Management of COPD

Question 1

What should also be treated in COPD ?

Answer 1

Improve exercise tolerance
Prevent exacerbation
Nutrition/ weight loss
Complications
Anxiety/ depression
Co-morbidities
Dysfunctional breathing
Palliative care

Question 2

What are the non-pharmacological managements for COPD ?

Answer 2

Smoking cessation
Vaccinations:
    - annual flu vaccine
    - pneumococcal vaccine 
Pulmonary rehabilitation:
    - 6 week course of classes
    - seen by many professions in healthcare 
    - exercise 
    - multidisciplinary approach
Psychological support:
    - multidisciplinary approach

Question 3

What are some pharmacological treatments ?

Answer 3

Inhaled therapy

Long term O2 therapy

Question 4

What are the benefits of pharmacological managements ?

Answer 4

Relieve symptoms
Prevent exacerbations
Improve quality of life

Question 5

What are some examples of inhaled therapy ?

Answer 5

Short acting bronchodilators
Long acting bronchodilators
High dose ICS and LABA

Question 6

What are some examples of short acting bronchodilators ?

Answer 6

SABA- salbutamol

SAMA- ipratropium

Question 7

What are some examples of long acting bronchodilators ?

Answer 7

LAMA- umeclidinium, tiotropium

LABA- salmeterol

Question 8

What are some examples of high dose ICS and LABA ?

Answer 8

Relvar (fluticasone/vilanterol)

Fostair MDI

Question 9

What are the conditions of long term O2 therapy ?

Answer 9

Stopped smoking for at least 6 months 
PaO2 <7.3kPa
        or 
PaO2 7.3-8kPa if:
    - polycythaemia
    - nocturnal hypoxia
    - peripheral oedema
    - pulmonary hypertension

Question 10

What is the treatment of acute exacerbations in primary care ?

Answer 10

Short acting bronchodilators:
    - salbutamol and/or ipratropium 
    - nebulisers if can't use inhalers 
Steroids:
    - prednisolone 40mg/day for 5-7 days 
Antibiotics:
    - most exacerbations are secondary to viral infection
    - if there is evidence of bacterial infection
Consider hospital admission if unwell:
    - tachypnoea 
    - low O2 sats (<90-92%)
    - hypotension

Question 11

What investigations can be taken for acute exacerbations in hospital ?

Answer 11

Full blood count
Glucose
Theophylline concentartion
Arterial blood gas
CXR
Sputum

Question 12

how can an acute exacerbation be managed on the ward ?

Answer 12

Oxygen- target Saturation 88-92%
Nebulised bronchodilators
Corticosteroids
Antibiotics (Oral Vs IV)
Assess for evidence of
respiratory failure

Question 13

In palliative care what is the management of breathlessness and dysfunctional breathing ?

Answer 13

Pharmacological - Morphine

Psychological support