Management of COPD

Question 1

What are you treating when managing of COPD?

Answer 1

• Improve exercise tolerance
• Prevent exacerbations
• Nutrition / Weight loss
• Complications ( Complications (Cor
  -pulmonale pulmonale, respiratory failure , respiratory failure
  etc..)
• Anxiety/ Depression
• Co-morbidities
• Dysfunctional breathing
• Palliative care

Question 2

COPD - NON-PHARMACOLOGICAL MANAGEMENT

Answer 2

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

Question 3

COPD - Pharmacological management benefits

Answer 3

• Relieve symptoms
• Prevent exacerbations
• Improve quality of life

Question 4

COPD - inhaled therapy: short acting bronchodilators

Answer 4

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

Question 5

COPD - inhaled therapy: long acting bronchodilators

Answer 5

– LAMA (Long acting anti – muscarinic agents, eg Umeclidinium, Tioptropium etc)
– LABA (Long acting B
2 agonist, eg- Salmeterol)

Question 6

COPD - inhaled therapy: high dose inhaled corticosteroids (ICS) and LABA

Answer 6

– Relvar (Fluticasone/vilanterol)
– Fostair MDI

Question 7

COPD - EXACERBATION (AECOPD)

Answer 7

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

Question 8

Primary care management of AECOPD

Answer 8

• Short acting bronchodilators
  
  • Salbutamol and/or Ipratropium
  • Neubulisers if cannot use inhalers
• Steroids
  
  • Prednisolone 40 mg per day for 5-7 days
• Antibiotics
  
  • Most exacerbations are secondary to viral infectio
    n
  • If there evidence of infection (fever, increase in volume/purulence of sputum)
• Consider hospital admission if unwell
  
  • Tachypneoa
  • Low Oxygen saturation (< 90-92%)
  • Hypotension etc

Question 9

AECOPD investigations required in patients admitted to hospital

Answer 9

• full blood count
• biochemistry and glucose
• theophylline concentration
• arterial blood gas
• electrocardiograph
• chest xray
• blood cultures in febrile patients
• sputum microscopy, culture and sensitivity

Question 10

Ward based management of AECOPD

Answer 10

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

Question 11

Palliative care of COPD

Answer 11

Management of Breathlessness and dysfunctional breathing
~ Pharmacological
~ Morphine
~ Psychological support
~ Palliative care referral
Anticipatory Care Plan
~ Hospital Admission
~ Ceiling of Treatment - ward based, HDU,
Ventilation
~ DNACPR