COPD

Question 1

What are some causes of possible COPD exacerbations?

Answer 1

• using the puffers correctly?
• infective (systemic or RTI)
• HF/pulmonary HTN
• anaemia
• metabolic disturbance
• allergens
• poor treatment compliance
• unknown

Question 2

How do you diagnose and monitor COPD?

Answer 2

Diagnosis:

1) spirometry or RFT:
- FER <70%
- FEV1 <80%

2) SpO2 - if <92% on >2 occasions when resting (get an ABG)

3) special test if:
- minimal COPD RFs (<5year smoking, young onset)
- exercise test (advanced disease)
- alpha1 antitrypsin - if young.

Monitoring:

• clinical assessment
• mild/mod do FEV1 + FVC every 12 months
• severe - ABGs if SpO2 <92% every 6 months.

Question 3

Definition of COPD?

Answer 3

chronic progressive irreversible airway disease _ parenchymal destruction:

• emphysema (alveoli wall destruction)
• chronic bronchitis >3 months productive cough >2 consecutive years
• small airway disease

Question 4

What is COPDX?

Answer 4

COPDX
C - confirm diagnosis
confirm with spirometry, if its substantially reversible (FEV1 >400ml) treat for asthma.

O - optimise function
pulmonary rehab
bronchodilators, ICS,
treat comorbidities (e.g. osteoporosis)

P - prevent deterioration
smoking cessation (nicotine replacement/varenicline)
flu vaccine, pneumococcal vaccine
mucolytics and LT O2 therapy

D - develop care plan
multidisciplinary care plans
enhance QOL, include family, allow them to take responsibility

X - manage exacerbations
systemic corticosteroids and antibiotics (mild amoxy + doxy, mod benpen + doxy, severe ceft/cefotaxime) as needed
controlled O2 delivery and bronchodilators
early diagnosis and management

Question 5

Outline the GOLD classification for treatment?

Answer 5

Stage 1 = FEV1 >80%

• short acting bronchodilator PRN
  
  • SABA (salbutamol)
  • SAMA (ipratropium)
  • or combo

Stage 2 = FEV1 50-80%

• pulmonary rehab
• long acting bronchodilator
  
  • LABA (salmeterol)
  • LAMA (tiotropium)

Stage 3 = 30-50%

• +ICS (triple therapy) if repeat exacerbations
• seretide (fluticasone + salmeterol)
• symbicort (budesonide + formoterol)

Stage 4 = <30% or <50% + resp failure

• long term O2 therapy (criteria):
  
  • PaO2 <55,
  • PaO2 55-60 with pul HTN
  • non smoker

Question 6

How would you direct a COPD consult?

Answer 6

S - smoking cessation
M - medication (inhaler, vaccine, corticosteroids)
O - oxygen
K - komorbidity (cardiac, OSA, OP, depression, asthma)
E - exercise/rehab
S - surgery

Question 7

How do the Aus Guidelines and GOLD treatment guidelines differ?

Answer 7

their FEV1 % predicted has different mild/mod/severe categories.
Gold:
mild >80%
mod 50-80% 
severe 30-50% 
<30% very severe 

Aus:
mild 60-80%
mod 40-50%
severe <40%

Question 8

What is your acute asthma management plan?

Answer 8

O - oxygen

S - salbutamol
H - hydrocortisone (decrease inflammation)
I - ipratropium (LAMA)
T - theophylline

M - magnesium sulphate
A - anaesthetics (intubation)
N

Prednisolone 2-5days after (oral)