Respiratory 5 - COPD Flashcards
define COPD and its main symptoms
irreversible obstructive airways disease usually due to long term smoking
FEV/FVC <70%
SOB, cough, sputum, frequent infections
grading level of breathlessness in history
ask about exercise, up a hill, on the flat, if they can leave home
8 investigations if you suspect COPD post spirometry
CXR - exclude pathology FBC - Hb BMI sputum culture ECG, Echo CT thorax - exclude fibrosis, cancer, bronchiec serum A1AT TLCO levels - indicates severity
steps 1, 2a or 2b in COPD management
additional options if very severe
1 - SABA or SAMA (salbutamol or ipratropium)
2a - not asthmatic or steroid responsive - LABA + LAMA combination inhaler
2b - asthmatic features or steroid responsive - LABA + ICS (Fostair,Symbicort)
nebs theophylline carbocysteine azithromycin prophylaxis long term O2 therapy
3 indications for long term O2 therapy at home in COPD + when can’t they have it
chronic hypoxia
polycythaemia
heart failure
NO if they smoke - kaboom!
explain COPD blood gas + oxygen therapy
if they have high bicarb, suggests they are a chronic retainer of CO2
type 2 resp failure
if retainer, keep in 88-92% range
summarise management of exacerbation of COPD
ABCCE approach
involve seniors early
CXR,ABG, sputum culture ECG, FBC, UE, blood cultures
summarise venturi masks
blue - 24% white - 28% orange - 31% yellow - 35% red - 40% green - 60%
useful for COPD patients to titrate O2 needs
3 x treatment if at home with exacerbation of COPD
pred 30mg OD 1-2 weeks
inhalers+nebs
Abx
4 aspects of hospital treatment for acute ex COPD
neb salbutamol + ipratropium
steroids
IV Abx
physio
4 things to consider in severe acute exCOPD
IV aminophylline
BIPAP /CPAP
intubation / ventilation ITU
doxapram if can’t intubate (respiratory stimulant)
