Michelle taylor copd oct 11 for blackboard


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Michelle taylor copd oct 11 for blackboard

  1. 1. COPDMichelle TaylorLecturer Faculty of Health & Social Science
  2. 2. 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
  3. 3. 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)
  4. 4. Diagnostic labels Chronic Bronchitis – irritation, inflammation & swelling of the bronchi Emphysema – affects the bronchi & builds up mucous in the alveoli Chronic Asthma
  5. 5. Emphysema Find a diagram of a diseased lung
  6. 6. Airflow Obstruction Find a picture of airflow obstruction
  7. 7. 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
  8. 8.  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)
  9. 9. 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
  10. 10. 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
  11. 11. SmokingSmoking is the most important factor in COPD. Itimpairs cilliary action, causing inflammation in theairway, increased mucous production, alveolardestruction and bronchiolar fibrosis
  12. 12. 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
  13. 13. DiagnosisSpirometry Chest X-ray
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. Meter dose inhaler
  19. 19. 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
  20. 20. 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?
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. Which Lung would YOU prefer??
  26. 26. 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