Management of COPD

Question 1

Which form of COPD is Airflow obstruction Hyperinflation?

Answer 1

Chronic Bronchitis

Emphysema

Question 2

Is COPD reversible?

Answer 2

Not fully

Is progressive

Question 3

What is the 3rd leading cause of death in the world?

Answer 3

COPD

Question 4

How do you diagnose COPD?

Answer 4

• Relevant History (Symptoms)
• Look for clinical signs
• Confirmation of diagnosis and assessment of severity
• Other relevant tests

Question 5

What are the different ways you can witness respiratory failure?

Answer 5

• Tachypnea
• Cyanosis
• Use of accessory muscles
• Pursed lip breathing
• Peripheral Oedema
• Ankle swelling, strain on right side of heart

Question 6

What is the use of spirometry in COPD?

Answer 6

Confirms diagnosis and assesses severity

Question 7

How do you analyse the results of a spiromtry to confirm COPD?

Answer 7

Question 8

How do you assess the severity of COPD using FEV1/FVC?

Answer 8

Question 9

What are the COPD baseline tests?

Answer 9

Spirometry - record absolute and % predicted value

CXR

ECG

FBC - Anaemic, polycthaemic, eosinophilia

BMI - weight, height

AIAT - Age of onset < 50

Anaemia can present as breathlessness

High blood cell count can be a sign of COPD

Polycthaemia = Increased RBC’s

AIAT is antitrypsin

Question 10

LOOK

Answer 10

Question 11

What are the different ways COPD is managed

Answer 11

Non-pharmacological

Pharmacological

Question 12

What are the Non-pharmacological treatments

Answer 12

• smoking cessation
• vaccination (flu yearly + pneumococcal every 5 years)
• pulmonary rehab
• nutritional assessment
• psychological support

Question 13

What does pulmonary rehabilitation involve?

Answer 13

Question 14

What are the benefits of Pulmonary Rehabilitation?

Answer 14

Question 15

What are the ways you can manage COPD?

Answer 15

Prevention of disease progression

Releive breathlessness

Prevention of exacerbation

Management of complications

Question 16

What is the interventions for the following aims

Prevention of disease progression

Releive breathlessness

Prevention of exacerbation

Management of complications

Answer 16

• Smoking cessation
• Inhalers
• Inhalers, Vaccines, Pulmonary Rehabilitation
• Long term Oxygen therapy

Question 17

What are the benefits of Pharmacological Management?

Answer 17

• Relieve symptoms
• Prevent exacerbations
• Improve QoL

Question 18

What the pharmacological management for COPD with SOB

Answer 18

1. SABA Salbutamol blue inhaler/Terbutaline
2. SABA+LAMA
3. SABA+LAMA/LABA (Salmeterol)

Question 19

What is the treatment for COPD with exacerbation

Answer 19

1. SABA+LAMA
2. SABA+LAMA/LABA
3. SABA+LAMA/LABA/ICS

Question 20

What are the short acting bronchodilators used in inhaled therapy in COPD?

Answer 20

Question 21

What are the long acting bronchodilators used to treat COPD?

Answer 21

Question 22

What are examples of High dose inhaled corticosteroids (ICS and LABA)

Answer 22

Question 23

How does the COPD inhaler treatment progress with severity, symptoms and exacerbation?

Answer 23

Question 24

When is it appropriate to use Oxygen with a COPD patient

Answer 24

Hypoxia with:

PaO2< 7.3 kPa

PaO2 7.3-8 kPa if:

• with second organ dysfunction
• polycthaemia
• nocturnal hypoxia
• peripheral oedema
• pulmonary hypertension

Question 25

What intervensions are used at different stages of COPD

Answer 25

Question 26

What are the symptoms of COPD exacerbation?

Answer 26

Increasing breathlessness Cough Sputum volume Sputum purulence Wheeze Chest tightness

Question 27

What is the effect of AECOPD on alveoli and mucus glands (including goblet cells)?

Answer 27

Alveolar wall destruction and mucus hypersecretion

Question 28

What does management of AECOPD involve?

Answer 28

* SA bronchodilators (salbutamol, ipratropium) * Change inhalers * Oral steroids (Prednisolone) * Antibiotics Admit if * Tachypnoea * Low O2 \< 90-92% * Hypotension

Question 29

What are the relevant AECOPD investigations?

Answer 29

FBC Biochemistry of glucose Theophyline concentration (in using theophyline) ABS ECG CXR Blood cultures in febrile patients Sputum Microscopy (ABS=Arterial blood gas)

Question 30

What are the different palliative care methods for COPD

Answer 30

Breathlessness/Dysfunctional breathing: * Pharmacological - Morphine * Psychological support * Palliative care referral