This document provides an overview of a health awareness lecture on smoking cessation and COPD. The key points covered include:
- National statistics on smoking-related deaths in the Philippines
- Health and economic impacts of the top 4 smoking-related diseases
- Reasons for the prevalence of smoking in the Philippines
- Toxic components of tobacco smoke and their effects
- Diseases and complications caused by smoking
- Benefits of smoking cessation
- Definition and components of COPD
- Risk factors, pathogenesis, clinical features, investigations and management of COPD
- Pharmacological management of COPD including short-acting and long-acting bronchodilators
ANTI-SMOKING-HEALTH-EDUCATION-CAMPAIGN.pptx This slide talks about Anti Smoking health Education Campaign . Common Risk Factors of Smoking and its Long Term Effects. In this slide you will also know what is smoking, what is tobacco smoking, the chemicals in the cigarettes, Most dangerous compound found in a cigarette, Kind of tobacco smoke.
What is second hand smoke?
What is Third hand smoke?
What is Mainstream smoke?
What is nicotine and its effect?
What's the difference between healthy lungs and smoking lungs?
ANTI-SMOKING-HEALTH-EDUCATION-CAMPAIGN.pptx This slide talks about Anti Smoking health Education Campaign . Common Risk Factors of Smoking and its Long Term Effects. In this slide you will also know what is smoking, what is tobacco smoking, the chemicals in the cigarettes, Most dangerous compound found in a cigarette, Kind of tobacco smoke.
What is second hand smoke?
What is Third hand smoke?
What is Mainstream smoke?
What is nicotine and its effect?
What's the difference between healthy lungs and smoking lungs?
Hystory of smoking: how did it start in different countries. Smoking effects on human body. Smoking in Europe: official data. Smoking in Lithuania: official data and numbers. Smoking at school. Prevention. Laws that affect smokers.
It is a slide show about tobacco. It can be used for college seminars & other seminar related to cancer or tobacco......For description you can collect info's from internet of all slides.....A little editing is required as your need....
Tobacco smoking: The direct inhalation of tobacco smoke, the basis of major health hazards. Long known to cause cancer in humans, tobacco smoking is generally held to be the leading preventable cause of cancer in developed countries. Tobacco smoking was formally classified as a "known human carcinogen" by the US government in 2000.
Hystory of smoking: how did it start in different countries. Smoking effects on human body. Smoking in Europe: official data. Smoking in Lithuania: official data and numbers. Smoking at school. Prevention. Laws that affect smokers.
It is a slide show about tobacco. It can be used for college seminars & other seminar related to cancer or tobacco......For description you can collect info's from internet of all slides.....A little editing is required as your need....
Tobacco smoking: The direct inhalation of tobacco smoke, the basis of major health hazards. Long known to cause cancer in humans, tobacco smoking is generally held to be the leading preventable cause of cancer in developed countries. Tobacco smoking was formally classified as a "known human carcinogen" by the US government in 2000.
Discover the effects of smoking on your finances,society,health,environment and unborn baby.These slides will open your eyes to the harmful effects of tobacco,so,much so that you won't want to touch it again.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
3. • Kahit na ang kita ng gobyerno mula sa
taxes ng sigarilyo ay umaabot sa PhP 23 billion
taun-taon
• Nababawasan ang ekonomiya
ng bansa dahil sa gastos na
pangkalusugan dulot ng
top 4 na sakit na dulot ng
paninigarilyo (Ca, CVD,
COPD, Diabetes) na umaabot sa
PhP 149 billion taun-taon.
SOURCE: Tobacco and Poverty Study, World Health Organization, 2008)
4. Bakit laganap sa Pilipinas ang
pag gamit ng SIGARILYO (tabacco)?
• MADALING MAKAKUHA
• AGGRESIBO AT LAGANAP NA KALAKAL
• KAKULANGAN SA KAALAMAN UKOL SA
PANGANIB SA KALUSUGAN
• KAKULANGAN SA PAGSASAGAWA NG
PATAKARAN AT PROGRAMA UPANG SUGPUIN
ANG EPIDEMYA NG SIGARILYO
5. SIGARILYO
ay ang natatanging LEGAL na produkto,
na kung ginamit base sa
manufacturers’ instructions,
ay siguradong papatayin ang kalahati
sa mga gumamit nito.
