You review a 60-year-old woman in the COPD clinic. She was diagnosed with COPD four years ago and is currently maintained on a salbutamol inhaler as required and a tiotropium inhaler regularly. She has recently managed to give up smoking and her latest FEV1 was 42% of predicted. Despite her current therapy she is have frequent exacerbations.
What is the most appropriate next step in her management?
Correct Answer B: Following the 2010 NICE guidelines the next step in management would be a combined long-acting beta2- agoinst (LABA) with an inhaled corticosteroid (ICS).
COPD: stable management:
NICE updated it's guidelines on the management of chronic obstructive pulmonary disease (COPD) in 2010.
General management:
Bronchodilator therapy:
FEV1 > 50%:
FEV1 < 50%:
For patients with persistent exacerbations or breathlessness:
Oral theophylline:
Mucolytics:
Cor pulmonale:
Factors which may improve survival in patients with stable COPD:
A 65-year-old woman with a history of chronic obstructive pulmonary disease (COPD) is admitted to the Emergency Department with breathlessness. This is her first admission with an exacerbation of COPD. Blood gases taken on room air shortly after admission are as follows:
What should her target oxygen saturations be?
Correct Answer A: When managing patients with COPD, once the pCO2 is known to be normal the target oxygen saturations should be 94-98%.
Oxygen therapy:
The British Thoracic Society published guidelines on emergency oxygen therapy in 2008. The following selected points are taken from the guidelines. Please see the link provided for the full guideline.
In patients who are critically ill (anaphylaxis, shock etc) oxygen should initially be given via a reservoir mask at 15 l/min. Hypoxia kills. The BTS guidelines specifically exclude certain conditions where the patient is acutely unwell (e.g. myocardial infarction) but stable.
Oxygen saturation targets:
Management of COPD patients:
Situations where oxygen therapy should not be used routinely if there is no evidence of hypoxia:
A 30-year-old female with a past history of asthma presents to the Emergency Department with pleuritic chest pain. Chest x-ray shows a right-sided pneumothorax with a 1.5cm rim of air and no mediastinal shift.
What is the most appropriate management?
Correct Answer C: This should be treated as a secondary pneumothorax as the patient has a history of asthma.
Pneumothorax:
The British Thoracic Society (BTS) published updated guidelines for the management of spontaneous pneumothorax in 2010. A pneumothorax is termed primary if there is no underlying lung disease and secondary if there is.
1- Primary pneumothorax:
Recommendations include:
2- Secondary pneumothorax:
3- Iatrogenic pneumothorax:
Which one of the following is least associated with bronchiectasis?
Correct Answer E: Traction bronchiectasis may be seen in some rare cases of stage IV pulmonary sarcoidosis but this is the least strong association of the five options.
Bronchiectasis: causes: Bronchiectasis describes a permanent dilatation of the airways secondary to chronic infection or inflammation.
There are a wide variety of causes are listed below:
Causes:
A 43-year-old lifelong non-smoker is diagnosed as having emphysema. Further tests reveal that he has alpha-1 antitrypsin deficiency.
What is the main role of alpha-1 antitrypsin in the body?
Correct Answer B:
Alpha-1 antitrypsin deficiency: Alpha-1 antitrypsin (A1AT) deficiency is a common inherited condition caused by a lack of a protease inhibitor (Pi) normally produced by the liver. The role of A1AT is to protect cells from enzymes such as neutrophil elastase.
Genetics:
Features:
Management:
*Trusted sources are split on which is a more accurate description.
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