Management Of COPD

Question 1

Describe the symptoms of COPD.

Answer 1

The symptoms of COPD include breathlessness, wheezing, recurrent cough, chest infections, and winter bronchitis.

Question 2

What are the three components of COPD?

Answer 2

The three components of COPD are reversible airflow obstruction, chronic inflammation in the airway (chronic bronchitis), and systemic effects such as malnutrition, muscle mass loss, and cardiac complications.

Question 3

How can COPD affect the respiratory system?

Answer 3

COPD can cause reduced air flow in the airways, gas exchange issues across the lungs (emphysema), and recurrent chest infections.

Question 4

Define the aim of COPD management.

Answer 4

The aim of COPD management is to improve exercise tolerance, prevent exacerbations, address weight loss and nutrition, manage comorbidities, and provide effective palliative care for terminally ill patients.

Question 5

Do patients with COPD require non-pharmacological interventions?

Answer 5

Yes, patients with COPD may benefit from non-pharmacological interventions such as smoking cessation, vaccination, pulmonary rehabilitation, nutritional support, and psychological support.

Question 6

Describe the Fletcher curve and its significance in COPD.

Answer 6

The Fletcher curve illustrates the rapid decline in lung function for individuals who continue to smoke after the onset of symptoms, emphasizing the importance of smoking cessation in managing COPD.

Question 7

Describe the benefits of smoking cessation for individuals with severe disability due to lung disease.

Answer 7

Smoking cessation can lead to a less steep decline in lung function, compared to those who continue to smoke, even in very late stages of the disease.

Question 8

What is pulmonary rehabilitation and how does it benefit patients with lung disease?

Answer 8

Pulmonary rehabilitation is a comprehensive six-week course involving exercise, individualized advice, psychological support, and multidisciplinary care. It can improve exercise capacity, reduce breathlessness, enhance quality of life, and decrease hospitalization.

Question 9

Define the evidence levels A and B in the context of pulmonary rehabilitation.

Answer 9

Evidence level A is the highest quality available, while evidence level B is the next best evidence.

Question 10

How do pneumococcal and flu vaccinations benefit patients with COPD?

Answer 10

Pneumococcal vaccination decreases hospitalization and all-cause mortality, while annual flu vaccination can also reduce hospitalization and mortality. The combination of both vaccines offers further benefits.

Question 11

Describe the aim of pharmacological management for COPD and its impact on the course of the illness.

Answer 11

The aim is to relieve symptoms, prevent exacerbations, and improve quality of life. Inhalers do not change the course of the illness but can provide symptom relief and prevent exacerbations.

Question 12

What are the three groups of inhalers available for COPD management?

Answer 12

The three groups are short-acting bronchodilators, long-acting bronchodilators, and inhaled corticosteroids.

Question 13

Explain the role of short-acting bronchodilators in COPD management.

Answer 13

Short-acting bronchodilators open up the airways but have a short duration of action, typically between one to four hours.

Question 14

Describe the multidisciplinary approach of pulmonary rehabilitation.

Answer 14

Pulmonary rehabilitation involves physiotherapists, psychologists, pharmacists, and occupational therapists providing individualized advice on exercise, checking inhaler technique, offering nutritional support, and providing psychological support.

Question 15

Describe the three broad groups of inhalers used in the management of COPD.

Answer 15

Short-acting beta agonists, short-acting anti-muscarinic agents, long-acting bronchodilators, and inhaled corticosteroids.

Question 16

What are the commonly used short-acting beta agonists for COPD management?

Answer 16

Salbutamol.

Question 17

Define LABA/LAMA in the context of COPD management.

Answer 17

Long-acting anti-muscarinic and long-acting beta-agonist.

Question 18

How are inhaled corticosteroids generally given in combination for COPD management?

Answer 18

In combination with a long-acting beta 2 agonist.

Question 19

Describe the treatment approach for COPD patients predominantly presenting with breathlessness.

Answer 19

Start with a short-acting bronchodilator, then progress to a combination of long-acting anti-muscarinic agent and short-acting preparation, followed by a combination of LABA/LAMA and short-acting bronchodilator, and escalate to all three classes if symptoms persist.

Question 20

What are the two types of inhaler devices mentioned in the content?

Answer 20

Dry powder and MDI (Metered Dose Inhaler).

Question 21

Describe the cost implications taken into account for various interventions in COPD management.

Answer 21

Cost implications are considered for interventions such as vaccination, smoking cessation support, pulmonary rehabilitation, and inhalers, with varying costs and impact on quality of life.