6. Ang usok ng sigarilyo ay merong
higit sa 7,000 chemicals,
higit sa 50 known or suspected carcinogens,
at maraming potent irritants.
8. 3 PANGUNAHING SANGKAP
NG USOK NG SIGARILYO
•NICOTINE ay ang sangkap ng
sigarilyo na
nakakahumaling/nakaka-addict.
Ito ay naiiwan sa dugo at
nakaapekto sa utak sa loobng
10 segundo. Ito’y nagdudulot sa
naninigarilyo para gumanda ang
pakiramdam dahil sa kemikal na
ilinalabas
nagdudulot
ng utak. Ito’y
rin ng pagtaas ng
tibok ng puso, blood pressure, at
adrenaline na nakakaganda ng
pakiramdam.
9. •TAR ay makapal, malapot na sangkap, at kung malanghap
ito ay didikit sa mga maliliit na buhok sa baga (lungs), na
tinatawag na cilia. Normal nitong pinoprotektahan ang baga
laban sa mga dumi at impeksyon, pero kung ito’y mapupuno
ng tar ‘di nila magagawang protektahan ang baga. Tinatakpan
rin ng Tar ang mga bahagi ng buong respiratory system,
pinaliliit nito ang mga tubo na nagdadala ng hangin
(bronchioles) at nababawasan rin ang pagkabanat ng
baga.
10. • CARBON MONOXIDE ay
nakakalasong kemikal na makikita
sa mga usok ng tambutso ng mga
sasakyan. Binabawasan nito ang
dami ng oxygen sa dugo at pati na
rin sa ibang organs. Dahil konti na
ang oxygen sa dugo, ito’y nagiging
malapot at ito ang dahilan upang
pumuwersa ang puso na mag
buga ng dugo.
11. Ang PANINIGARILYO ay gumagawa
ng samo’t saring problema sa
kalusugan at komplikasyon….
W A R N I N G
Ang mga susunod na slides ay may mga imahe na
hindi angkop sa mga bata, patnubay ng magulang
ay kailangan.
14. Ang paninigarilyo sa murang edad ay nakakapag pataas ng
panganib sa kanser sa baga (lung cancer) at bibig.
15. Smoking makes you about 10 times more likely
to die early from a major stroke or heart attack.
Pinatataas rin nito ang panganib na magkaroon ng diabetes.
16. Smokers suffer more frequently from
severe bronchitis and emphysema
(a disease where the chemicals in tobacco smoke severely damage
the lining of the lungs, and make it difficult to breathe).
17. Ang paninigarilyo ay nagdudulot ng pinsala sa mga maliliit
na ugat at pinipigilan nito ang pagdaloy sa mga kamay at
paa, na maaaring magkaroon ng gangrene at magdulot ng
pagkaputol ng paa at kamay.
20. Ang paninigarilyo ay nakakaapekto rin sa kutis at balat;
nakakapagdulot ito ng maagang pagtanda ng balat at
pagkakaroon ng mga kulubot (wrinkles).
21. Men who smoked for years were often unable
to have an erection due to low penile blood pressure.
Male smokers also have a lower sperm count and
more abnormal sperm than non-smokers.
28. Sa kada stick ng sigarilyo na nagagamit,
nawawalan ng 5 to 10 minutes ng buhay ang taong naninigarilyo
at ilinalagay rin nya sa panganib ang mga inosenteng tao sa
kanyang paligid.
29. URI NG USOK NG SIGARILYO
•MAINSTREAM SMOKE Ito ay combinasyon ng hinithit at
ibinugang usok matapos itong sindihan.
31. • THIRD-HAND SMOKE ay
kombinasyon ng usok at amoy
ng sigarilyo na dumidikit sa
buhok at damit ng naninigarilyo,
pati na rin sa sahig, mga kurtina,
appliances, mga gamit sa bahay,
mga laruan ng bata – kahit na
wala ng naninigarilyo.
34. • Sudden infant death syndrome (SIDS)
• Reduced lung function
• Increased blood pressure
• Headaches
• Acute lower respiratory infection –
bronchitis, pneumonia
• Respiratory irritation –
cough, phlegm, wheeze
• Difficulty in breathing
• Burning eyes and throat
• Ear infections
• Nose bleeds
• Frequency and severity of asthma
• Childhood cancers –
leukemia, lymphoma, brain tumor
35. ALAM ‘NYO BA?
The original “Marlboro Man”
may not
have been that macho or masculine
as his advertisements projected.
