COPD

Question 1

COPD Classification

Answer 1

GOLD 1 Mild FEV1 ≥ 80% predicted
GOLD 2 Moderate 50% ≤ FEV1 < 80% predicted
GOLD 3 Severe 30% ≤ FEV1 < 50% predicted
GOLD 4 Very Severe FEV1 < 30% predicted

Question 2

COPD
Risk Factors

Answer 2

Smoking (#1)
Occupational dust
Chemical exposure

Question 3

COPD
AECOPD Trigger

Answer 3

Viral URTI
Pneumonia
Environmental allergens or pollutants,
Smoking
CHF
PE
MI ≥ 80% predicted

Question 4

COPD
Assessment
Cardinal Symptoms

Answer 4

↑ SOB, ↑ sputum production, ↑ sputum purulence

Question 5

COPD
Assessment
Key Elements on History

Answer 5

Duration of symptoms
Severity of airflow limitation
Number of previous episodes (total/hospitalizations)
Co-morbidities
Premorbid functional status
Present treatment regimen
Previous use of mechanical
ventilation
Use of home oxygen

Question 6

COPD
Assessment
Clinical Signs of Severity

Answer 6

Rapid shallow pursed-lip breathing
Use of accessory muscles
Paradoxical chest wall movements
Worsening or new onset central
cyanosis
Peripheral edema
Hemodynamic instability
Decreased LOC or confusion
Decreased O2 sat.
Consider PE if deteriorating & not improving with standard COPD therapy

Question 7

COPD
investigations
Labs

Answer 7

CBC
CMP
VBG
Lactate
Respiratory Viral Panel

Question 8

COPD
Investigations
Tests

Answer 8

CXR
ECG
Pulse oximetry

Question 9

COPD
Management
Oxygen

Answer 9

Venturi masks (high-flow devices) preferred over nasal prongs
Target SaO2: >88% Goal PaO2 = 60-65mmHg

Question 10

COPD
Management
Bronchodilators

Answer 10

SABA: Salbutamol 2.5-5mg via nebulizer or 4-8 puffs via MDI with spacer
q15mins x3 PRN
Anticholinergic: Ipratropium bromide 500μg via nebulizer or 4-8 puffs
q15mins x3 PRN

Question 11

COPD
Management
Systemic Corticosteroids

Answer 11

Oral is equivalent to IV in most exacerbations
Oral Prednisone 40-60mg for 5-10 days
IV Methylprednisolone 125 mg BID-QID (for severe exacerbations or not
responding to oral steroids)

Question 12

COPD
Management
Antibiotics

Answer 12

Indication: ≥2 of:
1) ↑ sputum production
2) ↑ sputum purulence
3) ↑ SOB
Simple exacerbation:
Amoxicillin
2nd/3rd gen Cephalosporin
Macrolide
Doxycycline or TMP/SMX
Complicated exacerbation: Fluoroquinolone or Amoxicillin/Clavulanate

Question 13

COPD
Management
Ventilation

Answer 13

NIPPV such as CPAP or BiPAP (in respiratory acidosis severe dyspnea/distress

Question 14

COPD
Management
Intubation

Answer 14

For life-threatening exacerbations
Failed NIPPV
Altered LOC
Severe hypoxemia
Cardiovascular instability
Respiratory or cardiac arrest