COPD



Background

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.
COPD classification (post Bronchodilators)
Stage 1 Mild FEV1 / FVC <0.7
FEV1 > 80% predicted
Stage 2 Moderate FEV1 / FVC <0.7
50% < FEV1 < 80% pred.
Stage 3

Severe

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.

Initial Mx

  • 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

Investigations

  • CXR
  • Blood gases (see right)
  • ECG
  • FBC, U&E
  • Theophylline level if patient for admission (medical team)
  • Sputum microscopy and culture if purulent

Hypercarbic?


Acute Mx Bundle MUH

Patient presents to ED/AMU (GP or self referral).

Assessed by EM/AMU clinician and appropriate Ix (CXR, U&E, LFTs, CRP) requested.
Action Completed
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


Content by Dr Íomhar O' Sullivan 18/03/2005 Reviewed 30/04/2007. Last review Dr. ÍOS 30/03/17.