Chronic obstructive pulmonary disease (COPD) is characterised by airflow obstruction. The airflow obstruction is usually progressive, not fully reversible and does not change markedly over several months.
- ↓ FEV1 (<80% of predicted) and a ↓FEV1/FVC ratio (<0.7)
- The damage is the result of chronic inflammation - tobacco smoke etc.
- COPD preferred term (not chronic bronchitis or emphysema).
- Other factors, particularly occupational exposures, may also contribute to the development of COPD.
|Stage 1||Mild||FEV1 / FVC <0.7
FEV1 > 80% predicted
|Stage 2||Moderate||FEV1 / FVC <0.7
50% < FEV1 < 80% pred.
|FEV1 / FVC <0.7
30% < FEV1 < 50% pred.
|Stage 4||Very severe||FEV1 / FVC <0.7
FEV1 < 30% or FEV1 < 50% plus chronic resp failure
Management exacerbations COPD
Exacerbations of COPD are assoc. with ↑ dyspnoea/sputum purulence/volume/cough.
- O2 if required to keep SaO2 within individualised target range
- ↑ frequency of bronchodilator use (consider nebuliser)
- Oral antibiotics if purulent sputum
- Prednisolone 30 mg daily for 7 – 14 days – for all patients with significant increase in breathlessness, and all patients admitted to hospital, unless contraindicated
- Assess need for NIV
- Consider resp. stimulant only after discussion with medics/resp. teams
- Assess the need for intubation
- Consider iv theophyllines
- Blood gases (see right)
- FBC, U&E
- Theophylline level if patient for admission (medical team)
- Sputum microscopy and culture if purulent
Acute Mx Bundle MUH
Patient presents to ED/AMU (GP or self referral).
|Humidified O2 to Maintain Sats between 88 and 92% (FiO2 2L via nasal cannula or variety of masks)||On presentation. Print version MUH|
|Check ABG and repeat if FiO2 ↑ required or hypercarbia.
If in resp failure (pH <7.35) consider NIV / transfer to appropriate unit
|Within 30 minutes of presentation|
|Nebulised ß 2 agonists and/or anticholinergics||Within 30 minutes of presentation|
|Review laboratory results||Within 2 hours of presentation|
|Review Chest X-ray||Within 2 hours of presentation|
|PO antibiotics - Amoxicillin Or Clarithrmycin OR Doxicycline If new infiltrate, treat as pneumonia (see bundle)||Within 4 hours of presentation|
|PO Prednisolone 40mg (30mg if <60kg)||Within 4 hours of presentation|
|Consider COPD Outreach||Within 4 hours of presentation|
|Refer Respiratory team / nurse||Within 24 hours of admission|
|Ted stockings or LMWH prophylaxis||Within 8 hours of admission
Print version MUH