Management of COPD Flashcards
Symptoms of COPD?
breathlessness- emphysema causing impaired gas exchange
cough and recurrent chest infection- chronic bronchitis
What are the other systemic aspects of COPD?
loss of muscle mass
weight loss
cardiac disease
depression, anxiety etc..
What to treat in COPD?
improve exercise tolerance
prevent exacerbations
nutrition/ weight loss
complications (cor-pulmonale, resp failure etc.)
anxiety/ depression
co-morbidities
dysfunctional breathing
palliative care
What is the non-pharmacological management of COPD?
smoking cessation
vaccinations - pneumococcal vaccination
pulmonary rehabilitation - individualised exercises
nutritional assessment
psychological support
What is the inhaled therapy offered?
Short acting bronchodilators
SABA -salbutamol
SAMA- Ipratropium
Long acting bronchodilators
-LAMA (Long acting muscarinic agents e.g. umeclidinium, Tioptropium)
-LABA (Long acting Beta 2 agonist, eg -salmeterol)
High dose inhaled corticosteroids (ICS) and LABA
-Relvar (Fluticasone/vilanterol)
-Fostair MDI
What is the treatment ladder for COPD patients with predominant breathlessness?
SABA
SABA and LAMA
SABA+LAMA/LABA
then all three classes
What is the treatment ladder for COPD with repeating exacerbations?
LAMA + SABA
SABA + LAMA/LABA
What is the criteria for Long term oxygen?
stopped smoking for at least 6 months
hypoxic
paO2 <7.3kPa
or PaO2 7.3-8kPa if have second organ dysfunction
Standards for the diagnosis and management of patients with COPD?
at risk- smoking cessation
symptomatic- disease management and pulmonary rehabilitation
then oxygen therapy
What will a COPD exacerbation be due to?
mainly due to infection - viral
symptoms of COPD exacerbation?
increasing breathlessness
cough
sputum volume
sputum purulence
wheeze
chest tightness
Primary care management for acute exacerbation of COPD?
short acting bronchodilators
-salbutamol and / or ipatropium
-nebulisers if cannot use inhalers
steroids
-prednisolone 40mg per day for 5-7 days
antibiotics
-if evidence of infection
consider hospital admission if unwell
-tachypneoa
-low oxygen saturation
-hypotension
Investigations required in patients admitted to hospital after acute COPD exacerbation?
full blood count
biochemistry and glucose
theophylline concentration (if on oral theophylline)
arterial blood gas
electrocardiograph
chest x ray
blood cultures in febrile patients
sputum, microscopy, culture and sensitivity
What is the ward based management of acute exacerbation AECOP?
oxygen target saturation
nebulised bronchodilators
corticosteroids
antibiotics (oral vs Iv)
assess for evidence of respiratory failure
-clinical
-arterial blood gas
What happens to patients with acute respiratory failure?
hypoxic and develop CO2 retention
offered non invasive ventilation
