Emergency - COPD exacerbation

Question 1

What are the different types of COPD exacerbation?

Answer 1

Infective

• Worse breathlessness
• Worse cough
• Increased sputum production

Non-infective

• Change in sputum volume/colour/consistency
• Fever
• Raised white cells +/- CRP

Question 2

What investigations would you request as part of the A-E assessment?

Answer 2

B-

Pulse oximetry

Sputum culture

CXR

C-

Bloods

FBC – WCC raised

U&Es - salbutamol can cause hypokalaemia

CRP

Blood cultures if septic

ABG

ECG

Question 3

How would you manage a COPD exacerbation?

Answer 3

ABCDE approach

Oxygen via non-rebreather then titrate guided by ABGs to avoid CO2 retention

Nebulised salbutamol 5mg and ipratropium bromide 500 micrograms

Steroids – predisolone 30mg OD for 5/7

Antibiotics if raised CRP/WCC/purulent sputum - amoxicillin or doxycycline or clarithromycin

Consider IV aminophylline

Consider NIV if Type 2 respiratory failure and pH 7.2-7.3

If pH <7.25 consider ITU referral for assisted ventilation

Question 4

If they are a CO2 retainer what sats are you aiming for?

Answer 4

88-92%

(CO2 retainers will have type 2 resp failure but a raised bicarbonate showing compensation on their ABG)

Question 5

What is included in a COPD rescue pack?

Answer 5

prednisolone

amoxicillin or doxycycline or clarithromycin

Question 6

Which organisms typically cause an infective exacerbation of COPD?

Answer 6

Haemophilus influenzae (most common cause)

Streptococcus pneumoniae

Moraxella catarrhalis