Lecture 11: Exacerbations of asthma and COPD

Question 1

What are the signs and symptoms of severe asthma?

Answer 1

• peak expiratory flow rate 33-50%
• Unable to talk in sentences
• Respirtory rate >25
• Pulse >110

Question 2

What are the signs and symptoms of moderate asthma?

Answer 2

• peak expiratory flow rate 50-75%

Question 3

What is the treatment got severe asthma?

Answer 3

• referral to hospital – may not need admission
• Oxygen 40 – 60% via a Venturi mask
• oral corticosteroid- As prednisolone 40 – 50 mg
• Nebulised SABA
• Nebulised SAMA if needed

Question 4

What are the clinical signs of life threatening asthma?

Answer 4

• Altered conscious level
• Exhaustion
• Arrhythmia
• Hypotension
• Cyanosis
• Silent chest
• Poor respiratory effort

Question 5

What are the measurements for life threatening asthma?

Answer 5

• PEFR < 33% predicted or best
• SpO2 <92%
• PaO2 < 8 kPa
• ‘normal’ PaCO2 (4.6 – 6.0 kPa)

Question 6

What is the treatment for life threatening asthma?

Answer 6

• immediate hospital admission
• Nebulised beta agonists & ipratropium (oxygen as the driving gas)
• Oral corticosteroids – prednisolone 40 – 50 mg daily
• Oxygen if SpO2 < 92%, PEFR < 60% normal/best; Target 94-98%
  -IV aminophylline, salbutamol or terbutaline
• IV magnesium may be useful
• IV fluids/electrolytes especially K

Question 7

What patient monitoring is required in asthmatic patients?

Answer 7

• Respiratory rate
• Pulse – will return to normal despite SABA
• Oxygen saturation – aim for 94 – 98%
• PEFR (before and after SABA)
• Blood gases if indicated

Question 8

When are asthmatic patients discharged?

Answer 8

When stable and diurnal variation is less than 25%

Question 9

How do you treat mild exacerbations of COPD?

Answer 9

short acting bronchodilators (SABD)

Question 10

How do you treat moderate exacerbations of COPD?

Answer 10

SABDs plus A/Bs and/or oral ccs

Question 11

How do you treat severe exacerbations of COPD?

Answer 11

Hospitalization required and may be associated with acute respiratory failure

Question 12

What are the symptoms of exacerbation of COPD?

Answer 12

• Increased breathlessness
• Increased cough
• Increased sputum volume or purulence
• Increased wheeze
• Increased chest tightness- malaise, reduced exercise tolerance, peripheral oedema, accessory muscle use, confusion, cyanosis

Question 13

What are the causes of COPD exacerbations?

Answer 13

• Viral
• Bacterial
• Environmental pollutants

Question 14

What is the treatment of exacerbations of COPD?

Answer 14

• Bronchodilators (SABA +/- SAMA): Nebulised using air not oxygen, Inhaler may be suitable
• Prednisolone: 30mg daily for 7 – 14 days
  No need for tapering dose if less than 21 days
• Oxygen
• Antibiotics

Question 15

What are the likely oathogens that cause COPD exacerbations?

Answer 15

• Strep pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis

Question 16

What antibiotics are used to treat COPD exacerbations

Answer 16

• Amoxicillin 500mg every eight hours
• Doxycycline 200mg as a single dose then 100mg each day
• Clarithromycin 500mg every twelve hours