COPD treatment Flashcards
what is the treatment of COPD?
- smoking cessation
- patient education
- pneumococcal vaccination
- bronchodilators (ß2-agonist e.g. salbutamol)
- inhaled corticosteroid - anti-inflammatory
- pulmonary rehabilitation
why would you give a patient inhaled corticosteroid?
loss of ciliary function - mucus buildup, stasis, infection
what is pulmonary rehabilitation?
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
how does pulmonary rehab break cycle with MDT?
programme of exercise
disease education
nutritional advice
what is long term oxygen treatment administered?
for patients with extended periods of hypoxia, leading to pulmonary hypertension
what is long term oxygen treatment?
continuous low dose of oxygen therapy at home, at least 16hrs/day to improve survival
what are the criterias for a patient to be put on long term oxygen treatment?
patient must be non-smoker & have fire safety team inspect home
(dangerous, compressed oxygen)
when would surgical interventions be used in COPD?
last resort
to improve lung dynamics, exercise adherence & QoL
what are the surgical interventions for COPD?
removal of large bullae
lung volume reduction
lung transplant
what is an acute exacerbation of COPD?
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
how would acute infectious exerbations present?
acute severe SOB (dyspnoea)
fever
chest pain
what is management for acute exacerbations of COPD?
monitoring for hypoxia & hypercapnia appropriate Abx nebulised brochodilators oral steroids 24% / 28% oxygen therapy
what would you consider for worsening type 2 resp failure?
non-invasive ventilation
why would you give the patient appropriate Abx?
to cover H influenza & strep pneumonia (CAP pneumonia)
how would you monitor the patient for hypoxia & hypercapnia?
pulse oximetry & ABG analysis
what type of oral steroids would you give the patient?
short course, high dose oral prednisolone
what are complications of COPD?
- recurrent pneumonia (loss of cilia)
- pneumothorax
- resp failure
- cor pulmonale (RH failure)
what is pneumothorax?
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
why would you need to keep a patient on oxygen therapy under review?
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
how does asthma differ from COPD?
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