Question 22

What are the criteria for offering long term oxygen therapy to COPD patients?

Answer 22

Patients should have stopped smoking for at least six months, be hypoxic with a PaO2 less than 7.3 at rest, and have stable COPD when assessed for long term oxygen therapy.

Question 23

How does the management of stable COPD progress as the disease advances?

Answer 23

Management progresses from engaging in smoking cessation for high-risk individuals to addressing oxygen therapy and other interventions as the disease progresses.

Question 24

Define exacerbation of COPD and its common cause.

Answer 24

Exacerbation of COPD is mainly due to infection, commonly viral, leading to increased breathlessness, worsened cough, increased sputum production, wheeziness, and chest tightness.

Question 25

What are the recommended actions for COPD patients experiencing exacerbation?

Answer 25

Patients can be advised to use short-acting bronchodilators more frequently and, if unable to use an inhaler, offered nebulizer treatment.

Question 26

Describe the message from the approach to COPD management outlined in the content.

Answer 26

The approach emphasizes offering non-pharmacological treatment to achieve better quality of life and suggests specific interventions based on disease progression and exacerbation.

Question 27

Describe the criteria for considering hospital admission for a patient with COPD exacerbation.

Answer 27

Consider hospital admission if the patient is hypoxic, unable to maintain saturation above 90%, develops hypertension, confusion, significant morbidity, cyanosis, or is unable to cope at home.

Question 28

What are the normal investigations done for a patient admitted to the hospital with an acute exacerbation of COPD?

Answer 28

Full blood count, biochemistry, glucose, theophylline concentration (if on oral theophylline), blood gas DCG, chest X-ray, blood cultures (for febrile patients), and sputum for microbiology.

Question 29

How is supplemental oxygen managed for COPD patients during an exacerbation?

Answer 29

Supplemental oxygen is provided to maintain saturation between 88 to 92%, as too much oxygen therapy can suppress their respiratory drive and make them more drowsy.

Question 30

Define the concept of ‘hospital at home’ in the context of COPD exacerbation.

Answer 30

Hospital at home is an emerging concept where slightly enhanced care and monitoring is provided in the community for patients with acute exacerbation of COPD.

Question 31

What is the focus of chronic management for COPD patients?

Answer 31

The main focus of chronic management for COPD patients is on self-management, empowering patients with information and encouraging them to self-manage the condition.

Question 32

Describe the use of antibiotics in the management of COPD exacerbation.

Answer 32

Antibiotics are considered if there is evidence of bacterial infection, such as fever, increased volume or purulence of sputum. Intravenous antibiotics are given to patients who are too unwell to take tablets orally.

Question 33

What are the considerations for administering bronchodilators to COPD patients during an exacerbation?

Answer 33

Bronchodilators are delivered through a nebulizer for unwell patients, and if the patients are unwell, intravenous bronchodilators are given to those who are too unwell to take tablets orally.

Question 34

How is respiratory failure assessed in COPD patients during an exacerbation?

Answer 34

Respiratory failure is assessed by clinical assessment and arterial blood gas examination, and non-invasive ventilation is offered to patients who develop hypoxia and CO2 retention.

Question 35

Describe the purpose of the My COPD app.

Answer 35

The My COPD app designed to help patients manage their condition on their own, detect early exacerbation, and seek appropriate medical help.

Question 36

can patients approach end-of-life care for COPD?

Answer 36

Patients approaching end of life, particularly in a palliative state, should have their symptoms managed effectively with pharmacological treatments, psychological support, and consideration for referral to a palliative care team.

Question 37

Define anticipatory care plan in the context of COPD.

Answer 37

An anticipatory care plan involves having a conversation with the patient and family to determine their preferences for hospital admission, ceiling of treatment, ventilation, and CPR, particularly for patients likely to die of COPD.

Question 38

What are some recommended patient resources for COPD management?

Answer 38

Recommended resources include My Lungs My Life, Don’t Waste a Breath, and nodelays.co.uk, which provide information on self-management, inhaler technique, and when to seek correct medical advice.

Question 39

Describe the two broad categories of COPD management.

Answer 39

COPD management can be categorized into chronic management and acute management, with a focus on non-pharmacological and pharmacological approaches.

Question 40

What are some non-pharmacological approaches to COPD management?

Answer 40

Non-pharmacological approaches include vaccination, smoking cessation, pulmonary rehabilitation, weight management, and psychological support, as well as management of dysfunctional breathing.