Management of COPD Flashcards
What is COPD
- airflow obstruction
- not fully reversible
State the symptoms and clinical signs of COPD
- breathlessness ( no degree of variability) ; gradual onset
- cough ( productive, clear/white.. green/yellow in exacerbation sputum)
- Wheeze - on exertion
- weight loss
- peripheral oedema ( indicative of disease ( cor pulmonale and RF)
- Recurrent Chest infection
Signs
- use of accessory muscles
- pursed lip breathing
- hyperinflated chest ( fewer than 3 fingers between circoid cartilahge and manubrium)
- central cyanosis
Non-pharmalogical management of COPD
- smoking cessation
- vaccinations ( annual flu vaccine or pneumococcal vaccine)
- pulmonary rehabilitation
Pharmalogical management of COPD
Short acting bronchodilators; SABA( salbutamol) & SAMA (ipratropium)
Long acting bronchodilators
- LAMA ( long acting anti-muscarinic agents ( umeclidinium, tioptropium)
- LABA ( long acting B2 agonist , salmeterol)
High dose inhaled corticosteroids ( ICS) and LABA
- Relvar ( fluticasone/vilanterol)
- fostair MDI
COPD - Long Term Oxygen ( LTOT)
PaO2 < 7.3kpa or PaO2 7.3-8kpa if :
Polycythaemia
noctornal hypoxia
peripheral oedema
pulmonary hypotension
COPD exacerbation symptomd
Increased:
- breathlessness
- cough
- sputum volume/pureulence
- wheeze
- chest tightness
Signs
- confusion, cyanosis, drowsiness
- fever, flapping tremor ( type 2 resp failure)
- wheeze, oedema
AECOPD - primary care management
Short acting bronchodilators
- Salbutamol and/or iptratropium
- nebulisers if cannot use inhalers
Steroids
-predinosolone 40mg/day for 5-7 days
Antibiotics
-most exacerbations secondary to infection
Consider Hospital admission if unwell
- tachypneoa
- Low O2 saturation ( <90-92 %)
- hypotension
Tackle underlying cause:antibiotics
Improve oxygenation
- O2
- non-invasive ventilation
ECOPD - ward based management
O2 target saturation 88-92%
- nebulised bronchodilators
- corticosteroids
- antibiotics ( oral vs IV)
Investigations of COPD
-Spirometry
-Full Pulmonary function tests
-He dilution - gas trapping
-higher RV/Higher total lung capacity
RV/TLC= <30%
CO gas transfer
in abnormal alveoli=low gas trasnsfer
-low TLCO/KCO
CXR; hyperinflation, flattened diaphragm, bulla
Arterial blood gas; desaturate on excercise, at rest normal
Sputum culture
FBC
Symptoms of COPD
- breathlessness ( no variability)
- cough ( productive)
- mucous green/white/yellow in exacerbation sputum
- wheeze
- weight loss
- peripheral oedema ( can be linked to cor pulmonale + respiratory failure)
- Use of accessory muscles
- pursed lip rbeathing
- CO2 flapping ( due to hypercapnia)
- prolonged expiration
- paradoxical movement of lower ribs
- central cyanosis
Fine tremor ( overuse of B2 agonists)
Organisms likely to cause exacerbation COPD
S.pneumonia
H.influenza
M.catarrhalis
Treatment of COPD
- pharmacotherapy
- inhaled sreroi
