Management of COPD

Question 1

What are the main clinical symptoms of COPD

Answer 1

• exertional breathlessness (airflow obstruction)
• chronic cough with sputum (airway inflammation)
• recurrent chest infection (susceptible)
• wheeze/chest tightness
• weight loss

Question 2

What is discoverable in a COPD patient upon examination

Answer 2

• loss of muscle tone
• cardiac disease
• depression/anxiety
• reduced chest expansion
• prolonged expiration
• hyperinflated chest (increased anterior/posterior diameter)

Question 3

Give five baseline tests to assist in a diagnosis of COPD

Answer 3

• chest x-ray
• ECG (heart disease can also cause breathlessness)
• full blood count (secondary polycythaemia/anaemia)
• BMI (lower = poorer prognosis)

Question 4

What are the four main aims in the management of COPD and how can these be addressed

Answer 4

• prevention of disease progression (stop smoking)
• relieve breathlessness (inhalers)
• prevention of exacerbation (vaccines/pulmonary rehabilitation)
• management of complications (long term oxygen)

Question 5

What is pulmonary rehabilitation

Answer 5

• a programme of exercise and education for people with long-term lung conditions
• combination of physical exercise, physio, pharmacist talks and sessions with psychologists
• improves muscle strength to use oxygen more efficiently
• improves general fitness to cope better with feeling out of breath

Question 6

What are the three classes of inhaled COPD therapy

Answer 6

• short acting bronchodilators
• long acting bronchodilators
• high dose inhaled corticosteroids

Question 7

When is long term oxygen (LTOT) indicated in patients with COPD

Answer 7

• when PaO2 is less than 7.3kPa

- when normal PaO2 is combined with polycythaemia/nocturnal hypoxia/peripheral oedema/pulmonary hypertension

Question 8

What are the main symptoms of AECOPD (acute exacerbation of COPD)

Answer 8

increasing;

• breathlessness (dyspnoea)
• cough
• sputum volume/purulence
• wheeze
• chest tightness

Question 9

How can AECOPD be managed by an outpatient

Answer 9

• short acting bronchodilators
• steroids
• antibiotics

Question 10

How can AECOPD be managed on the ward

Answer 10

• oxygen saturation
• nebulised bronchodilators
• corticosteroids
• antibiotics (oral/IV)
• non-invasive ventilation in the case of respiratory failure

Question 11

Give some non-pharmacological methods of COPD management

Answer 11

• smoking cessation
• vaccination
• pulmonary rehabilitation
• nutritional assessment
• psychological support