This document provides guidelines for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (COPD). It discusses COPD definitions and risk factors. The guidelines recommend assessing patients based on symptoms, spirometry results, exacerbation risk, and comorbidities. Treatment options include smoking cessation, bronchodilators, pulmonary rehabilitation, oxygen therapy, and managing exacerbations and comorbidities. The guidelines provide an evidence-based framework for diagnosing and staging COPD severity, as well as treating stable COPD and acute exacerbations.
My all and slides mostly try to simplify pharmacy knowledge. Any time you are free to connect me. It's my pleasure to help you to get simplified pharmacy concepts. You may suggest topics needs to simplify the terminolog
Chronic Obstructive Pulmonary Disease (COPD) by Dr Kemi DeleKemi Dele-Ijagbulu
Presentation on definition and general overview of COPD, how to differentiate COPD from Asthma, how to make diagnosis of COPD, simple tools for assessment of COPD; available therapeutic options; as well as management of stable COPD, COPD exacerbations and comorbidities
My all and slides mostly try to simplify pharmacy knowledge. Any time you are free to connect me. It's my pleasure to help you to get simplified pharmacy concepts. You may suggest topics needs to simplify the terminolog
Chronic Obstructive Pulmonary Disease (COPD) by Dr Kemi DeleKemi Dele-Ijagbulu
Presentation on definition and general overview of COPD, how to differentiate COPD from Asthma, how to make diagnosis of COPD, simple tools for assessment of COPD; available therapeutic options; as well as management of stable COPD, COPD exacerbations and comorbidities
FRONTROW is a multi-level marketing firm that distributes health, beauty and wellness products, such as: -LUXXE White (Enhanced Glutathione) -LUXXE Protect (Pure Grapeseed Extract) -LUXXE Slim (L-Carnitine & Green Tea Extract) -LUXXE Renew (8 Berry Extract) We do not conduct photo shoots. We are not looking for models. We are looking for dynamic individuals who are interested in multi-level marketing.
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Breakout 1.2 Assessing competence in practice: Quality assured diagnostic spirometry - Monica Fletcher
Chief Executive Education for Health Chair European Lung Foundation
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
Breakout 3.1 How to…… Diagnose earlier and accurately: spirometry and history...NHS Improvement
Breakout 3.1 How to…… Diagnose earlier and accurately: spirometry and history taking - Chris Loveridge
Respiratory Practice Nurse Spirometry Clinical Lead
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
My presentation on GOLD
1. Global Strategy for Diagnosis,
Management and Prevention of
Chronic Obstructive Pulmonary Disease
Revised 2011
Dr. Mashfiqul Hasan
Resident, Phase A
Respiratory wing, Dept of Medicine
BSMMU
1
5. Description of Levels of Evidence
Evidence Sources of Evidence
Category
A Randomized controlled trials
(RCTs). Rich body of data
B Randomized controlled trials
(RCTs). Limited body of data
C Nonrandomized trials
Observational studies.
D Panel consensus judgment
5
6. Global Strategy for Diagnosis, Management and
Prevention of COPD, 2011: Chapters
Definition and Overview
Diagnosis and Assessment
Therapeutic Options
Manage Stable COPD
Manage Exacerbations
REVISED 2011
Manage Comorbidities
6
7. Definition of COPD
COPD, a common preventable and treatable
disease, is characterized by persistent airflow
limitation that is usually progressive and
associated with an enhanced chronic
inflammatory response in the airways and the
lung to noxious particles or gases.
