Ae in copd

AE OF COPD

1. ACUTE EXACERBATION OF COPD

2. Acute Exacerbation of COPD ( Chronic Obstructive Pulmonary Disease )   COPD is common and preventable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in airways and lungs to noxious particles or gases.   An exacerbation of COPD is an acute event characterized by a worsening of patient’s   respiratory symptoms that is beyond normal day to day variations.   Diagnoses of exacerbation relies exclusively on clinical presentation of patient complaining of an acute change of symptoms (dyspnea, cough, and/or sputum production) that is beyond day to day variation.

3.   Occur due to disruption of airways, alveoli and pulmonary blood vessels.   Refers to group of conditions associated obstruction of air flow entering or leaving lungs. with chronic It includes: 1) Bronchitis 2) Emphysema Causes : 1) Smoking - most common in India 2) Genetic - deficiency of alpha-1 antitrypsin 3) Age and Gender - >50 years and male more predominant 4) Air Pollution 5) Infections –  HIV/Tuberculosis and history of severe childhood respiratory infection leading to reduced lung function.

4.   Severity of exacerbation can be done by pulse oximetry. Measurement of arterial blood gas is vital if coexistence of acute or acute on chronic respiratory failure suspected. Emergency Care : 1. ABG analysis and SpO2 analysis done to find out Oxygen saturation. 84 % FiO2 for 2 ltr O2. 2. Position patient - sitting and loosen restrictive clothing 3. Assist ventilation if required and shift to intensive care unit. 4. Oxygen therapy (100 %) to be titrated to improve patients hypoxaemia with a target saturation of 92 -94 % .

5. 5 . Bronchodilators Salbutamol & Ipratropium bromide given in combination via nebulization every 6-8 hourly . ( Duolin ) 6 . Corticosteroids Hydrocortisone 100-200 mg IV stat then 6 hourly and repeated every 6-8 hours. 7 . Antibiotics : should be given when infection is underlying cause of exacerbation. Amoxycillin 500 mg orally or Ampicillin 500 mg IV every 8 hours OR if penicillin sensitive Erythromycin 500 mg orally every 6 hours. If patient is having severe pneumonia by atypical bacteria or Old age patient, then use antibiotics like Imipenem , Tazobactum or Piperacillin .

6. 8 . Lasix (Furosemide) 40 mg IV stat given as single bolus dose imrpoving biventricular failure. 9 . Advice patient to stop smoking . 1 . Maintenance of hydration is very important in COPD attack . DNS is used and Electrolyte imbalance restored by giving Cl, Na and K salts. 1 1 . If patient is having CO2 narcosis / Poor consciousness / pH is 7.2 or less intubate patient. If pH > 7.2 BiPAP can be given. If patient not improved with BiPAP more , then give mechanical ventilation. secretions & not tolerating 1 2 . If severe bronchospasm –  IV drip of magnesium 2gm In 100 ml NS can be used. Given very 4-6 hours.

7. 1 3 . Tab Deviry (Medroxy-progesterone) 10 mg for 15 days can be given by RT tube which acts as a respiratory stimulant.

8. Recent advances   Combination of Umeclidinium ( long acting anticholinergic) & Vilanterol ( long acting B2 agonist) are also available with once daily dose for maintenance of airflow in obstruction cases.   Aclidinium bromide (LAMA) in dry powder form for oral inhalation. Used for maintenance Rx of bronchospasm in cases of COPD. Dose is 400 mcg twice daily.   Tiotropium bromide (18 mcg oral inhalation once daily) & Oxytropium are newer long acting muscarinic antagonists ( LAMA ) more commonly used in COPD patients.