COPD

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COPD

  1. 1. OBJECTIVES What is COPD Related diagnoses Risk factors Pathophysiology Clinical features Investigation Management Prescription Smoking cessationmethods
  2. 2. COPDPreventable and treatable lung diseasewith some significant extrapulmonaryeffects that may contribute to severity inindividual patient Pulmonary component Airflow limitation(not fully reversible) Limitation is progressive and associated withan abnormal inflammatory response of thelung to noxious particles or gases.
  3. 3. RELATED DIAGNOSES Chronic BronchitisCoughSputum EmphysemaEnlargement of airspaces distalto terminal bronchioles with destructionof their walls (no fibrosis)
  4. 4. RISK FACTORSExposures Tobacco smoke Occupation Lung growth Infections Low SES Nutrition (unclear) Cannabis smokingHost factors Genetic factors Airway hyper-reactivity
  5. 5. PATHOPHYSIOLOGY Airway inflammation Loss of elastic recoil-Airway collapse
  6. 6. CLINICAL FEATURES Cough Sputum production Haemoptysis Breathlessness Pink puffers Blue bloaters Cor pulmonale
  7. 7. BREATHLESSNESSModified MRC dyspnoea scaleGrade Degree of breathlessness related to activities0 No breathlessness except with strenuous exercise1 Breathlessness when hurrying on the level or walking up aslight hill2 Walks slower than contemporaries on level ground becauseof breathlessness or has to stop for breath when walking atown pace3 Stops for breath after walking about 100 m or after a fewminutes on level ground4 Too breathless to leave the house, or breathless whendressing or undressing
  8. 8. SIGNS OF COPDPathologicalconditionsCOPDShape anddeformity of chestBarrel shaped chestMovement of chestwallDiminished all overMediastinaldisplacementNonePercussion note Normal or hyper-resonantBreath sounds Diminished vesicular withprolonged expirationVocal resonance Normal or reducedAdded sounds Ronchi (may be bothinspiratory or expiratory)
  9. 9. INVESTIGATION Chest x-ray:Cardiac failureLung cancerBullae Complete Blood Count: Alpha1 antiproteinase Pulmonary Function Test:Hallmark of COPD is airway obstruction.(reduction in FEV1 and FEV1/FVC)
  10. 10. Spirometric classification ofCOPD severity based onpost-bronchodilator FEV1Stage Severity FEV11 Mild FEV1/FVC < 0.70FEV1 ≥ 80% predicted2 Moderate FEV1/FVC < 0.7050% ≤ FEV1< 80% predicted3 Severe FEV1/FVC < 0.7030% ≤ FEV1 < 50% predicted4 Very severe FEV1/FVC < 0.70FEV1 < 30% predicted or FEV1 < 50% predictedplus chronic pulmonary failure
  11. 11.  Health status questionnaires: Arterial blood Gases:Demonstrate mild reductionin blood oxygen levels,and normal carbon dioxidelevels Heart Function Tests: Echocardiogram shows thefunction of the heart, and ECG will demonstrate changes ofright heart strain or heart failure (cor pulmonale)
  12. 12. MANAGEMENT Smoking cessation Bronchodilators Corticosteroids Oxygen therapy Pulmonary rehabilitation Surgical intervention Palliative care
  13. 13. BRONCHODILATORSROUTE: Inhaled in preferred Oral bronchodilatorsFor the management ofBreathlessnessDrugs Used: Short acting beta 2 agonist(milddisease)SalbutamolTerbutaline AnticholinergicIpratropium Long acting beta 2 agonist(moderateto severe)SalmeterolFormeterol AnticholinergicTiotropium bromide
  14. 14. CORTICOSTEROIDS ICS: frequency and severity of exacerbationPatient with sever disease (FEV1 <50%) Oral corticosteroids: ExacerbationsMaintenance therapyImpaired skeletal muscle functionand Osteoporosis