David Millar, Jr.
died from emphysema in 1987
after years of bad health.
Three more men who appeared
in Marlboro advertisements
– Wayne McLaren,
David McLean & Dick Hammer –
all died of lung cancer.
39. • In 2003, the Philippines enacted Republic Act 9211
aimed to:
- Promote smoke-free areas
- Inform public of the health risks
of tobacco use
- Ban all tobacco
advertisement and
sponsorship and restrict
promotions
- Regulate labelling of tobacco products
- Protect youth from being initiated
to smoking
40. • SMOKING BAN in public conveyances like jeepneys,
buses, taxis and tricycles.
• OTHER SMOKING BAN in elevators and stairwells,
locations in which fire hazards are present, health and
hospital facilities, public conveyances, and food
preparation areas.
• These places cannot have designated smoking areas.
41. A N O A N G P W E D E M O N G
GAWIN?…
Kung ikaw ay naninigarilyo, itigil
ito sa pinakamabilis na paraan.
Huwag mong hahayaan na may
manigarilyo sa loob ng inyong
bahay – protektahan mo ang
iyong sarili at iba laban sa
Secondhand smoke.
Makisali sa mga anti-smoking
campaigns – kailangan malaman
ng iba ang mga masamang
naidudulot ng paninigarilyo.
42. Kapag ikaw ay tumigil sa
pagyosi…
Sa loob ng 20 Minutes:
Bababa ang blood pressure sa normal
Magiging normal ang pulso
Body temperature ng kamay at paa ay tumataas at nagiging normal
Sa loob ng 8 oras:
Carbon Monoxide level sa dugo ay baba sa normal
Oxygen level sa dugo ay tataas sa normal
Smoker's breath ay nawawala
Sa loob ng 24 oras:
Ang chance ng pagkakaroon ng heart attack ay nababawasan
Sa loob ng 48 oras:
Ang mga ugat-ugat ay nagsisimula na ulit na tumubo
Ang abilidad sa pangamoy at panlasa ay bumabalik
43. Sa loob ng isang taon:
Ang panganib sa coronary heart disease ay kalahati
kaysa sa naninigarilyo
Sa loob ng 2 taon:
Panganib sa Heart attack ay bababa sa normal
Sa loob ng 5 taon:
Lung cancer death rate para sa average pack-a-day
smoker ay bababa ng halos kalahati
Panganib sa Stroke risk ay mababawasan
Panagnib mula sa mouth, throat at esophageal cancer
ay bababa ng kalahati kaysa sa mga naninigarilyo pa
Kapag ikaw ay tumigil sa
pagyosi…
44. Sa loob ng 10 taon:
Lung cancer death rate ay
parehas na sa mga taong hindi
naninigarilyo.
Ang mga nabuong pre-cancerous
cells ay napalitan na.
Sa loob ng 15 taon:
Panganib mula sa coronary heart
disease ay parehas na sa mga
taong hindi man lang nanigarilyo.
Kapag ikaw ay tumigil sa
pagyosi…
45. The choice is yours !
Help us in our crusade
and save lives !
.
