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COPD > Management > Flashcards

Management Flashcards

1
Q

What is the GOLD staging for COPD?

A

GOLD Stage 1: FEV1 > 80% predicted
Stage 2: FEV1 50-79% predicted
Stage 3: FEV1 30-49% predicted
Stage 4: FEV1 < 30% predicted

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2
Q

What is the number one treatment advice for COPD?

A

Smoking cessation

  • Professional advice
  • Nicotine replacement
  • Anti-depressants
  • Nicotine receptor blockers e.g. varenicline
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3
Q

What medications are used for COPD?

A
  • Inhaled bronchodilators: SABAs, LABAs, anti-muscarinics
  • Inhaled corticosteroids: reduce exacerbation frequency
  • Oral theophylline: bronchodilator (narrow therapeutic window)
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4
Q

Examples of inhaled bronchodilators

A
  • SABA e.g. salbutamol, terbutaline
  • LABA e.g. salmeterol, eformoterol
  • Anti-muscarinic e.g. ipratropium, tiotropium
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5
Q

Examples of theophylline and mucolytics

A
  • Aminophylline

- Carbocistene

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6
Q

What other treatment is needed for COPD?

A
  • Vaccination - influenza, pneumococcal
  • Oxygen - short burst for symptoms or > 15 hours/day
  • Physiotherapy
  • Pulmonary rehabilitation
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7
Q

What is the first-line treatment for COPD?

A

SABA or anti-muscarinic (SAMA)

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8
Q

What are the asthmatic features/features of steroid responsiveness in COPD?

A
  • Previous diagnosis of asthma or atopy
  • Higher blood eosinophil count
  • Substantial variation in FEV1 over time (at least 400ml)
  • Substantial variation in peak expiratory flow (at least 20%)
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9
Q

What is the next-line of treatment if there are no asthmatic/steroid responsiveness features?

A

Add a LABA + LAMA

- If patient has a SAMA, switch to SABA

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10
Q

What is the next-line of treatment if there are features of asthma/steroid responsiveness?

A

LABA + ICS
If patients remain breathlessness offer triple therapy LABA + LAMA + ICS
- If taking SAMA, switch to SABA

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11
Q

What is the management of an exacerbation?

A
  • Oxygen to give SaO2 88-92%
  • High dose SABAs (usually nebulised)
  • High dose corticosteroids (usually prednisolone 40mg/day - 7 days)
  • Antibiotic if purulent sputum or very severe illness
  • Reassess after 1 hour
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12
Q

What is the treatment for if the exacerbation is not resolving?

A
  • IV bronchodilator (salbutamol or theophylline)
  • Urgent intensive care opinion
  • Non-invasive ventilation (BiPAP)
  • Intubation and assisted ventilation
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13
Q

What are the side effects of B2 agonists?

A
  • Tachycardia
  • Arrhythmias
  • Myocardial ischaemia
  • Tremor
  • Paradoxical bronchospasm (when suddenly taken off salbutamol)
  • Hypokalaemia
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14
Q

What are anticholingeric/anti-muscarinic drug side effects?

A
  • SA - ipratropium
  • LA - tiotropium
    Side effects:
  • Dry mouth
  • Nausea
  • Headache
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15
Q

What are xanthines?

A

PDE inhibitors e.g. theophylline, aminophylline

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16
Q

What are the side effects of xanthines?

A
  • Tachycardia
  • Arrhythmias
  • Agitation
  • Convulsions
  • Hypokalaemia
17
Q

What is magnesium used for?

A

General bronchodilator effect (Ca channel blocker)

18
Q

What are the inhaled corticosteroids?

A
  • Beclamethasone
  • Fluticasone
  • Budenoside
19
Q

What are the oral + IV corticosteroids?

A
  • Oral prednisolone

- IV hydrocortisone

20
Q

What do leukotriene receptor antagonists do?

A

Leukotriene receptor antagonists block the binding of LTD4 to its receptor on target tissues e.g. montelukast

21
Q

What is the management of cor pulmonale?

A
  • Treat underlying cause
  • Treat respiratory failure (24% O2 if PaO2 <8kPa)
  • Treat cardiac failure with diuretics e.g. furosemide - monitor U+E (give amiloride or potassium supplements if neccessary)
  • Consider venesection if haematocrit >55%
  • Consider heart-lung transplantation in young people
22
Q

When non-invasive ventilation used?

A
  • Respiratory acidosis despite controlled O2 therapy
  • SOB with accessory muscle use
  • RR > 25
23
Q

What are the venturi mask amounts?

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A
  • Blue 2-4L/min = 24%
  • White 4-6L/min = 28%
  • Yellow 8-10L/min = 35%
  • Red 10-12L/min = 40%
  • Green 12-15L/min = 60%

COPD (4 decks)

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