Management of COPD Flashcards
How can COPD be ‘defined’?
- Airflow obstruction
- Progressive
- Not fully reversible
What symptoms are there in COPD?
- Breathlessness
- Cough
- Recurrent chest infection
Why do people develop COPD?
- Smoking causes inactivation of antiproteases or a1 AT deficiency
- Both lead to increase in neutrophils and elastase
- Tissue damage
People with COPD often have other conditions such as…
- Loss of muscle mass
- Weight loss
- Cardiac disease
- Depression, anxiety etc
What is required to diagnose COPD?
- Relevant history
- Look for clinical signs
- Confirmation of diagnosis and assessment of severity
- Other relevant tests
What history would suggest COPD?
- Aged 35 or over
- Current or former smoker
- Chronic cough
- Exertional breathlessness
- Sputum production
- frequent Winter Bronchitis
- Wheeze or chest tightness
What might be seen on examination of a COPD patient?
- Reduced chest expansion
- Prolonged expiration/wheeze
- Hyperinflated chest
- Respiratory failure
What are signs of respiratory failure?
- Tachypneoa
- Cyanosis
- Use of accessory muscles
- Pursed lip breathing
- Peripheral oedema
What investigation can be used to confirm COPD and assess the severity?
Spirometry
What baseline tests should be performed?
- Spirometry
- Chest X-ray
- ECG
- Full blood count
- BMI
- AIAT if under 50 years old
What is the aim of smoking cessation?
Prevention of disease progression
What is the aim of inhalers?
Relieve breathlessness
What is the aim of inhalers, vaccines and pulmonary rehabilitation?
Prevention of exacerbation
What is the aim of long term oxygen therapy?
Management of complications
What non-pharmacological options for management are there?
- Smoking cessation
- Vaccinations
- Pulmonary rehabilitation
- Nutritional assessment
- Psychological support
What are the benefits of pharmacological management?
- Relieve symptoms
- Prevent exacerbations
- Improve quality of life
What inhaled therapy options are there?
- Short acting bronchodilators
- Long acting bronchodilators
- High dose corticosteroids
What are examples of short acting bronchodilators?
- SABA: salbutamol
- SAMA: ipratropium
What are examples of long acting bronchodilators?
- LAMA: long acting anti-muscarinic agents: umeclidinium, tioptropium
- -LABA: long acting B2 agonist: salmeterol
What are examples of high dose inhaled corticosteroids?
- Relvar (fluticasone/vilanterol)
- Fostair MDI
How does treatment change with worsening FEV1?
- SABA
- LAMA or LABA
- LAMA and LABA
- ICS, LABA and LAMA
When is long term oxygen (LTOT) used?
-When PaO2<7.3kPa OR -When PaO2 7.3-8kPa but with -Polycythaemia -Nocturnal hypoxia -Peripheral oedema -Pulmonary hypertension
What are symptoms of AECOPD?
-Increasing breathlessness
-Cough
-Sputum volume
-Sputum purulence
-Wheeze
Chest tightness
How should AECOPD be managed?
- Short acting bronchodilators
- Steroids
- Antibiotics if evidence of infection
- Consider hospital admission
When should hospital admission be considered in cases of AECOPD?
- Tachypneoa
- Low oxygen saturation <90%
- Hypotension
What steroid treatment should be given to patients with AECOPD?
Prednisolone 40mg per day for 5-7 days
What investigations are required if patients are admitted with AECOPD?
- FBC
- Biochemistry and glucose
- Theophylline concentration
- Arterial blood gas
- Echocardiograph
- CXR
- Blood cultures in febrile patients
- Sputum microscopy, culture and sensitivity
How should AECOPD patients on wards be managed?
- Oxygen target saturation 88-92%
- Nebulised bronchodilators
- Corticosteroids
- Antibiotics
- Assessment for respiratory failure
