Medicines for Acute Exacerbation of COPD

Question 1

Dose of salbutamol for COPD exacerbation

Answer 1

salbutamol 100microg, up to 10 separate actuations via pMDI with spacer, repeated as needed

OR

salbutamol 2.5 to 5mg by inhalation via nebuliser

Question 2

What type of drug is terbutaline (Bricanyl)

Answer 2

B2-adrenoceptor agonist (used as a ‘reliever’ inhaler)

Question 3

Dose of terbutaline (Bricanyl) in COPD exacerbation

Answer 3

terbutaline 500microg, 1 to 2 actuations via DPI (dry powder inhaler), repeated as needed

Question 4

Dose of ipratropium bromide (Atrovent) in COPD exacerbation

Answer 4

ipratropium bromide, 21microg, up to 6 separate inhalations via pMDI with spacer, as needed

OR

ipratropium bromide, 250 to 500microg by inhalation via nebuliser, as needed

Question 5

Dose of prednis(ol)one for acute exacerbation of COPD

Answer 5

prednis(ol)one 30 to 50mg orally, once daily in the morning for 5 days

OR (if pt unable to tolerate oral therapy)

hydrocortisone 100mg IV, 6-hourly

Convert to oral therapy ASAP. If corticosteroid therapy has been less than 2 weeks duration, can safely stop abruptly without need for weaning.

Question 6

Is sputum culture recommended in acute exacerbation of COPD

Answer 6

No - as many pts with COPD are consistently colonised with H. influenzae, Moraxella catarrhalis &/or Strep pneumonia … so a +ve culture does not necessarily mean acute infection

Question 7

Are ABx always needed for acute exacerbations of COPD

Answer 7

No - if mild/moderate and managed on an outpatient basis, ABx does not consistently improve outcomes and can be withheld safely in many cases

Question 8

What ABx for acute exacerbation of COPD

Answer 8

amoxycillin 500mg orally, 8-hourly for 5 days

OR

doxycycline 200mg orally, for the first dose, then 100mg daily for a total treatment duration of 5 days

(Both are first-line, so can choose either)

Question 9

What SpO2 should you aim for in a pt with acute exacerbation of COPD

Answer 9

88 to 92%

Question 10

What are some adverse effects of theophylline

Answer 10

• Severe nausea and vomiting
• Diarrhoea
• Reflux
• Headache, irritability, anxiety
• Insomnia
• Tremor
• Palpitations
• Risk of toxicity due to narrow therapeutic range

NB: theophylline should be taken with food to avoid GIT upset. Do not crush the tablet.

Question 11

Side effects of B2 agonist

Answer 11

• Urinary retention
• Constipation
• Blurred vision
• Dry mouth
• Tremor
• Palpitations
• Hypokalaemia can occur with high doses and may be worsened by corticosteroids, diuretics, theophylline and hypoxia
• However, if inhaled, usually minimal systemic absorption

Question 12

How long until ipratropium bromide reaches peak effect

Answer 12

1.5 to 2 hours

Question 13

Duration of action of ipratropium bromide

Answer 13

6 hours

Question 14

Give some examples of long-acting B2 agonists

Answer 14

salmetorol, eformoterol

Question 15

What is the duration of action of long-acting B2 agonists

Answer 15

~12 hours (over twice the duration of action of short-acting B2 agonists)

Question 16

What are indications for inhaled corticosteroids in COPD

Answer 16

FEV1

Question 17

What is the onset and duration of action of B2 agonists?

Answer 17

B2 agonists

• -> Onset = 5-10 min
• -> Duration of action = 3-6hrs