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COPD (aetiology (exacerbation (infective (S.pneumoniae, H.influenzae (most…
COPD
aetiology
exacerbation
non-infective
infective
S.pneumoniae
H.influenzae (most common)
Moraxella catarrhalis
smoking
alpha-1 antityrpsin deficiency
treatment
stable management
general
smoking cessation
annual influenza vaccination
one-off pneumococcal vaccination
bronchodilator therapy
SABA or SAMA first line
if they remain breathless and FEV1 >50%
LABA
salmeterol
LAMA
tiotropium
if FEV1 <50%
LABA + ICS
LAMA
persistent exacerbations
if LABA --> LABA + ICS combo
otherwise give a LAMA and LABA + ICS combo
consider home supply of corticosteroids and Abx
oral theophylline
after trial of SABA and LABA
or if can't use inhaled therapy
dose needs to be reduced if macrolide or fluoroquinolone Abx co-prescribed
mucolytics
cor pulmonale
NOT acei, CCB, AB
loop diuretic
consider oxygen therapy
LTOT
Pa02 <7.3 kPa when stable
or >7.3 but <8 and have
secondary polycythaemia
nocturnal hypoxia
peripheral oedema
pulmonary HTN
at least 15h per day
severe airflow obstruction (FEV1<30% predicted)
cyanosis
pulmonary rehab
acute exacerbation
bronchodilators
nebuliser
MDI
systemic corticosteroid
prednisolone 30mg PO 7-14/7
antibiotics
theophylline
if poor response to bronchodilators
oxygen
NIV
hypercapnic ventillatory failure despite optimal medical therapy
pH 7.25-7.35
achieve the most benefit
mechanical ventillation
should be considered if pH<7.25
chest physio
diagnosis
spirometry
stage 1 mild
FEV1/FVC <0.7; FEV1 >80%
stage 2 - moderate
FEV1/FVC <0.7; FEV1 50-79%
stage 3 - severe
FEV1/FVC <0.7; FEV1 30-49%
stage 4 - very severe
FEV1/FVC<0.7; FEV1 <30%
defintion