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COPD Guide: Causes, Symptoms, Diagnosis & Treatment
- 1. COPD Dr. Imran Masood, PhD drimranmasood@iub.edu.pk
- 2. Table of contents • Definition • Etiology • Pathophysiology • Clinical presentation • Diagnosis • Assessment of severity • Treatment • Patient care
- 3. Definition Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.( GOLD, 2009) COPD has been defined (National Institute for Health and Clinical Excellence, 2010) as: • Airflow obstruction with a reduced FEV1/FVC ratio of less than 0.7.
- 5. Chronic Bronchitis is defined as a chronic or recurrent cough with sputum production on most days for at least 3 months of the year during at least 2 consecutive years, in the absence of other diseases recognized to cause sputum production. Emphysema is defined as an abnormal enlargement of the air spaces distal to the terminal bronchioles.
- 8. Etiology • Tobacco smoking • Noxious particles • Natural ageing process • Gender • Proteinase and anti-proteinase imbalance • Oxidative stress
- 11. Clinical presentation At risk Symptomatic Cough Wheeze Regular sputum production Exertional dyspnoea Exacerbation Respiratory Failure
- 14. The bronchitic ‘blue bloater’ and emphysemic ‘pink puffer’ represent two ends of the COPD spectrum. Signs and symptoms of COPD lie somewhere between the two extremes described The clinical progress of COPD depends on whether bronchitis or emphysema predominates
- 16. Diagnosis Lung function tests are used to assist in diagnosis. A spirometer is used to measure lung volumes and flow rates Airflow obstruction is defined as: • FEV1 less than 80% of that predicted for the patient and • FEV1/FVC less than 0.7. VC decreases in bronchitis and emphysema. RV increases in both cases but tends to be higher in patients with emphysema
- 17. Chest radiographs A patient with emphysema will have a flattened diaphragm with loss of peripheral vascular markings. A patient with bronchitis will have increased Broncho vascular markings and may also have cardiomegaly with prominent pulmonary arteries. α1-Antitrypsin Pulse oximetry Sputum culture
- 18. Assessment of severity of airflow obstruction (adapted from National Institute for Health and Clinical Excellence, 2010; GOLD, 2009)
- 19. Treatment Stable COPD Smoking cessation Nicotine replacement therapy Mucolytics In chronic productive cough Antibiotics Co-amoxiclav, amoxicillin, erythromycin, doxycycline, erythromycin or flucloxacillin Immunisation Pneumococcal vaccine (single dose) Annual influenza vaccinations
- 20. Class Sub class Drugs Dose Major side effects Short-acting bronchodilators short-acting b2- adrenoceptor agonist Salbutamol Terbutaline 200–400μg QID 500 μcg prn Tachycardia, palpitation tremors at high dose short-acting muscarinic antagonist Ipratropium 40 μg qid Dry mouth and other anticholinergic S.E Long-acting bronchodilators Long acting beta agonist Formoterol Salmeterol 12–24μg BD 50–100μgBD Same as SABA Long acting muscarinic antagonist Tiotropium 18 μg OD Same as SAMA Oral bronchodilator Theophylline 175-500mg BID Tachycardia, seizures insomnia, urination, vomiting Corticosteroid Inhaled corticosteroid Beclometasone Budesonide Fluticasone Mometasone 100–400 μcg twice a day 50–200 μcg 200–400 μcg Adrenal suppression Candidiasis O.D Oral corticosteroid Prednisone Prednisolone 10mg every morning Hypertension Diabetes Osteoporosis
- 21. Stepwise approachto the pharmacological management of chronicCOPD
- 22. Acute exacerbations of COPD Bronchodilators to treat increased breathlessness A β2-agonist can be given with or without an anticholinergic agent. Antibiotics First line agents An aminopenicillin or a macrolide or oxytetracycline. Corticosteroids Prednisolone 30 mg every morning, given for 7–14 days. Other treatment Intravenous aminophylline Oxygen therapy Chest physiotherapy Intravenous hydration Nebulized 0.9% sodium chloride
- 23. Treatment of hypoxaemia and cor pulmonale Peripheral oedema is managed using thiazide or loop diuretics. Oxygen is used to treat hypoxaemia, and this should also promote a diuresis. Domiciliary oxygen therapy Oxygen can be prescribed as oxygen cylinders or by use of a concentrator. Intermittent (short burst) administration Continuous LTOT for at least 15h/day
- 24. Treatment of Chronic Bronchitis Stable chronic bronchitis Class Drugs Major effects Anti tussives codeine dextromethorphan Short term symptomatic relief of cough Short-acting b2- adrenoceptor Agonists albuterol, metaproterenol Relaxes bronchial smooth muscles And control symptoms Facilitate mucus elimination Bronchodilators theophylline To control symptoms such as brochospasm, dyspnea and cough Facilitate mucus elimination anti cholinergic ipratropium Control symptoms Reduce mucus production Long acting beta agonist Formoterol Salmeterol LABA coupled with ICS may offer relief of chronic cough Inhaled corticosteroids beclomethasone, fluticasone budesonide Anti inflammatory activity Decrease airway hyper- responsiveness Relaxes bronchial smooth musles
- 25. Acute exacerbation • SABA or SAMA in addition a short course of systemic corticosteroid therapy (prednisone, prednisolone) • Antibiotics Mild to moderate ABECB • No antibiotics recommended • Smoking cessation • Postural drainage exercises • Oral or aerosolized bronchodilators • Condition not improve in 3-5 days then antibiotic therapy
- 26. Antibiotics recommendation ModerateABECB and /or any one of following : age ˂65 years, FEV1 ˃50% predicted, no cardiac disease or˂3 exacerbationsper year SevereABECB and /or anyone of following: age ≥65 years, FEV1 ≤50% predicted, cardiac disease, or ≥ 3 exacerbationsper year Azithromycin Clarithromycin Doxycycline Trimethoprim - Sulfamethoxazole Cefuroxime Cefdinir Amoxicillin and clavulanate Levofloxacin Gemifloxacin Moxifloxacin
- 27. Patient care Non-pharmacological treatment • advice and support to stop smoking • nutritional assessment • aerobic exercise training to increase capacity and endurance for exercise • relaxation techniques • education about their medicines, nutrition, self-management of their disease and lifestyle issues • psychological support because COPD patients often have decreased capacity to participate in social and recreational activities and can become anxious, depressed or fatigued