Exacerbations and comorbidities
7
8. Mechanisms Underlying
Airflow Limitation in COPD
Small Airways Disease Parenchymal Destruction
• Airway inflammation • Loss of alveolar attachments
• Airway fibrosis, luminal plugs • Decrease of elastic recoil
• Increased airway resistance
AIRFLOW LIMITATION 8
9. Emphysema & chronic bronchitis
Not included in the definition
Emphysema
Pathological term
Only one of several structural abnormalities
Chronic bronchitis
Independent disease entity
May precede or follow development of
airflow limitation 9
10. Burden of COPD
Leading cause of morbidity and mortality
worldwide
6th leading cause of death in 1990
Will be the 3rd leading cause of death by the
year 2020
11. Risk Factors for COPD
• Genes
• Lung growth and
• Exposure to particles
development
Tobacco smoke
• Gender
Occupational dusts, organic
• Age
and inorganic
• Respiratory infections
Indoor air pollution from
heating and cooking with • Socioeconomic status
biomass in poorly ventilated • Asthma/Bronchial
dwellings hyperreactivity
Outdoor air pollution • Chronic Bronchitis
12. Risk Factors for COPD
Genes
Infections
Socio-economic
status
Aging Populations
13. Global Strategy for Diagnosis, Management and
Prevention of COPD, 2011: Chapters
Definition and Overview
Diagnosis and Assessment
Therapeutic Options
Manage Stable COPD
Manage Exacerbations
REVISED 2011
Manage Comorbidities
14. Diagnosis of COPD
EXPOSURE TO RISK
SYMPTOMS FACTORS
shortness of breath tobacco
chronic cough occupation
sputum indoor/outdoor pollution
SPIROMETRY : Required to establish
diagnosis
17. Assessment of COPD
1. Assess symptoms
2. Assess degree of airflow limitation
using spirometry
3. Assess risk of exacerbations
4. Assess comorbidities
18. Assessment of COPD
1. Assess symptoms
Assess degree of airflow limitation using spirometry
Assess risk of exacerbations Test (CAT)
COPD Assessment
Assess comorbidities
or
mMRC Breathlessness scale
22. Assessment of COPD
1. Assess symptoms
2. Assess degree of airflow limitation
Spirometry for grading severity
23. Classification of Severity of Airflow
Limitation in COPD*
In patients with FEV1/FVC < 0.70:
GOLD 1: Mild FEV1> 80% predicted
GOLD 2: Moderate 50% < FEV1< 80% predicted
GOLD 3: Severe 30% < FEV1< 50% predicted
GOLD 4: Very Severe FEV1< 30% predicted
*Based on Post-Bronchodilator FEV1
24. Assessment of COPD
1. Assess symptoms
2. Assess degree of airflow limitation
using spirometry
3. Assess risk of exacerbations
Assess comorbidities
1. History of exacerbations and
2. Spirometry
26. (GOLD Classification of Airflow Limitation) Combined Assessment of COPD
Patient is now in one of
4
Four categories:
(C) (D)
(Exacerbation history)
>2
3 A: Les symptoms, low risk
Risk
Risk
B: More symtoms, low risk
2 1
(A) (B) C: Less symptoms, high risk
1 0
D: More symptoms, high risk
mMRC 0-1 mMRC>2
CAT < 10 CAT >10
Symptoms
(mMRC or CAT score))
27. Assess COPD Comorbidities
• Cardiovascular diseases
• Skeletal muscle dysfunction
• Osteoporosis
• Anxiety and Depression
• Metabolic syndrome
• Lung cancer
May influence mortality and hospitalizations
Should be looked for routinely and treated appropriately
32. Brief Strategies to Help the
Patient Willing to Quit Smoking
1. ASK Systematically identify all
tobacco users at every visit
2. ADVISE Strongly urge all tobacco
users to quit
3. ASSESS Determine willingness to
make a quit attempt
4. ASSIST Aid the patient in quitting
