Three aspects in the treatment of acute exacerbations of chronic obstructive pulmonary disease: the rôle of nebulised magnesium, the risks of oxygen and the utility of the CRB-65 score

Edwards, Llifon 2014. Three aspects in the treatment of acute exacerbations of chronic obstructive pulmonary disease: the rôle of nebulised magnesium, the risks of oxygen and the utility of the CRB-65 score. MD Thesis, Cardiff University. Item availability restricted.

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Abstract

Chronic Obstructive Pulmonary Disease (COPD) is one of the commonest long-term conditions worldwide. It is characterised by chronic airflow limitation, pathological changes in the lung and significant extra-pulmonary manifestations. The treatment of an acute exacerbation of COPD (AECOPD), involves glucocorticoids and bronchodilators supplemented by antibiotics if needed. In-hospital, oxygen, which has potential risks as well as benefits, and additional respiratory support can be given if the patient deteriorates. Clinicians need to decide which treatment to provide and who can be safely discharged. This has led to the advent of scoring systems to define severity in COPD This thesis examines the evidence base for the use of magnesium in airways disease and presents the results of the first randomised double-blind placebo-controlled trial using nebulised magnesium in the treatment of AECOPD. 116 patients were randomised, but after 3 nebulisations over 90 minutes, there was no significant difference in FEV1 compared to placebo (p=0.67). In a second study, the CRB65 score was retrospectively assigned to a cohort of patients presenting to the emergency department with AECOPD, using data collected from a previous audit. Patients with a CRB65 score of 0 or 1 had a low risk of in-hospital and 30- day mortality and could be considered for discharge, whereas those with scores between 2-4 required admission with mortality increasing with the score. The CRB65 score showed a similar utility in AECOPD as it does in pneumonia. Finally, 18 subjects with stable but severe COPD were randomised in a crossover study to two nebulisations with salbutamol and ipratropium over 15 minutes with a five minute interval between nebulisations, using air or oxygen as the driving gas. When oxygen was used there was a 3.1mmHg difference (p<0.001) at 35 minutes, compared to air, illustrating the potential risks of repeated nebulisations to those with severe COPD.

Item Type:	Thesis (MD)
Status:	Unpublished
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General)
Date of First Compliant Deposit:	30 March 2016
Last Modified:	05 Feb 2020 04:06
URI:	https://orca.cardiff.ac.uk/id/eprint/60162

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