Management of COPD

Question 1

What are the first aspects to treat when dealing with COPD?

Answer 1

Improve exercise tolerance by decreasing breathlessness

Preventing exacerbations

Question 2

2ndaspect is

Answer 2

Nutrition/weight loss

Preventing complications

Question 3

Thirs aspect to management

Answer 3

Anxiety/depression, co morbidities
dysfunctional breathing
palliative care

Question 4

Non- pharmacological management of COPD includes

Answer 4

Smoking cessation
Vaccinations (annual flu/pneumococcal vax)
Pulmonary rehab
nurtition support
psychological dupport

Question 5

What is Pulmonary rehabilitation?

Answer 5

6 weeks, 2 afternoons in a week - seen by physios (advice on types of exercise), psychologist, pharmacist (inhaler technique) and occupational therapist. Very effective, multi-team intervention

Question 6

What is involved in the pharmacological management?

Answer 6

(INHALERS)

Relieve symptoms
Prevent excacerbations
Improve QOL

Question 7

What type of drug is Salbutamol?

Answer 7

SABA (short acting bronchodilators)

Question 8

What type of drug is Ipratropium?

Answer 8

SAMA (Short acting anti muscarinic agent)

Question 9

What type of drugs are Umeclidinium, Tioptropium

Answer 9

Long acting bronchodilators - LAMAs Loong acting anti-muscarinic agents

Question 10

What type of drug is SALMETEROL?

Answer 10

Long acting beta2 agonist

Question 11

What are high dose corticosteroids (ICS) ususally given with?

Answer 11

Long acting beta 2 agonists

Question 12

What is Relvar?

Answer 12

Inhaled corticosteoids , another ICS used in clinical practice is Fluticasone

Question 13

What is the criteria to offer someone Long Term oxygen therapy?

Answer 13

Stopped smoking for at least 6 months

Hypoxic, PaO2 less than 7.3 at rest when they are not exacerbating

Question 14

What are the additional reasons why we can give Long term oxygen to patients with PaO2 7/3-8kPa

Answer 14

polycythaemia (high concentration of rbc in blood)
nocturnal hypoxia
peripheral oedema (suggests right heart dysfunction)
pulmonary hypertension (suggests right heart dysfunction)

Question 15

What are the signs and symptoms of COPD Exacerbation?

Answer 15

Increasing breathlessness
• Cough worse
• Sputum volume
• Sputum purulence
• Wheeze
• Chest tightness

Question 16

Excacerbation, what do you offer them? (primary care management)

Answer 16

•Short acting bronchodilators
– Salbutamol and/or Ipratropium
– Neubulisers if cannot use inhalers

• Steroids
– Prednisolone 40 mg per day for 5-7 days

• Antibiotics
– Most exacerbations are secondary to viral infection
– If there evidence of infection (fever, increase in volume/purulence of sputum)

Question 17

When do you consider hosipital admission?

Answer 17

Consider hospital admission if unwell
– Tachypneoa
– Low Oxygen saturation (< 90-92%)
– Hypotension etc
or other complications

Question 18

Patient arrives in hospital with COPD, what investigations are you likely to do?

Answer 18

• Full blood count
• Biochemiostry and glucose
• Theophylline concentration (in patients using theophylline preparation)
• Arterial blood gas
• Electrocardiograph (ECG)
• Chest X-Ray
• Blood cultures in febrile patients
• Sputum microscopy, culture and sensitivity