management of COPD

Question 1

symptoms of COPD

Answer 1

SOB 
constant cough and sputum 
recurrent chest infection 
loss of muscle mass and weight loss
cardiac disease
anxiety and depression

Question 2

what to treat in COPD

Answer 2

SOB 
prevent exacerbations 
nutrition/weight loss
complications 
anxiety/depression
co-morbidities
dysfunctional breathing 
palliative care

Question 3

why is SOB treated

Answer 3

improve exercise tolerance

Question 4

what effect do exacerbations of COPD have on health

Answer 4

every exacerbation leads to reductions in health

can predict mortality

Question 5

name 2 complications of COPD

Answer 5

cor pulmonale - pulmonary hypertension puts pressure on the heart
respiratory failure

Question 6

how is dysfunctional breathing treated

Answer 6

no pharmacological treatment, only psychological

anxious state –> deeper and harder breathing

Question 7

5 types of non-pharmacological management of COPD

Answer 7

smoking cessation 
vaccinations 
pulmonary rehabilitation
nutritional assessment 
psychological support

Question 8

smoking cessation

Answer 8

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

Question 9

pulmonary rehabilitation

Answer 9

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

Question 10

benefits of pulmonary rehabiliation

Answer 10

increased exercise capacity 
reduced perceived intensity of SOB
increased health-related QOL
reduced hospitalisation and hospital days 
reduced anxiety and depression in COPD

Question 11

nutritional assessment in COPD

Answer 11

BMI <19 often
small frequent meals
address weight increase/decreases

Question 12

vaccinations in COPD

Answer 12

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

Question 13

benefits of pharmacological management in COPD

Answer 13

relieves symptoms
prevents exacerbations
increases QOL

only pulmonary rehabilitation reduces mortality, not pharmacology

Question 14

inhaled therapy

Answer 14

short acting bronchodilators
long acting bronchodilators
high dose inhaled corticosteroids + LABA

Question 15

short acting bronchodilators

Answer 15

work in minutes, last 30mins, generally as reliever
SABA: salbutamol
SAMA: ipratropium

Question 16

long acting bronchodilators

Answer 16

LAMA e.g. umeclidinium, tiotropium

LABA e.g. salmeterol

Question 17

what does SAMA stand for

Answer 17

short acting muscarinic antagonist

ends it ‘-ium’

Question 18

do we give ICS alone in COPD

Answer 18

NO

increases chance of pneumonia

Question 19

long term oxygen therapy

Answer 19

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

Question 20

symptoms of acute exacerbation of COPD (AECOPD)

Answer 20

increased SOB 
cough 
increased sputum volume 
sputum purulence
wheeze
chest tightness

Question 21

primary care management of AECOPD

Answer 21

short acting bronchodilator
steroids
abx
consider hospital admission if unwell

Question 22

short acting bronchodilator in AECOPD

Answer 22

salbutamol +/- ipratropium

nebulised if unable to use inhaler

Question 23

steroids for AECOPD

Answer 23

known to reduce length of exacerbation

prednisolone 40mg/day, 5-7days

Question 24

abx for AECOPD

Answer 24

most exacerbations are 2y to viral infection

evidence of infection (fever, increased vol/purulence of sputum, crepitations)

Question 25

when to consider hospital admission for AECOPD

Answer 25

tachypnoea
low O2 sats (<90-92%)
hypotension etc

unable to cope at home, living alone, severe SOB, poor/deteriorating general condition, poor activity level, cyanotic, worsening peripheral oedema, impaired consciousness or acute confusion, already receiving LTOT, rapid rate of onset, significant co-morbidity, SaO2 <92%, changes on CXR

Question 26

AECOPD in 2y care investigations

Answer 26

FBC (check renal function)
biochem + glucose
theophylline conc (in pts using theophylline preparation)
ABG (also method and amount of O2 delivery)
ECG
CXR
blood culture in febrile pts
sputum microscopy, culture, sensitivity

Question 27

AECOPD ward based management

Answer 27

O2 target sat = 88-92%
nebulised bronchodilators
corticosteroids
abx
assess for evidence of resp failure (clinical, ABG)
in acute resp failure - non-invasive ventilation (NIV)

Question 28

palliative care for COPD

Answer 28

management of SOB and dysfunctional breathing
NIV if likely to die in next 2yrs
anticipatory care plan

Question 29

palliative management of SOB and dysfunctional breathing in COPD

Answer 29

pharmacological: low dose morphine to control SOB
psychological support
palliative care referral

Question 30

anticipatory care plan in palliative COPD management

Answer 30

discuss with patient
hospital admission
ceiling of treatment: ward based, HDU, ventilation
DNACPR