COPD exacerbation

Question 1

Common causes of bacterial exacerbations

Answer 1

H.influenzae
Strep pneumoniae
Moraxella catarrhalis

Question 2

Common causes of viral exacerbations

Answer 2

30%, human rhinovirus is most common

Question 3

Features of exacerbation

Answer 3

Increase dypnoea, cough, wheeze, increase in sputum, hypoxic, acute confusion

Question 4

When should patients be admitted with COPD

Answer 4

Severe breathlessness, acute confusion or impaired consciousness, cyanosis, O2 sats <90, social reasons, significant co-morbidity

Question 5

What oxygen therapy should be started

Answer 5

28% venturi mask at 4L/min and aim for 88-92%

Question 6

Pharmacological agents used in exacerbations of COPD

Answer 6

Nebulised bronchodilator with salbutamol and ipatropium. IV hydrocortisone or oral prednisolone.

Question 7

When can IV theophylline be used

Answer 7

Considered when patients are not responding to nebulised bronchodilators

Question 8

What to do when type 2 respiratory failure develops

Answer 8

Non invasive ventilation such as BiPaP - Expiratory and inspiratory positive airway pressure initial settings