Management of COPD

Question 1

What are some baseline tests that should be done to patients that present with suspected COPD (7) N.B anogram

Answer 1

Think Cab fec s - COPD patient can’t walk very far before being out of breath so they need a ‘cab (for) fec s (ake)’

Spirometry - FEV1, FVC - reduced in COPD

Chest x-ray - hyperinflation, flat hemidiaphragms,large central pulmonary arteries (due to increase in pressure so pulmonary hypertension caused by combo of hypoxia, inflammation and loss of capillaries in sever emphysema), decreased peripheral vascular markings (peripheral artery blood flow decreases due to RA and V hypertrophy - not enough blood blood being pushed out to periphery), bullae (large air space)

ECG - heart scan- shows rhythm and electrical activity
RA and V hypertrophy from cor pulmonale

FBC - full blood count.

BMI recorded

CT - bronchial wall thickening, scarring, air space enlargement

AAT deficiency test if below 50 y/o

Question 2

why would COPD cause high blood cell count

Answer 2

Low oxygen levels (chronic) because of these, the kidneys will compensate by increasing erythropoietin which stimulates bone marrow

Question 3

COPD management: how would you prevent disease progression?

Answer 3

smoking cessation

Question 4

COPD management: how would you relieve breathlessness

Answer 4

inhalers

Question 5

COPD management: how would you prevent exacerbation

Answer 5

inhalers, vaccines, pulmonary rehabilitation

Question 6

COPD management: how would you manage complications

Answer 6

long term oxygen therapy

Question 7

COPD – Non- Pharmacological

Management

Answer 7

Smoking Cessation
Vaccinations – Annual Flu vaccine – Pneumococcal vaccine

Pulmonary rehabilitation

Nutritional assessment

Psychological support

Question 8

Inhaled therapy:

short acting bronchodilators

Answer 8

works immediately but only for about half an hour

2 groups-
SABA – beta agonist
SAMA- anti-muscarinic

Question 9

Inhaled therapy:

long acting bronchodilators

Answer 9

takes longer to start working but works for longer

Question 10

What are high dose inhaled corticosteroids (ICS) always given with?

Answer 10

ICS are steroids and always given with a bronchodilator!

Question 11

if FEV1 is >50 % after SABA or SAMA then what treatment do you give?

Answer 11

Long acting beta 2 agonist (LABA) and if that doesn’t work then can add LABA together with an inhaled corticosteroids (2 together) or again if that doesn’t work ALL 3 then a LAMA + LABA/ICS combination inhaler

OR

Long acting muscarinic antagonist (LAMA)

Question 12

if FEV1 is <50 % after SABA or SAMA then what treatment do you give?

Answer 12

Long acting beta 2 agonist (LABA) and inhaled corticosteroids as combination inhaler

OR

Long acting muscarinic antagonist (LAMA)