Problem 4: Managing Exacerbation of COPD Flashcards
What is an infective exacerbation of COPD?
Symptoms of infective exacerbation include non-infective symptoms such as increased SoB, cough, increased sputum production. But WITH symptoms of an upper respiratory chest infection also
What is the difference between infective and non-infective COPD exacerbation?
Infection; severity / treatment needed varies
What are the signs and symptoms of infective exacerbation of COPD?
Symptoms of infective exacerbation include non-infective symptoms such as increased SoB, cough, increased sputum production. But WITH symptoms of an upper respiratory chest infection also
What tests and examinations are carried out in infective exacerbation diagnosis?
If infective, could be pneumonia. CURB-65 score to evaluate; Confusion, Urea level (BUN > 19 mg/dL), Respiratory rate > 30, Blood pressure <90mmHg / 60mmHg. Age > 65
Clinical management decisions made on score.
How is infective COPD exacerbation managed?
Two branches of management: at home or in hospital
Self-management: starting oral corticosteroid, starting abx therapy, adjusting bronchodilator therapy
Hospital: investigations in primary care / investigations in hospital and pulse oximetry.
NICe guidelines
Immediate treatment; SABA, SAMA, in bed stay enoxaparin
Antibiotics; amoxicillin 1st line, + clarithromycin in moderate to severe.
Consider doxycycline in allergic
Corticosteroids; prednisolone, 30mg OD 7 - 14 weeks
SE: diabetes, osteoporosis, muscle wastage and adrenal suppression
Oxygen therapy 88-92% sats
How are exacerbations of infective COPD prevented?
Vaccinations (flu and pneumococcal)
Patient education, avoiding pollutants etc and recognizing symptoms and signs early.
Explain how COPD affects the cardiovascular system?
7
Discuss how Cor Pulmonale is treated?
8
What is Cor Pulmonale?
Right sided heart failure
Increased strain and pressure on right ventricle (right ventricular hypertrophy). Increased pulmonary resistance due to hypoxia induced vasoconstriction. Wide spread vasoconstriction due to hypoxic alveoli - leads to hypertrophy and failure of right ventricle. Increase in JVP.
At receptor level, explain why ipratropium and tiotropium are not used concomitantly?
Ipratropium bromide is an anticholinergic (parasympatholytic) agent, which blocks the muscarinic receptors of acetylcholine, and, based on animal studies, appears to inhibit vagally mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released from the vagus nerve.
Tiotropium is a long-acting, antimuscarinic agent, which is often referred to as an anticholinergic. It has similar affinity to the subtypes of muscarinic receptors, M1 to M5. In the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilation.
Anticholinergic adverse effects ???
How is infective exacerbation diagnosed?
On examination / observation of:
- respiratory rate
- physical appearance (cyanosis)
- pulse rate
- temperature
Lab tests
- FBC for infection / anaemia
- Sputum cultures
- U+E tests
- Arterial blood gas (showing acidosis)
- Blood cultures in the patient is pyrexial
Chest x-ray
ECG - heart rhythm
