Exacerbation of COPD

Question 1

What are 6 possible clinical features of an acute exacerbation of COPD?

Answer 1

1. Dyspnoea
2. Cough
3. Wheeze
4. Increase in sputum production
5. Hypoxia
6. Acute confusion

Question 2

What is the most common bacterial organism that causes infective exacerbations of COPD?

Answer 2

Haemophilus influenzae

Question 3

What are the 3 commonest bacterial causes of infective COPD exacerbations?

Answer 3

1. Haemophilus influenzae
2. Streptococcus pneumoniae
3. Moraxella catarrhalis

Question 4

What proportion of COPD exacerbations are accounted for by respiratory viruses?

Answer 4

30%

Question 5

What is the most important virus that causes infective COPD exacerbations?

Answer 5

human rhinovirus

Question 6

What are 4 initial aspects of the management of COPD?

Answer 6

1. Give oxygen (? target saturations)
2. Nebulisers: salbutamol, ipratropium
3. Steroids: oral prednisolone or IV hydrocortisone
4. Antibiotics if any evidence of infection

Question 7

What is the course of prednisolone for COPD exacerbations?

Answer 7

30mg daily for 5 days

Question 8

When would IV hydrocortisone be given instead of prednisolone?

Answer 8

if the exacerbation is severe

Question 9

When do NICE recommend giving antibiotics to treat COPD exacerbations?

Answer 9

if sputum is purulent or there are clinical signs of pneumonia

Question 10

What are 3 of the options for first line oral antibiotics for a COPD exacerbation?

Answer 10

1. Amoxicillin
2. Clarithromycin
3. Doxycycline

Question 11

What are 5 possible investigations that you would perform in an acute exacerbation of COPD?

Answer 11

1. ABG
2. Chest x-ray
3. Blood tests: FBC, U+Es, LFTs, CRP
4. Sputum culture
5. ECG

Question 12

What important information will an ABG tell you to help guide the management of an infective exacerbation of COPD?

Answer 12

bicarb will tell you about whether they chronically retain CO2

if the bicarb is raised by 4 for every 1 that the PCO2 is increased, this suggests chronic retention, so aim for sats 88-92. if bicarb is raised by only 1 for every 1 raise in PCO2 this suggests it is not a chronic retention picture

Question 13

What are the next aspects of management is a COPD patient with an acute exacerbation is still not stabilised with nebulisers, steroids and antibiotics?

Answer 13

ITU input required, and consider non-invasive ventilation such as BiPAP

further deterioration is an indication for invasive ventilation

Question 14

What are the different colours of Venturi masks and their corresponding percentages?

Answer 14

• Blue: 24%
• White: 28%
• Yellow: 35%
• Red: 40%
• Green: 60%

Question 15

Which part of an ABG tells you the inspired oxygen?

Answer 15

FiO2 - inspired oxygen percentage

Question 16

In a healthy person, what should be the relationship between FiO2 and PaO2?

Answer 16

PaO2 should be approx. 10 less than the FiO2 (room air = 21%, normal PaO2 = 11kPa)