoring for hypoxia & hypercapnia 
appropriate Abx
nebulised brochodilators
oral steroids
24% / 28% oxygen therapy

Question 13

what would you consider for worsening type 2 resp failure?

Answer 13

non-invasive ventilation

Question 14

why would you give the patient appropriate Abx?

Answer 14

to cover H influenza & strep pneumonia (CAP pneumonia)

Question 15

how would you monitor the patient for hypoxia & hypercapnia?

Answer 15

pulse oximetry & ABG analysis

Question 16

what type of oral steroids would you give the patient?

Answer 16

short course, high dose oral prednisolone

Question 17

what are complications of COPD?

Answer 17

1. recurrent pneumonia (loss of cilia)
2. pneumothorax
3. resp failure
4. cor pulmonale (RH failure)

Question 18

what is pneumothorax?

Answer 18

abnormal collection of air in pleural space - causes uncoupling of lung from chest wall
occurs because of lung parenchyma damage with sub-pleural bullae formation & rupture

Question 19

why would you need to keep a patient on oxygen therapy under review?

Answer 19

keep under review for CO2 retention (hypoxia driven ventilation), normally high CO2 adjust HCO3- (choroid plexus cells), now CO2 adjusted for (increase HCO3-), compensate pH change - now pH normal, but CO2 is still high (ratio just adjusted by increasing HCO3-), so need to check CO2 isn’t high

Question 20

how does asthma differ from COPD?

Answer 20

asthma:
early onset, family history
symptoms episodic - obvious triggering factors
daily variability in symptoms
patients have overt wheezing that rapidly responds to bronchodilators
lung function test - reverses with bronchodilators
sputum / blood eosinophilia