management of COPD

Question 1

what are we treating In COPD?

Answer 1

• Improve their breathlessness
• Prevent exacerbations- particularly during winter.
• Improve exercise tolerance
• Nutrition/weight loss
• Further Complications such as respiratory failure, cor-pulmonale
• Dysfunctional breathing
  o Psychological and physiological breathing to help control their breathing

Question 2

Explain how to assess the severity of acute and chronic COPD.

Answer 2

• Normal FEV1 is 80%
• Moderate is 50-79%
• Acute is 30-59%
• Severe <30%

Question 3

hat happens during exacerbations? (worsening symptoms of COPD)

Answer 3

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

Question 4

Describe non-pharmacological aspects of COPD management.

Answer 4

• Smoking cessation services
• Vaccinations
  o Annual flu vaccine
  o Pneumococcal vaccine
• Pulmonary rehabilitation
• Nutritional assessment
• Psychological support

Question 5

• Pulmonary rehabilitation

Answer 5

o A comprehensive class where patients are seen by. Physiotherapists, taught how to do a shuttle walk (improve exercise tolerance), teach rebreathing techniques, smoking cessation adviser sees them, inhaler technique is seen, and a pharmacist too.
o Upper weight training to improve their muscle mass
o Dietician
- There are great benefits to this including relieving symptoms, preventing exacerbations and improve quality of life.

Question 6

Describe the classes of drugs and modes of delivery available in the management of obstructive lung diseases, COPD.

inhaled.

Answer 6

• Inhaled therapy:
• Short acting bronchodilators
  o SABA (salbutamol)
  o SAMA (ipratropium)

-	Long acting bronchodilators
o	LAMA (kick in slower but last longer. Long acting anti-muscarinic agents Umeclidinium, Tioptropium
o	LABA (long acting b agonist eg Salmeterol)

-	High dose inhaled corticosteroids (ICS) and LABA
o	Relvar (Fluticasone, vilanterol)
o	Fostair MDI

Question 7

another mode of delivery offered but not in Scotland

Answer 7

COPD- Long term oxygen (LTOT)
-	Someone needs to be hypoxic for PaO2 to be <7.3 kPa
-	PaO2 7.3-8 kPa 
o	polycythaemia 
o	nocturnal hypoxia 
o	peripheral oedema 
o	pulmonary hypertension

Question 8

another mode of delivery response to infection

Answer 8

o Most exacerbations are secondary to viral infection

o Used if there is evidence of infection (fever, increase in volume/purulence of sputum)

Question 9

when are they admitted to hospital?

Answer 9

o	Tachypneoa
o	Low oxygen saturation (SaO2 <90%)
o	Hypotension
o	Confusion
o	Cyanosis
o	Worsening peripheral oedema

Question 10

following hospital admission what investigations are examined?

Answer 10

• Full blood count
• Glucose levels
• Theophylline concentration (patients using a theophylline preparation)
• Arterial blood gas (documenting the amount of oxygen given and by what delivery device)
• Electrocardiograph
• Chest X-ray
• Microscopy of sputum

Question 11

Describe other treatment strategies which are important in the palliation of COPD.

Answer 11

• Management of breathlessness and dysfunctional breathing
  o Pharmacological- morphine
  o Psychological support
  o Palliative care when disease is ADVANCED
• Anticipatory care plan
  o Hospital admission
  o Ceiling of treatment- ward, HDU, ventilation
  o DNACPR (Do not resuscitate decision)

Patient education resources

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