Management of COPD

Question 1

What causes COPD?

Answer 1

Exposure to noxious gases/particles, affecting the lower respiratory tract

Question 2

What are the symptoms of COPD?

Answer 2

Chronic cough with phlegm
Breathlessness
Frequent chest infections

Question 3

What are some non-pharmacological treatments for COPD?

Answer 3

Smoking cessation
Vaccinations - pneumonia/influenza
Pulmonary rehabilitation

Question 4

What is the step wise treatment for COPD?

Answer 4

1. SABA and/or SAMA as reliever
2. LAMA + SABA or LABA + SAMA
3. Add theophylline
4. Add ICS

Question 5

Why are mucolytics sometimes given for COPD patients & what are some examples?

Answer 5

To loosen their sputum, e.g. carbocysteine, or acetylcysteine

Question 6

Why arent ICS not used that much in COPD patients?

Answer 6

Because they have limited responses and can increase risk of pneumonia

Question 7

Which 2 types of inhalers should you never give together, and why?

Answer 7

SAMA and LAMA as it can cause anticholinergic adverse effects

Question 8

What is an examples of a SAMA and a LAMA?

Answer 8

Remember SILT
SAMA - ipratropium
LAMA - tiotropium

Question 9

What are the brands for ipratropium?

Answer 9

Atrovent
Inhalvent

Question 10

What are the brands for tiotropium?

Answer 10

Spiriva
Spiriva Respimat

Question 11

How would an acute exacerbation of COPD present?

Answer 11

pO2 <90%
Cyanosis
Severe breathlessness
Peripheral oedema

Question 12

How is an acute exacerbation of COPD treated?

Answer 12

Venturi 24% oxygen mask
30mg prednisolone OD 5/7
200mg doxycycline STAT, then 100mg OD 5/7

Alternative antibiotics can be:
Amoxicillin TDS 5/7, or
Clarithromycin 500mg BD 5/7

Question 13

What are some side effects of theophylline?

Answer 13

Tremors
Restlessness
Insomnia
N+V
Arrhythmia