COPDMichelle TaylorLecturer Faculty of Health & Social Science
Aims & Objectives Definition of COPD? Diagnostic labels of COPD What is Airflow Obstruction? Factors to be considered Pathophysiology of contributing factors Signs & symptoms of COPD Diagnosis of COPD Treatment & Management
DefinitionCOPD is – Chronic Obstructive Pulmonary Disease General term used to describe certain conditions where people have difficulty breathing with long-term affects, that may not be fully reversible and can cause permanent damage to the lungs. In COPD air sacs lose their elasticity and they collapse or don’t inflate properly In COPD the breathing tubes are blocked with mucous and become swollen so air cannot move in and outBritish Lung Foundation (2011)
Diagnostic labels Chronic Bronchitis – irritation, inflammation & swelling of the bronchi Emphysema – affects the bronchi & builds up mucous in the alveoli Chronic Asthma
Airflow Obstruction Find a picture of airflow obstruction
What is airflow obstruction? Airflow obstruction is defined as a reduced FEV1 (forced expiratory volume in 1 second) Forced expiratory volume is the amount of air which can be forcibly exhaled from the lungs in the 1st second of a forced exhalation Forced Vital Capacity (FVC) is the maximum amount of air you can expel when breathing out Measured by spirometers
Calculation depends upon gender, age, height, if you are a smoker & level of fitness Different classifications - FEV1% is between 50 – 80% MILD COPD - FEV1% is between 30 – 49% MODERATE COPD - FEV1% is below 30% SEVERE COPDNICE (2004)
Factors to consider Significant airflow obstruction may be present before the individual is aware of it 30,000 people in the UK die of COPD every year COPD produces symptoms, disability and impaired quality of life COPD is now the term used for conditions with airflow obstruction once diagnosed as chronic bronchitis and emphysema
Pathophysiology – contributing factors Recurrent or chronic respiratory problems including wheezing, coughing, infection & the production of phlegm Allergens – dust & air pollution Hereditary factors - genetic Smoking – pipe, cigar or cigarette Occupational exposure – chemicals & toxic fumes
SmokingSmoking is the most important factor in COPD. Itimpairs cilliary action, causing inflammation in theairway, increased mucous production, alveolardestruction and bronchiolar fibrosis
Signs & Symptoms Wheezing Coughing Sputum production Shortness of breath/Dyspnoea Chest tightness Barrel chest (lung over-distension) Prolonged expiration - because accessory muscles are used for inspiration and abdominal muscles are used to force air out of lungs Decreased breath sounds
Ask your patients about the presence of the following factors Weight loss Effort intolerance Waking at night Ankle swelling Fatigue Occupational hazards Chest pain Haemoptysis
Assessment of severity This is important as it has indications for treatment and relates to prognosis True assessment includes the degree of airflow obstruction and disability, frequency of exacerbations and the following prognostic factors Exercise capacity BMI Partial pressure of O2 in arterial blood
Treatment Eliminate exposure to things that cause COPD Quit smoking Exercise and pulmonary rehabilitation Inhaled medications to open the breathing tubes or decrease the inflammation Oxygen Pneumococcal and flu vaccines
Meter dose inhaler (MDI) Choose appropriate device Educate patients Best evidence for bronchodilators = MDI + SPACER Regular assessment of ability to use device should be taken Ensures delivery of the medication to the lungs NB. Spacers MUST be compatible with MDI Rinse mouth after use if using a steroid inhaler
Management Inhaled bronchodilator therapyShort acting B2 agonist – initial treatment for reliefof breathlessness and exercise limitation (example‘salbutamol’)Effectiveness should be assessed by improvement insymptoms, i.e. Activities of Living, exercise capacity andrapidity of symptom relief
Nebulisers Consider if symptoms distressing or disabling despite maximal therapy using inhalers. But DISCONTINUE after Reduction in symptoms Increase in patients ability to undertake Activities of Living Increase in exercise capacity Improvement in lung function NB. Monitor ability to use and consider application i.e. mask, mouthpiece?
Still a problem?Patients who remain symptomatic should be given Long acting bronchodilators (LAB) once daily (e.g. salmeterol) LAB should be used if > 2 exacerbations/yr Consider – patient response, side effects, patients preference, cost
Oxygen (LTOT) NB – can cause respiratory depression if given inappropriately Indicated when patients have PaO2 < 7.3 when stable To benefit, breathe supplemental O2 for at least 15hrs/day
Pulmonary rehabilitation An MDT programme of care for patients with chronic respiratory impairment that is individually tailored and designed to optimise the individual’s physical and social performance and autonomy Not for immobile, unstable angina, recent MI Includes physical training, disease education, nutritional, psychological and behavioural intervention
MDT management Via assessment - spirometry, O2 needs and aids Managing - pulmonary rehab, hospital at home/early discharge (ACTRITE, IMPACT) including palliative care, identification of anxiety/depression, dietary, exercise, benefits, travel advice Self management Education
Summary Discussed the definition of COPD Discussed the diagnostic labels of COPD Described what Airflow Obstruction is Discussed the factors to be considered Described the pathophysiology of contributing factors Discussed the signs & symptoms of COPD Discussed the diagnosis of COPD Described the treatment & Management
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