Management of COPD

Question 1

List some of the non-respiratory symptoms of COPD.

Answer 1

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

Question 2

What are the most important things to treat in COPD even though you cannot fully treat it?

Answer 2

Improve exercise tolerance
Prevent exacerbations

Question 3

What are some of the other things related to COPD that we can try to treat?

Answer 3

Nutrition/weight loss
Complications of COPD- cor-pulmanale, respiratory failure.

Question 4

What is the third sector of things to manage in terms of COPD?

Answer 4

Anxiety/depression
Dysfunctional breathing
Palliative care

Question 5

Name the five sectors of non pharmacological malmanagement of COPD.

Answer 5

• Smoking Cessation
• Vaccinations – Annual Flu vaccine – Pneumococcal vaccine
• Pulmonary Rehabilitation
• Nutritional assessment
• Psychological support

Question 6

What happens in pulmonary rehabilitation?

Answer 6

6 weeks of classes where the patient is seen by a physiotherapist, psychologist, a pharmacist and an occupational therapist.
They give advice on exercise dependant on exercise ability

Question 7

What are the two vaccinations which should be offered to all patients with COPD?

Answer 7

Pneumococcal & influenza vaccine

Question 8

What are the benefits of pharmacological management?

Answer 8

• Relieve symptoms
  – Prevent exacerbations
  – Improve quality of life

Question 9

What are the three groups of inhalers available?

Answer 9

• Short acting Bronchodilators
• Long acting bronchodilators
• High dose inhaled corticosteroids (ICS) and LABA

Question 10

Give some examples of short acting bronchodilators.

Answer 10

– SABA (eg- Salbutamol)
– SAMA (eg- Ipratropium)

Question 11

Give some examples of long acting bronchodilators.

Answer 11

– LAMA (Long acting anti – muscarinic agents, egUmeclidinium, Tioptropium etc)
– LABA (Long acting B2 agonist, eg- Salmeterol)

Question 12

Give some examples of high dose inhaled corticosteroids (ICS) and LABA.

Answer 12

– Relvar (Fluticasone/vilanterol)
– Fostair MDI

Question 13

What are the requirements for having long term oxygen?

Answer 13

Must have stopped smoking for at least six months
Hypoxic (PaO2<7.3kPa)

Question 14

Name the symptoms of acute exacerbation of COPD

Answer 14

• Increasing breathlessness
• Cough worse
• Sputum volume increased
• Sputum purulence
• More wheezey
• Chest tightness increased

Question 15

What are the options in primary care if a patient has acute exacerbation of COPD?

Answer 15

Offer short acting bronchodilators
Offer steroids
Offer antibiotics
Admit to hospital if v unwell

Question 16

Which steroid can be given in response to acute exacerbation of COPD?

Answer 16

Prednisolone 40 mg per day for 5-7 days

Question 17

List some of the investigations carried out in the hospital in those w acute exacerbation of COPD.

Answer 17

Full blood count
Chest x-ray
Biochemistry and glucose
Arterial blood gas
Electrocardiograph
Blood cultures in febrile patients
Sputum microscopy

Question 18

What is the ward based management for those w an acute exacerbation of COPD?

Answer 18

• Oxygen- target Saturation 88-92%
• Nebulised bronchodilators
• Corticosteroids
• Antibiotics (Oral Vs IV)
• Assess for evidence of respiratory failure
  – Clinical
  – Arterial blood gas (ABG)

Question 19

In terms of palliative care, what type of management of Breathlessness and Dysfunctional breathing is offered to those w COPD?

Answer 19

– Pharmacological - Morphine
– Psychological support
-Palliative care referral

Question 20

In terms of palliative care, what type of management regarding anticipatory care plan is offered to those w COPD?

Answer 20

– Hospital Admission
– Ceiling of Treatment – ward based, HDU,
Ventilation
– DNACPR