5. ARRANGE Schedule follow-up contact
33. Pharmacological therapy for stable
COPD
Beta2-agonists
Short-acting beta2-agonists
Long-acting beta2-agonists
Anticholinergics
Short-acting anticholinergics
Long-acting anticholinergics
Combination short-acting beta2-agonists + anticholinergic in one inhaler
Methylxanthines
Inhaled corticosteroids
Combination long-acting beta2-agonists + corticosteroids in one inhaler
Systemic corticosteroids
Phosphodiesterase-4 inhibitors
34. Bronchodilators in COPD
• Central to the symptom management
• Inhaled : preferred
• Choice depends on availability & individual
patient response
• As needed or regular
• Long acting : convenient, more effective
• Combination
34
35. ICS in COPD
• Controversial
• Limited to specific indications
• Regular treatment with ICS improves
symptoms, lung function and quality of life in
patients with FEV1 <60% predicted
(Evidence A)
• Does not modify the long term decline of
FEV1 nor mortality (Evidence A)
• Adverse effects
35
37. Non-pharmacologic therapies :
pulmonary rehabilitation
Improvements in exercise tolerance and
symptoms of dyspnea and fatigue
Effective pulmonary rehabilitation
program duration: 6 weeks
If exercise training is maintained at home
the patient's health status remains above
pre-rehabilitation levels
38. Other treatments
• O2 therapy
• Ventilatory support
• Surgical treatments
– Lung volume reduction surgery
– Bronchoscopic lung volume reduction
– Lung transplantation
– Bullectomy
38
39. Global Strategy for Diagnosis, Management and
Prevention of COPD, 2011: Major Chapters
Definition and Overview
Diagnosis and Assessment
Therapeutic Options
Manage Stable COPD
Manage Exacerbations
REVISED 2011
Manage Comorbidities
40. Goals of Therapy
Relieve symptoms
Improve exercise tolerance Reduce
symptoms
Improve health status
Prevent disease progression
Prevent and treat exacerbations Reduce
risk
Reduce mortality
41. Identify & reduce exposure
to risk factors
• Tobacco smoke
– Key intervention (Evidence A)
• Occupational exposures
– Avoid continued exposures (Evidence D)
• Indoor & outdoor air pollution
– Biomass fuel
– Efficient ventilation, non polluting cooking
device (Evidence B)
41
42. Manage Stable COPD: Non-pharmacologic
Patient Essential Recommended Depending on
local guidelines
Smoking cessation (can Flu vaccination
A include pharmacologic Physical activity Pneumococcal
treatment) vaccination
Smoking cessation (can
Flu vaccination
include pharmacologic
B, C, D Physical activity Pneumococcal
treatment)
vaccination
Pulmonary rehabilitation
43. Manage Stable COPD: Pharmacologic
Patient First choice Second choice Alternative Choices
LAMA
SAMA prn or
A or LABA Theophylline
SABA prn or
SABA and SAMA
LAMA
SABA and/or SAMA
B or LAMA and LABA
Theophylline
LABA
ICS + PDE4-inh.
C LABA or LAMA and LABA SABA and/or SAMA
LAMA Theophylline
ICS + ICS andLAMA or
ICS + LABA and LAMA or Carbocysteine
LABA or
D ICS+LABA and PDE4-inh.or SABA and/or SAMA
LAMA LAMA and LABA or Theophylline
LAMA and PDE4-inh.
44. FIRST CHOICE
C D
GOLD 4
Exacerbations per year
ICS + LABA ICS + LABA
>2
or or
LAMA LAMA
GOLD 3
A B
GOLD 2
SAMA prn LABA 1
or or
GOLD 1 SABA prn LAMA
0
mMRC 0-1 mMRC>2
CAT < 10 CAT >10
45. SECOND CHOICE
C D
GOLD 4
Exacerbations per year
LAMA and LABA ICS and LAMA or
ICS + LABA and LAMA or >2
ICS + LABA and PDE4-inh or
GOLD 3 LAMA and LABA or
LAMA and PDE4-inh.
