Treatments Flashcards
What is the general management of COPD?
Smoking cessation, annual influenza vaccine and one-off pneumococcal vaccine
What bronchodilator therapy is offered to patients with COPD?
SABA (salbutamol) or SAMA (ipratropium) is first line treatment
After bronchodilators, how is the next step in COPD determined?
By the FEV1 value
If the FEV1 > 50%, what is the next step in treatment of COPD
LABA (salmeterol) or LAMA (tiotropium)
If the FEV1 < 50%, what is the next step in treatment of COPD?
LABA + ICS in a combination inhaler, or LAMA
What treatment is offered to patients with COPD who have persistent exacerbations of SOB?
If taking a LABA, switch to LABA-ICS combo
Otherwise give LAMA and LABA-ICS combo inhaler
When should you prescibe theophylline to patients with COPD?
After patient has trialled SABA and LABA or to patients who cannot used inhaled therapy
What should you prescribe for a patient with cor pulmonale?
Loop diuretic for oedem and consider long term oxygen therapy
When should LTOT be offered to patients with COPD?
Offer LTOT with patients with a pO2 of <7.3kPa or those with a pO2 of 7.3-8 kPA and one of the following:
- nocturnal hypoxaemia
- peripheral oedema
- pulmonary hypertension
What are the recommendations for a patient with primary pneumothorax?
If rim or air is < 2cm and patient is not SOB then discharge shoul dbe considered - otherwise aspirate patient
If this fails - insert chest drain
What are the recommendations for secondary pneumothorax?
If patient is > 50 and rim of air is > 2cm and/or patient is SOB then insert a chest drain
Aspiration attempted if rim of air is 1-2cm. All patients should be admitted for at least 24hrs
If pneumothorax is less than 1cm, then give oxygen and admit for 24hrs
What is Step 1 of asthma management?
Inhaled SABA as required
What is Step 2 of asthma management?
Add inhaled steroid at 200 - 800mcg/day - generally started at 400 mcg but variable with severity of disease
What is Step 3 of asthma management?
Add a LABA and assess control of asthma - if control with LABA is inadequate continue with LABA and increased inhaled steroid dose to 800mcg.
If there is no response to LABA; stop LABA and increased inhaled steroids to 800mcg. If control is still inadequate, trial other therapies (leukkotriene receptor antagonist or theophylline)
What is Step 4 of asthma management?
Consder trials of:
- Increasing inhaled steroid to 2000mcg/day
- Add a fourth drug (Leukotriene receptor antagonist, theophylline, B2 agonist tablet)
