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) & FEV1/FVC ratio (<0.7)
- The damage from chronic inflammation - smoke etc
- COPD preferred term (not 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. |
| 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 |
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 resp. team
- Assess the need for intubation
- Consider iv theophyllines
Investigations
- CXR
- Blood gases (see right)
- ECG
- FBC, U&E
- Theophylline level if for admission (medical team)
- Sputum microscopy and culture if purulent
Hypercarbic?
Acute Mx Bundle MUH
Patient presents to ED/AMU (GP or self referral).
| 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 Clarithromycin OR Doxycycline. 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 |