A B
GOLD 2
LAMA or LAMA and LABA 1
LABA or
GOLD 1 SABA and SAMA
0
mMRC 0-1 mMRC> 2
CAT < 10 CAT > 10
46. ALTERNATIVE CHOICES
C D
GOLD 4 PDE4-inh. Carbocysteine
Exacerbations per year
SABA and/or SAMA SABA and/or SAMA >2
Theophylline Theophylline
GOLD 3
GOLD 2 A B
SABA and/or SAMA 1
Theophylline Theophylline
GOLD 1
0
mMRC 0-1 mMRC> 2
CAT < 10 CAT >10
47. Monitoring & follow up
• Disease progression & development of
complications
• Monitor pharmacotherapy
• Exacerbation history
• Comorbidities
47
48. Global Strategy for Diagnosis, Management and
Prevention of COPD, 2011: Chapters
Definition and Overview
Diagnosis and Assessment
Therapeutic Options
Manage Stable COPD
Manage Exacerbations
REVISED 2011
Manage Comorbidities
49. Acute Exacerbation
• an acute event
• characterized by a worsening of the
patient’s respiratory symptoms
• that is beyond normal day-to-day
variations and
• leads to a change in medication
50. Consequences Of COPD Exacerbations
Negative Impact on
impact on symptoms
quality of life and lung
function
EXACERBATIONS
Accelerated Increased
lung function economic
decline costs
Increased
Mortality
51. Precipitating factors
• Respiratory tract infection (Bacterial
or viral)
• Exposure to pollutants
• Interruption of maintenance therapy
• Overlaping
52. Investigation for acute exacerbation
• Pulse oxymetry, ABG
• Chest radiograph
• ECG
• CBC
• Sputum for CS
• Biochemical tests
• Spirometry : Not recommended
53. Potential indications for hospital
assessment and admission
• Marked increase in the intensity of symptoms
• Onset of new physical signs
• Failure to respond to initial medical management
• Severe underlying COPD
• Frequent exacerbations
• Serious comorbidities
• Older age
• Insufficeint home support
56. Pharmacologic treatment
• Short acting bronchodilators
• Short acting inhaled β2 agonist with or
without short acting anticholinergic
(Evidence C)
• No significant difference betweent MDI with
or without spacer and nebuliser
• IV methylxanthines only to be used in
selected cases (Evidence B)
57. Pharmacologic treatment: Coticosteroids
• Shorten recovery time, improve FEV1 &
PaO2, reduce the risk of early relapse,
treatment failure & length of hospital stay
(Evidence A)
• 30-40 mg prednisolone for 10-14 days
(Evidence D)
• Nebulised budesonide may be an alternative
58. Pharmacologic treatment: Antibiotics
• Indications
• Increased dyspoea, sputum purulence, sputum
volume (Evidence B)
• Increased sputum purulence with one other cardinal
symptoms (Evidence C)
• Mechanical ventilation (Evidence B)
• Length of antibiotic therapy : 5-10 days (Evidence D)
• The choice of antibiotic
• Route of administration
60. Respiratory support
• Oxygen therapy
– Key component of hospital treatment
– Target saturation of 88-92%
– ABG should be checked 30-60 minutes later
– Venturi masks for accurate & controlled delivery
62. Indications for NIV
At least one of following:
• Respiratory acidosis
• Severe dyspnea with clinical signs suggestive
of respiratory muscle fatigue, increased work
of breathing or both (Use of respiratory
accessory muscles, paradoxical motion of the
abdomen, or retraction of the intercostal
spaces)
63. Indications for ICU admission
– Severe dyspnoea that responds inadequately
to initial emergency therapy
– Changes in mental status
– Persistent or worsening hypoxemia (PaO2 <
5.3 kPa, 40 mm Hg) and/or severe/worsening
respiratory acidosis (PH <7.25) despite
supplemental O2 & noninvasive ventilation
– Need for invasive mechanical ventilation
– Need for vasopressors – hemodynamic
instability
64. Indications for invasive mechanical
ventilation
– Unable to tolerate NIV or NIV failure
– Respiratory or cardiac arrest
– Respiratory pauses with loss of consciousness or
gasping
– Diminished consciousness, psychomotor agitation
inadequately controlled by sedation
– Massive aspiration
– Persistent inability to remove respiratory secretions
– Heart rate <50 /min with loss of alertness
– Severe hemodynamic instability without response to
fluids and vasoactive drugs
– Severe ventricuar arrhythmia
– Life threatening hypoxemia in patients unable to
tolerate NIV
65. Discharge criteria
• Able to use long acting bronchodilators with or
without ICS
• Inhaled SABA therapy is required no more
frequently than every 4 hrs
• Able to walk across room
• Able to eat & sleep
• Stable for 12-24 hrs
• Fully understand correct use of medication
• F/U & home care arrangement
• Patient, family & physician are confident
66. Checklist at time of discharge
• Maintenance pharmacotherapy regimen
• Reassessment of inhaler technique
• Education regarding role of maintenance
regimen
• Completion of steroid therapy & antibiotics
• Need for LTOT
• Follow up visit in 4-6 weeks
• Management plan for comorbidities
67. Home management of
exacerbation
• Nurse administered home care
• Effective & practical alternative to
hospitalization in selected patient without
acidotic respiratory failure (Evidence A)