FN: COPD acute exacerbations

Question 1

Causes

Answer 1

Viral URTI (30%)
Also bacterial infections

Question 2

History

Answer 2

Smoking Status
Exercise capacity
Current treatment
Previous exacerbations

Question 3

Investigations

Answer 3

PEFR
Bloods: FBC, U + E, ABG, CRP, cultures
Sputum culture
CXR: infection , pneumothorax
ECG

Question 4

Differential

Answer 4

Pneumothorax
Pulmonary oedema
PE
Asthma

Question 5

Management

Answer 5

1. Controlled oxygen therapy
2. Nebulied bronchodilators
3. Steroids
4. Abx
5. NIV if no response

Question 6

Controlled oxygen therapy

Answer 6

• Sit up
• 24% O2 via Venturi mask: spO2 99-92%
• Vary FiO2 and SpO2 target according to ABG
• Aim for PaO2 >8 and increased PCO2 of <1.5 kPa

Question 7

Nebulised Bronchodilators

Answer 7

• Air driven wih nasal specs
• Salbutamol 5mg/4h (SABAs)
• Ipratropium 0.5mg/6h

Question 8

Steroids

Answer 8

• Hydrocortison 200mg IV

* Prednisolone 40mg PO

Question 9

Abx

Answer 9

• If evidence of infection

* Doxy 200mg PO sat then 100mg OF PO for 5d

Question 10

NIV if no response:

Answer 10

• Repeat nebs and consider aminophylline IV
• Consider NIV (BiPAP) if pH 30
• Consider invasive ventilation if pH7.26
• Depends on pre-morbid state: exercise capacity, home O2 comorbidity
• If evidence of infection
• Doxy 200mg PO sat then 100mg OF PO for 5d