management of COPD Flashcards
(30 cards)
symptoms of COPD
SOB constant cough and sputum recurrent chest infection loss of muscle mass and weight loss cardiac disease anxiety and depression
what to treat in COPD
SOB prevent exacerbations nutrition/weight loss complications anxiety/depression co-morbidities dysfunctional breathing palliative care
why is SOB treated
improve exercise tolerance
what effect do exacerbations of COPD have on health
every exacerbation leads to reductions in health
can predict mortality
name 2 complications of COPD
cor pulmonale - pulmonary hypertension puts pressure on the heart
respiratory failure
how is dysfunctional breathing treated
no pharmacological treatment, only psychological
anxious state –> deeper and harder breathing
5 types of non-pharmacological management of COPD
smoking cessation vaccinations pulmonary rehabilitation nutritional assessment psychological support
smoking cessation
all patients should have access to smoking cessation services
long term benefit is key - helps reduce the overall decline
smoking increases rate of lung function decline
pulmonary rehabilitation
2x/wk for 6wks talk through nature of disease specialists brought to patient physios - shuttle walking pharmacists - check inhalers and techniques weight training to increase muscle mass psychological support
benefits of pulmonary rehabiliation
increased exercise capacity reduced perceived intensity of SOB increased health-related QOL reduced hospitalisation and hospital days reduced anxiety and depression in COPD
nutritional assessment in COPD
BMI <19 often
small frequent meals
address weight increase/decreases
vaccinations in COPD
annual flu vaccine
5 yrly pneumococcal vaccine - reduced COPD hospitalisation, reduced all cause morality
both vaccines: reduced COPD hospitalisation, reduced all cause mortality
vaccines reduce severity of illness
benefits of pharmacological management in COPD
relieves symptoms
prevents exacerbations
increases QOL
only pulmonary rehabilitation reduces mortality, not pharmacology
inhaled therapy
short acting bronchodilators
long acting bronchodilators
high dose inhaled corticosteroids + LABA
short acting bronchodilators
work in minutes, last 30mins, generally as reliever
SABA: salbutamol
SAMA: ipratropium
long acting bronchodilators
LAMA e.g. umeclidinium, tiotropium
LABA e.g. salmeterol
what does SAMA stand for
short acting muscarinic antagonist
ends it ‘-ium’
do we give ICS alone in COPD
NO
increases chance of pneumonia
long term oxygen therapy
not everyone will need it
not given to smokers
given when patient is hypoxic at rest of O2 levels at PaO2 <7.3kPa
OR
PaO2 7.3-8kPa if polycythaemia, nocturnal hypoxia, peripheral oedema, pulmonary hypertension
symptoms of acute exacerbation of COPD (AECOPD)
increased SOB cough increased sputum volume sputum purulence wheeze chest tightness
primary care management of AECOPD
short acting bronchodilator
steroids
abx
consider hospital admission if unwell
short acting bronchodilator in AECOPD
salbutamol +/- ipratropium
nebulised if unable to use inhaler
steroids for AECOPD
known to reduce length of exacerbation
prednisolone 40mg/day, 5-7days
abx for AECOPD
most exacerbations are 2y to viral infection
evidence of infection (fever, increased vol/purulence of sputum, crepitations)
