Resp - Acute Exacerbation Of COPD

Question 1

Causes

Answer 1

• URTI (30%)

- Bacterial infections

Question 2

Presentation

Answer 2

• cough + sputum
• breathless
• wheeze
• look very unwell

Question 3

Ix

Answer 3

• PEFR
• Bloods: FBC, U+E, ABG, CRP, cultures
• Sputum culture
• CRX: infection/pneumothorax
• ECG

Question 4

Differential

Answer 4

• Pneumothorax
• Pulmonary oedema
• PE
• Asthma
• Pneumonia

Question 5

Important factors when planning discharge

Answer 5

• Spirometry
• establish optimal maintenance therapy
• GP/specialist f/u
• home oral steroids and ABC
• pneumococcal + flu vaccine
• home assessment

Question 6

Mx of acute exacerbation - O2 therapy

Answer 6

• Sit pt up
• 24% via venture mask: 88-92%
• Vary FiO2/SpO2 target according to ABG
• Aim for PaO2 >8 and PCO2 <1.5 kPa

If no response to Rx: consider NIV, esp if pH <7.26

Question 7

Mx of acute exacerbation -nebulised bronchodilators

Answer 7

• Salbutamol: 5mg/4h

- ipratropium: 0.5mg/6h

Question 8

Mx of acute exacerbation - Steroids

Answer 8

• Hydrocortisone 200mg IV

- Prednisolone 40mg PO for 7-14d

Question 9

Mx of acute exacerbation - ABX

Answer 9

• only give if evidence of infection

- Doxy 200mg PO stat when 100mg OD PO 5d