This document summarizes guidelines for diagnosing and treating chronic obstructive pulmonary disease (COPD). It outlines how spirometry is used to diagnose COPD and confirms airway limitation. It lists common drug treatments for stable COPD including beta agonists, muscarinic antagonists, corticosteroids, and antibiotics. It also discusses supplemental oxygen therapy guidelines based on blood gas levels. Three assessment cases are included related to exacerbation management and non-invasive ventilation.

1. Global initiative for chronic
Obstructive
Lung
Disease
Dr. SYEDA MISHAL SALEEM
RESIDENT PHYSICIAN,
INTERNAL MEDICINE
POF HOSPITAL, WAH CANTT
REPORT 2021

4. SPIROMETRY :
• Maximal patient effort
• Bronchodilation:
400mcg SABA or 160mcg SAMA or both
• FEV1 should be measured 10-15 min after SABA or 30-
45 min after SAMA or both.
• < 1 sec pause between inspiation and expiration.
• 3 readings/ pleatue with difference of less then 5%
(150ml).
• Presence of FEV1/FVC < 0.7 ( post bronchodilation)
confirms air flow limitation.

9. TREATMENT OF STABLE COPD
BETA AGONIST
ANTIBIOTICS
NON
PHARMACOLOGICAL
MUSCARINIC
ANTAGONIST
CORTICOSTEROIDS
PDE4
INHIBITORS
INTERVENTIONAL
TECHNIQUES

14. Azithromycin (250mg/day or 500mg 3times/week) or Erythromycin (250mg X BD) for 1year

15. >15hours per day, does not lengthen time to death, but
decreases frequency of exacerbation.
It should be offered if pO2< 7.3kPa or with pO2 7.3 to 8 kPa
with one of the following:
• Secondary Polycythemia
• Nocturnal hypoxaemia
• Peripheral Edema
• Pulmonary Hypertension

21. • Prior to availability of blood gases, use 28% venturi mask
at 4L/min and aim of oxygen saturation is 88-92% , for
patients with risk of hypercapnia but no prior history of
respiratory acidosis.
• Adjust target to 94% to 98%, if pCO2 is normal.

25. ASSESSMENT # 1:
You review a 60yrs old woman, diagnosed case of COPD for
4 years. She is maintained on salbutamol inhaler as required
and tiotropium inhaler regularly. Her latest FEV1 was 42% of
predicted. Despite her current treatment she is having
frequent exacerbations.
What is the most apprpriate next step in management??

27. ASSESSMENT # 2:
A 70 year old man who is knon to have COPD, is admitted to
medical unit with suspected infective exacerbation of COPD.
What should be target saturation, untill ABGs are available?
88% to 92%

28. ASSESSMENT # 3:
A 69 year old man, with COPD, presented to ED with dyspnoea.
Three days ago he was on Amoxicillin and prednisilone.
Since arriving in hospital, he has been given back to back
salbutamol and ipratropium nebulizations. The oxygen
concentration has been titrated to 28% to achieve saturations of
88-92%. Due to his poor response aminophyline is started (with
cardiac monitoring). 30 minutes later his ABGs are:
pH 7.3
pCO2: 7.6 kPa
pO2: 8.1 kPa
What is most apprpriate next step in management??
NON INVASIVE VENTILATION

29. Thank You!