49. COPD
Associated with
Abnormal inflammatory response of the lungs
To noxious particles and gases
Severe COPD leads to
Respiratory failure
Repeated hospitalization
Death
51. Chronic Bronchitis
Productive cough, for
at least 3 months
at least 2 consecutive years
Absence of any other identifiable cause of
excessive sputum production
Airflow limitation that is not fully reversible
Abnormal inflammatory response to noxious
agent - e.g., smoking
52. Emphysema
Alveolar wall destruction
Irreversible enlargement of air spaces
Distal to the terminal bronchioles
Without evidence of fibrosis
53. Burden of Disease: Epidemiology
In 2010, estimated 384 million patients
Leading cause of morbidity and mortality
Induces substantial economic and social burden
Second leading cause of death
Annual deaths due to COPD
About 3 million
4.5 million by 2030
55. Risk factors
Exposure
Tobacco smoke
Bio mass fuel smoke, open fires
Chronic uncontrolled asthma
Occupational dusts and chemicals
Infections, overcrowding, damp
Low socioeconomic status
Host Factors
Genes (alpha1- anti-trypsin↓)
Hyper responsiveness
Lung growth, low BW
Advanced age
56. COPD Increasing Worldwide
Increase in exposure to risk factors (especially
tobacco) in developing countries & in women
Changing demographics globally, with more
people living into the COPD age range
65. Chronic Bronchitis
Mild dyspnea
Cough is prominent
Copious, purulent sputum
More frequent infections
Cor pulmonale common
66. Emphysema
Severe dyspnea
Cough after dyspnea
Scant sputum
Less frequent infections
Terminal respiratory failure
Cor pulmonale rare
67. mMRC Grading of Dyspnea
Grade Description
0 Dyspnea only with strenuous exercise
1 Dyspnea when hurrying or walking up a slight hill
2
Walks slower than people of the same age because of
dyspnea or has to stop for breath when walking at own pace
3 Stops for breath after walking 100 m or after a few minutes
4 Too dyspneic to leave house or breathless when dressing
68. Physical Examination
Physical exam may be normal in some
Hyper-inflated chest, barrel chest
Wheezes or quiet breathing
Pursed lip / accessory muscles resp.
Peripheral edema
Cyanosis, ↑ JVP
Cachexia
Cough, wheeze, dyspnea, sputum
73. Management
Risk reduction
Smoking cessation:
Reduces the rate of decline in lung
function
Results in clinical improvement
74. Goals of Management
Reduce
Risk
Reduce
Symptoms
Relieve symptoms
Improve exercise tolerance
Improve health status
Prevent disease progression
Prevent and treat complications
Reduce mortality
75. Principles of Management
Stable COPD
Inhalation treatment is preferred
LAMA (long acting antimuscarinic agent) is the FIRST choice
LABA (long acting beta agonists) are the SECOND best choice
ICS (inhaled corticosteroids) are the THIRD choice
SABA and SAMA (salbutamol, ipratropium) for short bursts
NO systemic steroids in stable COPD
77. Inhaled therapy
The mainstay of COPD therapy
Drugs are delivered as aerosols or powders
delivered direct to the airways
first-pass metabolism in the liver is avoided
lower doses are necessary
unwanted systemic effects are minimized
80. Remember mMRC grading?
mMRC grading is for assessing the severity of
1. Breathlessness
2. Angina
3. Chest pain
4. Fatigue
Grade Description
0 Dyspnea only with strenuous exercise
1 Dyspnea when hurrying or walking up a slight hill
2
Walks slower than people of the same age because of dyspnea or has to stop for
breath when walking at own pace
3
Stops for breath after walking 100 m or after a few
minutes
4
Too dyspneic to leave house or breathless when dressing
81. Assessment & Management of COPD
Grade FEV1 (%pred)
Gold 1
Gold 2
Gold 3
Gold 4
> 80
50 - 79
30 - 49
<30
Assessment of
Airflow limitation
Exacerbation
History
0 or 1
NOT
requiring
admission
Assessment of Symptoms
mMRC 0-1 mMRC 2+
> 2 or > 1
requiring
admission
C D
A B
Diagnosis
FEV1 / FVC
< 0.7
82. C D
A B
Smoking cessation + Pulmonary rehabilitation
Physical activity
Influenza & Pneumococcal vaccine
Regular follow up and spirometry
Bronchodilator
salbutamol - SABA
ipratropium - SAMA
Long acting bronchodilator
LABA - salmeterol, formoterol
LAMA - tiotropium
LABA + LAMA
LAMA
LAMA + LABA
LAMA + ICS
Budesonide, fluticasone
LAMA + LABA + ICS
Roflumilast (if FEV1 < 50%)
Macrolides (if smoker)
83. Management of exacerbations
Most common causes
infections of the bronchial
tree
air pollution
increase in smoking
In ~35%, unknown cause
Treatment
Antibiotics
Systemic steroids
Mechanical ventilation, if
required
Oxygen*
Avoid high flow oxygen!
85. COPD is a complicated
illness
Prefer prevention
86.
87. “Everything is lawful for me,”
but not everything is beneficial.
“Everything is lawful for me,”
but I will not let myself be
dominated by anything..
I Corinthians 6:12 ESV