PRE MEETING QUESTIONS

COPD – PBL 8

CLINICAL FEATURESHypercapnia ( CO2) Hypoxia ( O2)

Hyperventilation Dyspnoea

Asterixis Headaches/fatigue

Flushed skin Cynosis

Disturbed sleep Tachapneoa

Nausea, vomiting

Increased Blood Pressure (polycythaemia)

Systemic hypotension or hypertension depending on the underlying diagnosis

Arrhythmias? Arrhythmias?

Wheezing, hyperinflation (ie, barrel chest), decreased breath sounds, hyperresonance on percussion, and prolonged expiration

Disorientation Disorientation

Delirium Delirium

Convulsions

Unconsiousness Changes in conciousness

TESTS Chest X-ray Spirometry: diagnosis of obstructive

lung disease and for assessment of the severity of disease

Serum chemistries: compensatory increase in serum bicarbonate concentration?

FBE: also hypoxemic? secondary polycythemia?

Drug screens: opiates, barbiturates, and benzodiazepines?

CT

TREATMENT Beta-agonists (short and long):act on the

beta2-adrenergic receptor, causing smooth muscle relaxation, resulting in dilation of bronchial passages (eg, albuterol, salmeterol)

Anticholinergic agents: cause airway smooth muscles to relax by blocking stimulation from cholinergic nerves (ipratropium)

Corticosteroids: act to reduce inflammation in the airways, in theory reducing lung damage and airway narrowing caused by inflammation. Do not provide immediate relief of symptoms more for treating/preventing acute exacerbations of COPD (prednisone, fluticasone)

OXYGEN THERAPY COPD with an FEV1 of less than 1.5 L. A PaO2 on air of less than 7.3 kPa (55 mmHg) with

or without hypercapnia. Measurements should be taken on two occasions at least 3 weeks apart after appropriate bronchodilator therapy.

Oxygen is most commonly delivered to the patient via a nasal cannula or mask attached to the tubing. The nasal cannula is usually the delivery device of choice since it is well tolerated and doesn't interfere with the patient's ability to communicate, eat, or drink.

88% - 92% sats achieved

Chest physiotherapy Nutrition: Underweight/overweight? Cold Air: bronchospasm and increased

breathlessness Surgery: a) Bullectomy - surgical removal

of a bulla, a large air-filled space that can squash the surrounding, more normal lung; b) Lung volume reduction surgery - parts of the lung that are particularly damaged by emphysema are removed; c) Lung transplantation is sometimes performed for severe COPD, particularly in younger individuals.

STOP SMOKING

POSITIVE PRESSURE VENTILATION

process of forcing air into the lungs of a patient, usually using a bag valve mask (BVM) or mechanical ventilator

Works by forcing air into the lungs and thereby increasing the pressure inside the airway relative to the outside

Endotracheal tube or tracheostomy tube

NON INVASIVE VENTILATION Administration of ventilatory support without using

an invasive artificial airway (endotracheal tube or tracheostomy tube) - best current technique uses tight-fitting facial masks to deliver bilevel positive airway pressure ventilatory support (BiPAP)

Similar reductions in diaphragm energy expenditure and improvements in arterial blood gas levels

Cheaper Lower mortality rates Lower complications Lower length of ICU care Lower nursing care

COPD: Journal of Chronic Obstructive Pulmonary Disease2009, Vol. 6, No. 3, Pages 171-176 , DOI 10.1080/15412550902902646

Non-Invasive Ventilation (NIV) in the Clinical Management of Acute COPD in 233 UK Hospitals: Results from the RCP/BTS 2003 National COPD Audit