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COPD

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COPD. Or Chronic Bronchitis That Was. Dr Bruce Davies. www.bradfordvts.co.uk ... Chronic bronchitis. Emphysema. COAD. Chronic airflow restriction. Some cases ... – PowerPoint PPT presentation

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Title: COPD


1
COPD
  • Or Chronic Bronchitis That Was
  • Dr Bruce Davies
  • www.bradfordvts.co.uk

2
Possible Areas to Cover
  • Diagnosis
  • Initial investigation
  • Management plans
  • Referral criteria
  • Follow plans
  • Troubleshooting
  • The evidence base

3
Possible Areas to Cover
  • Ideas for Audit
  • Sources of further information
  • Case Histories
  • Future developments
  • Prevalence
  • Risk factors
  • Prevention

4
Labels encompassed by COPD
  • Chronic bronchitis
  • Emphysema
  • COAD
  • Chronic airflow restriction
  • Some cases of chronic asthma

5
Definition
  • Chronic slowly progressive airways obstruction,
    not fully reversible
  • FEV1 lt80 predicted
  • FEV1/FVC ratio lt70
  • Impairment largely fixed

6
Prevalence
  • Depends on where you work!
  • MaleFemale 41
  • UrbanRural 21
  • 5-25 of population
  • Declining, or being redefined!
  • 1-4 consultations per GP per week
  • Strongly social class related
  • Increases with age

7
Risk Factors
  • Smoking
  • Asthma
  • Genetic
  • Social class (Independent ? Of other factors)
  • Pollution
  • Occupational dust exposure
  • Recurrent infection

8
Symptoms
  • Smokers cough - Mild
  • Breathlessness on exertion - Moderate
  • Cough /- sputum - Moderate
  • Breathlessness on any exertion - Severe
  • Peripheral oedema - Severe

9
Diagnosis
  • Spirometry preferred to PEFR
  • If PEFR used then it needs to be done over
    several weeks to confirm lack of variability
  • CXR to exclude other problems
  • Bronchodilators only give limited improvement of
    PEF

10
Management Plans
  • Essential at all stages
  • Quit rates improved by
  • Active cessation programmes
  • NRT

11
Management Plans
  • Exercise.
  • Encouraged where at all possible, evidence that
    graded programmes are beneficial is growing.

12
Management Plans
  • Obesity and poor nutrition make things worse

13
Management Plans
  • Depression
  • Common concurrent problem
  • Social problems
  • Also common

14
Management Plans
  • Vaccination
  • Influenza for all
  • ? Pneumococcal

15
Management Plans
  • Short acting Bronchodilator PRN
  • or
  • Anticholinergic MDI, PRN
  • Regular use of above
  • Combination of two

16
Management Plans
  • ? Steroid trial
  • ? Regular inhaled steroid, if positive response
    to trial
  • Assess for home nebuliser
  • Assess for LTOT

17
Management Plans
  • Probably useless
  • Xanthines
  • Long acting beta agonists

18
Steroid Trial
  • 30mg prednisolone daily for 2 weeks
  • 200ml increase in FEV1 from baseline
  • Subjective improvement is negative
  • Objective improvement in 10-20

19
Referral Criteria
  • Suspected severe COPD
  • To confirm diagnosis optimise therapy
  • Onset of Cor pulmonale
  • To confirm diagnosis optimise therapy
  • ? Need for oxygen therapy
  • To measure blood gasses

20
Referral Criteria
  • ? Nebuliser therapy
  • To exclude inappropriate prescriptions
  • Assessment for oral steroids
  • To justify long term use / withdrawal supervision
  • Bullous lung disease
  • ? Surgery

21
Referral Criteria
  • lt10 pack years of smoking
  • To confirm or exclude the diagnosis
  • Rapid decline in FEV1
  • To encourage early intervention
  • Aged less than 40
  • ? Alpha 1 anti-trypsin deficiency

22
Referral Criteria
  • Uncertain diagnosis
  • To make one!
  • Symptoms disproportionate to lung function
  • To look for other explanations

23
Acute Exacerbations
  • Or
  • Help

24
Features
  • Worsening of previously stable state
  • Increased dyspnoea
  • Chest tightness
  • Fluid retention
  • Increased wheeze
  • Increased sputum
  • Increased sputum purulence

25
Assessment
  • Able to cope at home?
  • Good social circumstances?
  • Cyanosis?
  • Consciousness?
  • Degree of breathlessness
  • General condition?
  • LTOT?
  • Level of activity?

26
Home Treatment
  • Increase bronchodilators
  • 7 day course of Abx
  • Steroids for 1 week
  • Consider CXR, admission or referral if not back
    to normal in 2 weeks

27
Other Stuff
28
Evidence ?
  • Rather good for these suggestions
  • Very much a EBM field
  • British Thoracic Society

29
References
  • Thorax, 1997 52(suppl 5) S1-S32
  • Common Diseases, Fry, MTP, 1995.

30
Prevention
  • Fags
  • Fags
  • Fags
  • Pollution
  • Occupational factors
  • ? Housing

31
Questions
  • Should practices have spirometers?
  • Or open access to lung function clinics?
  • Should practice nurses run regular follow-up
    clinics?
  • How should a practice audit this area?
  • Should practices have smoking cessation clinics?
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