RESPIRATORY

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Introduction

5 min

Introduce yourself and the group

Provide rationale for the session and relevance to clinical practice

Outline 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

Explain structure of session

Total time:

45 min

Number of students:

1-5

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

Students can scan the QR code opposite to view all investigation results on their phone as you work through the session.

Resources linked to this session:

None

Activity 1: History Taking and Examination

10 min

Ask student(s) to take a focussed history from the patient (maximum 10 minutes), to include past medical history (including admissions, home oxygen or nebuliser use), drug history, family history and social history. This can be observed if capacity of tutors allows.

Activity 2: Diagnostic Reasoning and Case Based Discussion

5 min

Ask the student(s) to present the key findings of the case. Feedback on history taking style & presentation (max 1 minute).

Consider:

What differential diagnoses have you considered and why are these less likely?
What investigations would be useful acutely 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

Allow the students to view the ABG results from the patient. 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?

pH 7.28

pCO2 7.9kPa

pO2 26.8kPa

HCO3 38mmol.l

Activity 4: Basic Imaging

5 min

Allow the students to view the patient’s chest radiograph. If none is available, use the example below. Ask the students to systematically interpret the radiograph.

Discuss the common x-ray findings in COPD.

Activity 6: Prescribing

5 min

Ask the students to find a drug chart and prescribe appropriate initial management for acute infective exacerbation of COPD to include: oxygen, bronchodilators, antibiotics and steroids. They can use the BNF if needed - the QR code opposite links to the BNF online.

Activity 7: Further Management

5 min

Ask the student(s) to find the trust COPD guidelines/care bundle on the intranet. Alternatively, use national guidelines - the QR code opposite links to 2019 GOLD guidelines.

Using appropriate guidelines on management of patients with acute exacerbation of COPD, discuss 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?