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COPD with persistent hypercapnia — SCE Respiratory MCQ

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HardCOPDCOPD with persistent hypercapniaSCE Respiratory

A 73-year-old man admitted with COPD exacerbation is improving after NIV. ABG on air before discharge shows pH 7.39, PaCO2 7.8 kPa, PaO2 8.6 kPa and bicarbonate 35 mmol/L. He has had two admissions with acute hypercapnic respiratory failure in 12 months. What is the most appropriate management?

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Correct answer: C — Refer for assessment for home non-invasive ventilation

This ABG shows compensated chronic hypercapnic respiratory failure: PaCO2 is markedly raised at 7.8 kPa, bicarbonate is raised at 35 mmol/L, and pH is normal. He has also required NIV for acute hypercapnic respiratory failure and has had recurrent admissions. Under UK COPD guidance, an adequately treated patient with chronic hypercapnic respiratory failure who has required assisted ventilation during an exacerbation should be referred to a specialist centre for consideration/assessment of long-term home NIV. Long-term oxygen therapy is assessed on persistent hypoxaemia when stable, not on PaCO2 alone; his PaO2 of 8.6 kPa on air does not meet standard LTOT criteria. Bronchodilator reversibility testing alone, discharge without follow-up, and long-term acetazolamide are not appropriate management of chronic hypercapnic ventilatory failure.

Reference: NICE guideline NG115: Chronic obstructive pulmonary disease in over 16s: diagnosis and management, 2018 (updated 2019), recommendations 1.2.73 and 1.2.56–1.2.57. https://www.nice.org.uk/guidance/ng115/chapter/Recommendations