COPD

Question 1

What is involved in non-pharmacological management of COPD?

Answer 1

Lifestyle changes e.g. smoking cessation
Patient education
Pneumococcal vaccination

Question 2

Describe the pharmacological management of stable COPD?

Answer 2

Inhaled therapy:
SABA as needed for all
LABA + LAMA if no features of asthma or steroid responsiveness
LABA + ICS if features of asthma or steroid responsiveness
Combined LABA + LAMA + ICS as next step if needed

Oral therapy:
Oral steroids not generally used long-term, but may be started by specialist
Mucolytics if chronic productive cough
Prophylactic antibiotics is frequent serious exacerbations
Roflimulast in severe COPD with mainly chronic bronchitis
Theophylline if unable to use inhaled therapy

Question 3

What are the criteria for long-term oxygen therapy in COPD?

Answer 3

PaO2 <7.3 kPa when stable OR

PaO2 7.3 - 8kPa when stable plus one of: polycythaemia, peripheral oedema, pulmonary hypertension

Question 4

What surgical options are available for COPD?

Answer 4

Bullectomy
Lung reduction surgery
Transplant

Question 5

What are the potential complications of COPD?

Answer 5

Acute Exacerbations (usually infectious)
Recurrent pneumonia
Lung cancer
Bronchiectasis
Pneumothorax
Polycythaemia
Anaemia
Depression
Cor pulmonale 
Respiratory failure

Question 6

What are the management options for acute exacerbations of COPD?

Answer 6

Oral corticosteroids
Inhaled / nebulised salbutamol
Oxygen
Antibiotics (if infectious exacerbation)
Airway management - invasive ventilation, BiPAP
IV theophylline