  15. 15. OXYGEN THERAPY Long term domiciliary oxygen therapy (LTOT):Provided by oxygen concentratorMinimum of 15 hours/dayAIM:The paO2 to at least 8 kPa (60 mmHg) or SaO2to at least 90%. Ambulatory oxygen therapy:In patients who desaturate on exercise & showobjective improvement in exercise capacity &/ordyspnoea with oxygen.
  16. 16. SURGICALINTERVENTION: Bullectomy Lung Volume Reduction Surgery (LVRS) Lung TransplantationPULMONARY REHABILITATION Treatment program that incorporate education andcardiovascular conditions
  17. 17. PALLIATIVE CARE Addressing end-of-life needs is an important, yetoften ignored aspect of care in advanced disease. Morphine preparations: Breathlessness Benzodiazepines (low dose): Anxiety
  18. 18. Rx For Mild COPDName of the patient: (-)Date:Gender: (-)Age : (-)Address : (-)Rx:Short acting bronchodilatorsSalbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.SFollow up:Name of physician:Signature:
  19. 19. Rx For Moderate COPDName of the patient: (-) Date:Gender: (-)Age : (-)Address : (-)Rx:Short acting bronchodilatorsSalbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.SLong acting bronchodilatorsSalmeterol ( 25mcg) 2-4 puffs twice dailyLong acting anticholinergicsTiotropium (9mcg) inhaler 2 puffs once dailyIpratropium Bromide (Atrovent) 2-3 puffsFollow up:Name of physician:Signature
  20. 20. Rx For Severe COPDName of the patient: (-) Date:Gender: (-)Age : (-)Address : (-)Rx:Short acting bronchodilatorsSalbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.SLong acting bronchodilatorsSalmeterol ( 25mcg) 2-4 puffs twice dailyInhaled CorticosteroidsPrednisone 60 mg qd for 7 daysPrednisone tapered off over additional 2 weeksFollow up:Name of physician:Signature
  21. 21. Rx For very Severe COPDName of the patient: (-) Date:Gender: (-)Age : (-)Address : (-)Rx:Short acting bronchodilatorsSalbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.SLong acting bronchodilatorsSalmeterol ( 25mcg) 2-4 puffs twice dailyInhaled CorticosteroidsPrednisone 60 mg qd for 7 daysPrednisone tapered off over additional 2 weeksFollow up:Name of physician:Signature
  22. 22. SMOKING CESSATIONMETHODSSmokers who are not motivated to try to stop smoking- Record smoking status at regular intervals- Anti-smoking advice- Encourage change in attitude towards smoking to improve motivationMotivated light smokers (<10/day)- Anti-smoking advice- Anti-smoking support programmeMotivated heavy smokers (10-15/day)- As above plus nicotine replacement therapy (NRT) (minimum 8 weeks)Motivated heavy smokers (>15/day)- As above plus bupropion if NRT and behavioural support areunsuccessful and patient remains motivated
  23. 23. HEALTH BENEFITS OFSMOKING CESSATION
  24. 24. PHARMACOLOGICALTREATMENTo Nicotine Replacement Therapy (NRT)o Gumo Patcho Inhalero Nasal Sprayo Lozengeo Bupropiono Combination Therapy
  25. 25. SUMMARY COPD : Disease state characterized by airflow limitation thatis not fully reversible It includes: Emphysema and Chronic bronchitis Risk factors: Exposure and Host factors C/F: Cough, Haemoptysis, Sputum, Breathlessness, Pinkpuffers, Blue bloater. Investigation: Radiograph, CBC, Pulmonary function test,Health status questionnaire, Arterial blood gases, Heartfunction test. Management: Bronchodilators, corticosteroids, Pulmonaryrehabilitation, Oxygen therapy, Surgical interventions, Palliativecare. Smoking cessation methods
  26. 26. REFERRENCES DAVIDSON Bedside Techniques (Shabbir) GOOGLE WIKIPEDIA
  27. 27. THANK YOU

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