COPD Stable Management

Question 1

What is the general management advise for COPD patients?

Answer 1

• Smoking cessation advice
• Annual Influenza vaccination
• One-off pneumococcal vaccination

Question 2

What is the first line therapy for COPD?

Answer 2

SABA or SAMA

(But just use SABA - SAMA (Ipratropium may increase CVD risk)

If they remain breathless….the next step is determined by the FEV1

Question 3

If breathless and FEV1 >50% predicted, what is the next line of treatment?

Answer 3

LABA or LAMA

Question 4

If FEV1 <50% what is the next line of treatment?

Answer 4

LABA + ICS (In a combination inhaler) (Seretide, Relvar, Fostair)

LAMA (Tiotropium)

Question 5

If the patient is still breathless or have exacerbations, what is the third line treatment?

Answer 5

• Triple Therapy - LABA+ICS & LAMA

Question 6

If the patient has a chronic productive cough, what should be considered?

Answer 6

Mucolytics - e.g Carbocisteine

Question 7

What can be considered for further therapy if inhalers are still not controlling the patient’s breathlessness?

Answer 7

Oral Theophylllines

These can be used with the inhalers or for people who cannot tolerate inhalers.

Question 8

When should oral theophylline doses be reduced?

Answer 8

If the patient is taking a macrolide or flouroquinolone

They are associated with increased risk oof CV death - most likely due to QT prolongation.

Question 9

What are some features of cor pulmonale?

Answer 9

• Peripheral odema
• Raised JVP
• Systolic parasternal heave
• Loud P2

Question 10

What is your treatment strategy for cor pulmonale?

Answer 10

Loop diuretics for oedema and consider long term oxygen therapy.

ACE-inhibitors, calcium channel blockers and alpha blockers are not recommended by NICE

Question 11

What factors may improve survival in patients with stable COPD?

Answer 11

1. Smoking cessation - the single most important intervention in patients who are still smoking
2. Long term oxygen therapy in patients who fit criteria
3. Lung volume reduction surgery in selected patients

Question 12

In COPD, why are inhaled corticosteroids prescribed?

Answer 12

COPD - reason for using inhaled corticosteroids - reduced exacerbations

Question 13

A 69-year-old woman who has a long history of COPD phones for advice. For the past two days she has felt more short-of-breath and is using her inhalers more. She is coughing up clear sputum. There is no fever, haemoptysis or chest pain. She is ensure whether to take her ‘rescue’ medications. What is the most appropriate advice?

• Hold-off the rescure medications for now, review in 24 hours
• Take a course of prednisolone
• Take a course of prednisolone + the antibiotic
• Arrange a 7 day loan of a home nebuliser

Take the antibiotic

Answer 13

NICE only recommend adding in an antibiotic if the sputum is purulent.

(And obviously take into accoutn any signs of temperature)

Question 14

Name some mucolytics (mucokinetics) used in chronic productive cough?

Answer 14

Carbocysteine

Acetylcysteine