Management of COPD Flashcards
Multi system disease
not only affects the lungs and breathing :
- muscle wasting and weight loss
- pulmonary hypertension
- anxiety and depression
- obstructive sleep apnoea
- acute respiratory failure
Causes of COPD
- smoking
- air pollution and dust
- host factors
Who is a typical COPD patient ?
- aged over 35
- smoker
- presentation with cough or excessive sputum production
- frequent winter bronchitis
- not presenting with typical clinical features of asthma
Diagnosis
- history of symptoms
- cough
- sputum production
- dyspnoea
- history of exposure to risk factors
- objective evidence of obstruction
Investigations
- lung function tests
- peak expiratory flow
- arterial blood gases
- chest x ray
- sputum sample
- reversibility testing
Treatment goals
- smoking cessation
- vaccinations
- pharmacological therapy
- oxygenation and ventilatory support
- pulmonary rehabilitation
- end of life support
Abbreviations
LABA = LONG ACTING BETA 2 AGONIST
LAMA = LONG ACTING MUSACRINIC ANTAGONSITS
Benefits of combining LABA AND LAMA
- improved bronchodilation with minimal increase in the incidence of side effects
- improve symptoms and lung function
- greater impact on PROs
- reduces exacerbations
- most cost effective option
Inhaled steroids in COPD
- do not affect the rate of decline in FEV1
- beneficial effect on exacerbation rate in severe disease
- evidence to suggest the rate of decline in health status reduces
- suggestion ICS improve long term survival
Oral medications
Oral steroids ( eg. prednisolone ) = not usually recommended, advanced COPD when steroids cannot be fully withdrawn following exacerbation
Roflumilast - phosphodiesterase inhibitor - oral bronchodilator for severe COPD with chronic bronchitis
Mucolytics (EG. carbocisteine) = chronic cough, productive sputum
METHYLXANTHINES (EG. THEOPHYLINE ) - offered once inhaled therapy is optimise, add on therapy for breathlessness, drug interactions
Macrolide antibiotics ( azithromycin ) - specialist use only, reduce frequency of exacerbations, resistance
Antibiotics
common pathogens :
- streptococcus pneumonia
- haemophilus influenza
- Moraxella catarrhalis
AMOXICILLIN 500 MG TDS
CO-AMOXICLAV 635MG TDS
DOXYCYCLINE OR CLARITHROMYCIN
STEROIDS
PREDNISOLONE 30MG OM FOR 5 DAYS