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    Ronald Thakor
    COPD is progressive airflow obstruction caused predominantly by smoking that leads to airway and lung damage and chronic inflammation. It is characterized by exertional breathlessness, chronic cough, sputum production, and frequent winter bronchitis. Diagnosis is made through spirometry showing airflow obstruction that is not fully reversible. Management involves bronchodilators, steroids, vaccinations, pulmonary rehab, and addressing risk factors like smoking.

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    COPD is progressive airflow obstruction caused predominantly by smoking that leads to airway and lung damage and chronic inflammation. It is characterized by exertional breathlessness, chronic cough, sputum production, and frequent winter bronchitis. Diagnosis is made through spirometry showing airflow obstruction that is not fully reversible. Management involves bronchodilators, steroids, vaccinations, pulmonary rehab, and addressing risk factors like smoking.

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    COPD is progressive airflow obstruction caused predominantly by smoking that leads to airway and lung damage and chronic inflammation. It is characterized by exertional breathlessness, chronic cough, sputum production, and frequent winter bronchitis. Diagnosis is made through spirometry showing airflow obstruction that is not fully reversible. Management involves bronchodilators, steroids, vaccinations, pulmonary rehab, and addressing risk factors like smoking.

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    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    60 views2 pages

    Copd

    Uploaded by

    Ronald Thakor
    COPD is progressive airflow obstruction caused predominantly by smoking that leads to airway and lung damage and chronic inflammation. It is characterized by exertional breathlessness, chronic cough, sputum production, and frequent winter bronchitis. Diagnosis is made through spirometry showing airflow obstruction that is not fully reversible. Management involves bronchodilators, steroids, vaccinations, pulmonary rehab, and addressing risk factors like smoking.

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    of 2

    COPD Grade 2 SOB when hurrying or walking up a slight hill

    Grade 3 Walks slower than contemporaries on the level because of SOB, or has to stop for
    COPD is progressive airflow obstruction, not fully reversible and does not change markedly breath when walking at own pace
    over several months. Predominantly caused by smoking Grade 4 Stops for breath after walking 100m or after a few mins on the level
     Airway and parenchymal damage Grade 5 Too breathless to leave the house, or SOB when dressing or undressing
     Chronic inflammation, usually due to tobacco smoke EXACERBATION - A sustained worsening of the patient’s symptoms from their usual stable
     COPD is now the preferred term for patients who were previously diagnosed as state which is beyond normal day to day variations and is acute in onset
    having chronic bronchitis or emphysema Symptoms o Worsening SOB
     Occupational exposures may also contribute to the development of COPD o Increased sputum production
    RISK FACTORS o Changing sputum colour
     Over 35 o Cough
     Smokers or ex-smokers Initial Management
    SYMPTOMS Increase frequency of bronchodilator use – consider giving via nebuliser
     Exertional breathlessness  Oral antibiotics if purulent sputum (sputum culture not normally recommended)
     Chronic cough  Prednisolone 30mg OD for 7-14 days
     Regular sputum production MANAGEMENT
     Frequent ‘winter’ bronchitis Breathlessness and exercise limitation
    Step 1 - Short-acting Bronchodilator PRN
     Wheeze
     No clinical features of asthma - Night time waking with SOB or wheeze with diurnal o β2-agonist or -Salbutamol 100-200 DPI/Terbutaline 400-500 DPI
    variation is most likely to be asthma o Anticholinergic -Ipratropium Bromide 20-40 DPI
    INVESTIGATIONS Step 2 - Combined therapy – short acting β2-agonist and short-acting anticholinergic
    Spirometry - Airflow obstruction is defined as: - Fenoterol/Ipratropium 200/80 MDI tds
     FEV1 <80% predicted and - Salbutamol/Ipratropium 75/15 MDI tds
     FEV1/FVC <0.7 Step 3 - Long-acting Bronchodilator
     Clinically significant COPD is not present if FEV1 and FEV1/FVC ratio return to o Long acting β2-agonist or - Salmeterol 25-50 DPI BD
    normal with drug therapy o Long-acting anticholinegric - Tiotropium 18 DPI OD
     Asthma may be present if: Step 4 - Moderate or Severe COPD – Trial of:
    o Serial PF measurements show significant diurnal or day-to-day variability
    o Long acting β2-agonist and - Salmeterol 25-50 DPI BD
    o There is a >400ml response to bronchodilators
    o Inhaled corticosteroid - Beclomethasone 100-250-400 BD
    o There is a >400ml response to 30mg Prednisolone OD 2/52
    - Fluticasone 50-500
    ..once diagnosis of COPD has been made - Budesonide 100/200/400
     CXR  BMI and ?weight loss  Discontinue if no benefit after 4 weeks

     Breathlessness (use MRC scale)  Sxs of heart failure  Combination: Salmeterol/Fluticasone or Formoterol/Budesonide
    Step 5 o Uniphyllin (usually hospital prescription) - Aminophylline PO
     FBC  Haemoptysis - TheophyllinePO
    SEVERITY OF AIRFLOW OBSTRUCTION - FEV1 % predicted  Offer pulmonary rehab & Consider ref to surgery (bullectomy/transplantation etc.)
     Mild 50 – 80 % Frequent Exacerbations
     Moderate 30 – 49 %  Annual influenza vaccination
     Severe <30 %  Pneumococcal vaccination
    MRC DYSPNOEA SCALE  Self management advice
    Grade 1 Not troubled by breathlessness except on strenuous exercise

    NICE Guidelines 2004


    Optimise bronchodilator therapy
     Add inhaled corticosteroids if
    o FEV1 < 50% and
    o 2 or more exacerbations in a 12mth period
    Chronic productive cough
     Trial of mucolytic therapy- Carbocisteine PO
    Respiratory Failure - Assess for appropriate oxygen – usually refer
    Cor Pulmonale - Oxygen and Diuretics
    Abnormal BMI / Anxiety and Depression / Smoking - offer cessation

    NICE Guidelines 2004

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