Respiratory Flashcards
A 64-year-old man attends his general practitioner for a review of his chronic obstructive pulmonary disease (COPD).
His current treatment is limited to a salbutamol inhaler when required, and he reports using this at least 5-times daily and twice overnight, as he wakes up feeling breathless. He reports that, since his diagnosis, he has stopped smoking.
Further questioning reveals that the patient has never suffered from asthma, but has a severe peanut allergy for which he carries an adrenaline auto-injector.
Based on the above information, what is the most appropriate additional therapy to initial in this patient?
LABA + ICS
Which vaccinations should COPD patients recieve?
Annual influenza and one off pneumococcal
What are the indications for offering patients with COPD long term oxygen therapy?
Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
What is the most common organism causing infective exacerbations of COPD?
Haemophilus influenzae
What antibiotic is used prophylactically in certain groups of COPD patients to manage exacerbations?
Azithromycin
What is the main criteria for determining whether a patient with chronic obstructive pulmonary disease (COPD) should be offered long-term oxygen therapy?
Two arterial blood gases measurements with pO2 < 7.3 kPa
What are the asthmatic features/features suggesting steroid responsiveness in COPD?
previous diagnosis of asthma or atopy
a higher blood eosinophil count
substantial variation in FEV1 over time (at least 400 ml)
substantial diurnal variation in peak expiratory flow (at least 20%)
When should azithromycin (usually 250 mg 3 times a week) be considered for people with COPD?
If they:
do not smoke and
have optimised non-pharmacological management and inhaled therapies, relevant vaccinations and (if appropriate) have been referred for pulmonary rehabilitation and continue to have 1 or more of the following, particularly if they have significant daily sputum production:
frequent (typically 4 or more per year) exacerbations with sputum production
prolonged exacerbations with sputum production
exacerbations resulting in hospitalisation.
What constitutes Stage 1 (Mild) COPD?
FEV1 is >80% of what is expected.
What constitutes Stage 2 (Moderate) COPD?
FEV1 which is 50-79% of the predicted value
What constitutes Stage 3 (Severe) COPD?
FEV1 which is 30-49% of the predicted value.
What constitutes Stage 4 (Very severe) COPD?
FEV1 <30% of the predicted value.
What is the appropriate management for a secondary pneumothorax <1cm
admit and give oxygen for 24 hours and review
