Acute exacerbation of COPD

Question 1

What is the most common cause of a bacterial infective exaccerbation of COPD?

Answer 1

Haemophilus influenzae

Question 2

What are the other possible causes of bacterial infective exacerbations of COPD?

Answer 2

Streptococcus pneumoniae
Moraxella catarrhalis

Question 3

What is the most common viral cuase of infective exacerbation of COPD?

Answer 3

human rhinovirus

Question 4

What are the presenting features of an infectiv exacerbation of COPD?

Answer 4

Increased breasthlessness, cough and wheeze
Increased sputum production
Hypoxia
Some cases: acute confusion

Question 5

What are reasons to admit someone with an acute exacerbation of COPD?

Answer 5

severe breathlessness
acute confusion or impaired consciousness
cyanosis
oxygen saturation less than 90%
social reasons- inability to cope at home
significant comorbidity (cardiac disease or diabetes)

Question 6

What is the medical management of an acute exacerbation of COPD?

Answer 6

Increase bronchodilator therapy (nebuliser)
Oral prednisolone
Antibiotics

Question 7

How much and for how long would you give oral prednisolone for an acute exacerbation?

Answer 7

30mg for 5 days

Question 8

What antibiotics woudl you consider giving someone with an acute exacerbation?

Answer 8

Amoxicillin
Clarithromycin
Doxycycline

Question 9

What is the initial oxygen saturation for someone presneting with a severe acute exacerbation of COPD?

Answer 9

Initial oxygen saturation target of 88-92% should be used

Question 10

What is the initial management of someone presenting with a severe acute exacerbation of COPD at risk of hypercapnia?

Answer 10

28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia

Question 11

What would you adjust the oxygen target to in someone with normal pC02 during a severe acute exacerbation?

Answer 11

94-98%

Question 12

What nebulised bronchodilator therapy would you consider in someone with an acute severe exacerbation?

Answer 12

beta adrenergic agonist: e.g. salbutamol
muscarinic antagonists: e.g. ipratropium

Question 13

What steroid therapy would you consider in someone with an acute severe exacerbation of COPD?

Answer 13

IV hydrocortisone may sometimes be considered instead of oral prednisolone

Question 14

What medication would you consider in someone with an acute severe exacerbation of COPD not responding to bronchodilator therapy?

Answer 14

IV theophylline

Question 15

What are patients with COPD prone to developing?

Answer 15

Type 2 respiratory failure

Question 16

What would you give if type 2 respiratory failure develops?

Answer 16

Non-invasive ventilation

Question 17

What form of non-invasive ventilation is typically used in someone with type 2 respiratory failure?

Answer 17

bilevel positive airway pressure (BiPaP)

Question 18

According to NICE, when would you only give antibiotics for an acute exacerbation of COPD?

Answer 18

In the presence of purulent sputum or clinical signs of pneumonia