Treatment Flashcards
What is the first line of treatment for COPD?
Smoking cessation
What is involved in smoking cessation?
- Professional advice
- Nicotine replacement
- Antidepressants (bupropion)
- Nicotine receptor blockers (varenicline)
What is the treatment ladder in COPD?
- Start a SABA or SAMA
- Start a LABA + LAMA (if no asthmatic or steroid responsive features) or LABA + ICS (if asthmatic or steroid responsive features)
- Start LABA + LAMA + ICS
- Escalate to specialist care:
Nebulisers
Oral theophylline
Carbocisteine (mucolytic)
Long-term prophylactic antibiotics
LTOT
When would you step up from a SABA or SAMA?
If patient remains breathless or has exacerbations
What are asthmatic or steroid responsive features?
- Any previous diagnosis of asthma or atopy
- Higher blood eosinophil count
- Substantial variation in FEV1 over time (at least 400ml)
- Substantial diurnal variation in PEF (at least 20%)
When would you give triple therapy (LABA + LAMA + ICS)?
If patient has a severe exacerbations (requiring hospitalisation) or they have 2 moderate exacerbations within a year
What would you do if after 3 months from changing from a LABA + LAMA to triple therapy, the patient’s symptoms have not improved?
Go back to LABA + LAMA
When would a patient be referred for LTOT?
- SpO2 <92% breathing air
- PaO2 <7.3kPa on air when stable
- PaO2 7.3-8kPa when stable + 1 of the following:
Secondary polycythaemia
Peripheral oedema
Pulmonary HTN - FEV1 < 50%
- Cyanosis
- Raised JVP
What inhalers are salbutamol (SABA) inhalers?
Ventolin
Airomir
Salamol easi-breathe
BLUE
What inhalers are terbutaline (SABA) inhalers?
Bricanyl
WHITE
What inhalers are salmeterol (LABA) inhalers?
Serevent
GREEN
What inhalers are formoterol (LABA) inhalers?
Oxis
BLUE/GREEN
What are the side effects of B2 agonists?
- Tachycardia
- Arrhythmias
- Myocardial ischaemia
- Tremor
- Paradoxical bronchospasm
- Hypokalaemia
What inhalers are ipratropium (SAMA) inhalers?
Atrovent
GREEN
What inhalers are tiotropium (LAMA) inhalers?
Spiriva
GREEN
What are the side effects of Anti-muscarinic/anti-cholinergic drugs?
- Dry mouth
- Nausea
- Headache
What cautions must you consider when giving Anti-muscarinic/anti-cholinergic drugs?
- Prostatic hyperplasia and bladder outflow obstruction
* Patients susceptible to glaucoma
What inhalers are beclomethasone inhalers?
Becotide
BROWN
What inhalers are budesonide inhalers?
Pulmicort
BROWN
What inhalers are combined budesonide and formoterol?
Symbicort
RED
What inhalers are fluticasone inhalers?
Flixotide
BROWN
What inhalers are combined fluticasone and salmeterol?
Seretide
PURPLE
What are the side effects of ICS?
- Candidiasis
- Hoarseness
- Adrenal suppression
- Osteoporosis
- Growth restriction in children
What are the signs of theophylline toxicity?
- Tachycardia
- Arrhythmias
- Agitation
- Convulsions
- Hypokalameia
- Levels can increase in sepsis and viral infections
What are the common drug interactions with theophylline?
- Ciprofloxacin and OCP reduce clearance
* Anticonvulsants increase clearance
How can patients prevent COPD exacerbations?
- Vaccination – influenza, pneumococcal
- Oxygen – short burst for symptoms or >15 hrs/day
- Physiotherapy
- Pulmonary rehabilitation
- End of life care
What oxygen masks are used for COPD and why?
Venturi masks
• Can give a defined concentration of inspired oxygen
• Used in COPD where it is important not to over-ventilate the patient
What oxygen saturations do we aim for in COPD patients?
88-92%
