Management of COPD

Question 1

How can COPD be ‘defined’?

Answer 1

• Airflow obstruction
• Progressive
• Not fully reversible

Question 2

What symptoms are there in COPD?

Answer 2

• Breathlessness
• Cough
• Recurrent chest infection

Question 3

Why do people develop COPD?

Answer 3

• Smoking causes inactivation of antiproteases or a1 AT deficiency
• Both lead to increase in neutrophils and elastase
• Tissue damage

Question 4

People with COPD often have other conditions such as…

Answer 4

• Loss of muscle mass
• Weight loss
• Cardiac disease
• Depression, anxiety etc

Question 5

What is required to diagnose COPD?

Answer 5

• Relevant history
• Look for clinical signs
• Confirmation of diagnosis and assessment of severity
• Other relevant tests

Question 6

What history would suggest COPD?

Answer 6

• Aged 35 or over
• Current or former smoker
• Chronic cough
• Exertional breathlessness
• Sputum production
• frequent Winter Bronchitis
• Wheeze or chest tightness

Question 7

What might be seen on examination of a COPD patient?

Answer 7

• Reduced chest expansion
• Prolonged expiration/wheeze
• Hyperinflated chest
• Respiratory failure

Question 8

What are signs of respiratory failure?

Answer 8

• Tachypneoa
• Cyanosis
• Use of accessory muscles
• Pursed lip breathing
• Peripheral oedema

Question 9

What investigation can be used to confirm COPD and assess the severity?

Answer 9

Spirometry

Question 10

What baseline tests should be performed?

Answer 10

• Spirometry
• Chest X-ray
• ECG
• Full blood count
• BMI
• AIAT if under 50 years old

Question 11

What is the aim of smoking cessation?

Answer 11

Prevention of disease progression

Question 12

What is the aim of inhalers?

Answer 12

Relieve breathlessness

Question 13

What is the aim of inhalers, vaccines and pulmonary rehabilitation?

Answer 13

Prevention of exacerbation

Question 14

What is the aim of long term oxygen therapy?

Answer 14

Management of complications

Question 15

What non-pharmacological options for management are there?

Answer 15

• Smoking cessation
• Vaccinations
• Pulmonary rehabilitation
• Nutritional assessment
• Psychological support

Question 16

What are the benefits of pharmacological management?

Answer 16

• Relieve symptoms
• Prevent exacerbations
• Improve quality of life

Question 17

What inhaled therapy options are there?

Answer 17

• Short acting bronchodilators
• Long acting bronchodilators
• High dose corticosteroids

Question 18

What are examples of short acting bronchodilators?

Answer 18

• SABA: salbutamol

- SAMA: ipratropium

Question 19

What are examples of long acting bronchodilators?

Answer 19

• LAMA: long acting anti-muscarinic agents: umeclidinium, tioptropium
• -LABA: long acting B2 agonist: salmeterol

Question 20

What are examples of high dose inhaled corticosteroids?

Answer 20

• Relvar (fluticasone/vilanterol)

- Fostair MDI

Question 21

How does treatment change with worsening FEV1?

Answer 21

• SABA
• LAMA or LABA
• LAMA and LABA
• ICS, LABA and LAMA

Question 22

When is long term oxygen (LTOT) used?

Answer 22

-When PaO2<7.3kPa
OR
-When PaO2 7.3-8kPa but with 
  -Polycythaemia
  -Nocturnal hypoxia
  -Peripheral oedema
  -Pulmonary hypertension

Question 23

What are symptoms of AECOPD?

Answer 23

-Increasing breathlessness
-Cough
-Sputum volume
-Sputum purulence
-Wheeze
Chest tightness

Question 24

How should AECOPD be managed?

Answer 24

• Short acting bronchodilators
• Steroids
• Antibiotics if evidence of infection
• Consider hospital admission

Question 25

When should hospital admission be considered in cases of AECOPD?

Answer 25

• Tachypneoa
• Low oxygen saturation <90%
• Hypotension

Question 26

What steroid treatment should be given to patients with AECOPD?

Answer 26

Prednisolone 40mg per day for 5-7 days

Question 27

What investigations are required if patients are admitted with AECOPD?

Answer 27

• FBC
• Biochemistry and glucose
• Theophylline concentration
• Arterial blood gas
• Echocardiograph
• CXR
• Blood cultures in febrile patients
• Sputum microscopy, culture and sensitivity

Question 28

How should AECOPD patients on wards be managed?

Answer 28

• Oxygen target saturation 88-92%
• Nebulised bronchodilators
• Corticosteroids
• Antibiotics
• Assessment for respiratory failure