RESPIRATORY

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

ABOUT THIS SESSION

This is a self-directed learning resource designed to be worked through in the clinical environment.

Learning objectives:

Take a focussed history from a patient presenting with probable exacerbation of COPD and consider appropriate differential diagnoses
Suggest and interpret results of relevant investigations for an acute exacerbation of COPD
Understand the management of acute infective and non-infective exacerbations of COPD

Total time:

45 min

Number of students:

1-2

Grade of students:

3rd to 5th year medical students

Created by:

Dr Kit Tigwell

Uploaded:

14th September 2019

Last updated:

14th September 2019

Resources needed for this session:

Pen, paper, prescription chart

Resources linked to this session:

None

Activity 1: History Taking and Examination Skills

10 mins

Take a focused history from a patient with COPD (maximum 10 minutes), to include past medical history (including admissions, home oxygen or nebuliser use), drug history, family history and social history.

Activity 2: Diagnostic Reasoning

5 min

Consider:

What differential diagnoses have you considered and why are these less likely? Suggest at least three differentials along with two features in the history/examination that support each one.
What investigations would be useful in the acute setting and what are you expecting them to show?
How can you clinically assess the severity of an acute exacerbation of COPD and, accordingly, what would be your initial management?

Activity 3: Bedside Tests

5 min

View the ABG results for the patient you have seen. If none are available, use the example opposite.

Discuss the ABG findings using the questions below as prompts:

Is there a pH disturbance?
Is it likely to be metabolic or respiratory driven?
What pathological process is driving this? Is it likely to be acute or chronic?
How would these results alter your management of the patient?

ABG on 35% oxygen

pH 7.28

pCO2 7.9

pO2 26.8kPa

HCO3 38mmol.l

Activity 4: Basic Imaging

5 min

View the patient’s chest radiograph. If none is available, use the example below. Systematically interpret the radiograph using an A to E approach.

Suggest three common x-ray findings in COPD.

Activity 6: Prescribing

5 min

Find a drug chart and prescribe appropriate initial management for acute infective exacerbation of COPD including: oxygen, bronchodilators, antibiotics and steroids. Use a BNF if needed.

Activity 7: Further Management

5 min

Find the local COPD guidelines/care bundle on the intranet. Alternatively, use national guidelines such as the 2019 GOLD Guidelines.

Using appropriate guidelines on management of patients with acute exacerbation of COPD, consider the following points:

Is there a risk of oxygen therapy in some patients with COPD? How should this be managed?
When is non-invasive ventilation indicated? Are there any circumstances when this might not be appropriate?
Where should patients with an acute exacerbation of COPD be managed for ongoing care? What ceiling of care is appropriate for your patient?
What criteria should be met prior to discharge following an acute exacerbation of COPD? What follow up or home support should be arranged?