COPD An Overview - PowerPoint PPT Presentation

Loading...

PPT – COPD An Overview PowerPoint presentation | free to download - id: 3ee011-MjI1M



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

COPD An Overview

Description:

COPD An Overview Mariya Aziz 17/01/2012 * * * * * * * * * Curriculum Statement 15.8 Smoking cessation advice Acute management of SOB Importance of PEFR, reversibility ... – PowerPoint PPT presentation

Number of Views:79
Avg rating:3.0/5.0
Slides: 33
Provided by: mar349
Learn more at: http://www.airedale-gp-training.co.uk
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: COPD An Overview


1
COPDAn Overview
  • Mariya Aziz
  • 17/01/2012

2
Curriculum Statement 15.8
  • Smoking cessation advice
  • Acute management of SOB
  • Importance of PEFR, reversibility testing
    Spirometry
  • Principles of treatment of COPD
  • Exacerbations of COPD
  • Emergency Referrals

3
Epidemiology
  • Affects 3 million people in the UK
  • 900,000 diagnosed with an estimated 2 million
    remaining undiagnosed
  • Symptoms usually insidious which can delay
    diagnosis
  • Most patients are not diagnosed until their
    fifties
  • Consider in all symptomatic patients gt35 with
    smoking hx

4
Background
  • Main cause is smoking
  • Alpha-1 Antitrypsin Deficiency
  • Race
  • Poor diet and low birth weight
  • Characterised by airflow obstruction that is -
    Irreversible - Persistent over several months -
    Progressive in the long term
  • Airflow obstruction is defined as reduced
    FEV1/FVC ratio (lt 0.7)

5
History
  • SMOKING
  • SOB on exertion
  • Chronic cough
  • Regular sputum production
  • Frequent infections/bronchitis
  • Wheeze
  • Chest pain and haemoptysis are not typical
    symptoms

6
Signs
  • Hyper-inflated chest- poor expansion
  • Use of accessory muscles
  • Tachypnoea
  • Pursing of lips
  • Wheeze/ Reduced BS
  • Peripheral oedema
  • Raised JVP
  • Cachexia

7
Investigations
  • Perform spirometry if COPD seems likely
  • CXR
  • FBC to identify polycythaemia or anaemia
  • PEFR
  • BMI
  • Alpha-1 Antitrypsin if early onset/FH
  • ECG Echo if Cor Pulmonale is suspected
  • Sputum culture

8
(No Transcript)
9
Clinical features COPD Asthma
Smoker or ex-smoker Nearly all Possibly
Symptoms under age 35 Rare Often
Chronic productive cough Common Uncommon
Breathlessness Persistent and progressive Variable
Night time waking with breathlessness and or wheeze Uncommon Common
Significant diurnal or day to day variability of symptoms uncommon Common
10
Spirometry
  • Measures timed expired and inspired volumes
  • FEV1/FVC lt 70 (0.7)
  • FEV1 lt 70 Predicted
  • lt15 response to Reversibility test
  • Flow volume loop

11
(No Transcript)
12
Severity of COPD
  • FEV1 50-80 Mild
  • FEV1 30-49 Moderate
  • FEV1 lt 30 Severe

13
Management
  • Smoking Cessation
  • Behavioural support
  • 2-3 give up
  • Pharmacotherapy
  • Nicotine replacement Therapy
  • Bupropion (Zyban)
  • Varenicline (Champix)

14
Fletcher and Peto 1977
15
Inhaled Therapy
  • Aims - Reduce symptoms exacerbations
  • SABA - useful but limited
  • SEs-Tremor, tachycardia, hypokalaemia
    hyperglycaemia
  • SAMA reduce resting tone of smooth airways
  • SEs- dry mouth
  • LABA- duration 12 hours
  • Prolonged improvement in airflow
  • LAMA- Half-life 36 hours
  • Sustained improvement in airflow obstruction
  • Cost effective

16
Corticosteroids
  • Little evidence to suggest any affect on
    inflammatory cell
  • Effective in combination with LABA
  • 2nd line in patients with FEV1 lt50
  • SEs- oral candidiasis, bruising
  • Increased risk of pneumonia but decreased risk of
    Exacerbations

17
Breathlessness and exercise limitation
SABA or SAMA as required
FEV1 50
FEV1 lt 50
Exacerbations or persistent breathlessness
LABA
LAMA Discontinue SAMA ________ Offer LAMA in
preference to regular SAMA four times a day
LABA ICS in a combination inhaler ________ Cons
ider LABA LAMA if ICS declined or not tolerated
LAMA Discontinue SAMA ________ Offer LAMA in
preference to regular SAMA four times a day
Persistent exacerbations or breathlessness
LABA ICS in a combination inhaler ________ Con
sider LABA LAMA if ICS declined or not tolerated
LAMA LABA ICS in a combination inhaler
SABAs (as required) may continue at all stages
Offer
Consider
18
Oral Therapy
  • Oral Steroids
  • Theophylline
  • Relax smooth muscle
  • Increases diaphragm muscle strength
  • Increases cardiac output
  • SEs nausea, tachycardia
  • Reduce dose with Macrolides Fluoroquinolone
  • Mucolytics

19
Oxygen Therapy
  • LTOT- Long term oxygen therapy
  • gt15 hours a day
  • Aim improve survival
  • Consider in
  • Severe COPD
  • Polycythaemia
  • Cor Pulmonale
  • O2 Sats lt 92
  • PaO2 lt7.3 kPa or 7.3-8.0 kPa if co-morbidities
  • Requires Pulse oximetry ABGs
  • Measure on 2 occasions 3 weeks apart

20
Oxygen Continued
  • Ambulatory
  • Specialist assessment
  • Improve exercise tolerance QoL
  • Short Bursts
  • Only in those with episodes of severe SOB
  • NIV (Non invasive ventilation)
  • Hypercapnic Respiratory Failure
  • Required assisted ventilation during exacerbation
  • Hypercapnic/acidotic on LTOT
  • Specialist centre for referral

21
Pulmonary Rehab
  • Drug treatment alone- Limited effectiveness
  • Indivdualized programmes including
  • Physical training
  • Disease education
  • Dietary advice/ Weight control
  • Psychological behavioural intervention
  • Depression and anxiety
  • Recognise the signs and symptoms
  • No specific Antidepressants- sedative

22
Cor Pulmonale
  • Heart Failure Secondary to Lung Disease
  • Chronic hypoxia
  • Salt and water retention ( increased sympathetic
    drive to kidneys
  • Peripheral oedema raised JVP
  • Right ventricular hypertrophy Failure
  • Diagnosis on clinical features
  • Fluid Overload- Diuretics
  • No recommendation for ACE, Ca channel blockers or
    Alpha blockers

23
Exacerbations
  • Worsening of signs symptoms
  • RR gt 25, use of accessory muscles, wheeze
  • Increased cough, sputum volume/purulence
  • Upper airway symptoms- cold, sore throat
  • Reduced ET, fatigue
  • New onset/ Increasing fluid retention
  • Severe- cyanosis/ acute confusion

24
Exacerbation Continued
  • Causes
  • 30 no identifiable cause
  • Viral URTI/LRTI Bacterial
  • Consider Pneumonia, LVF, PE
  • Investigations
  • Oximetry
  • CXR
  • Sputum only if recurrent
  • Management
  • Increase bronchodilators
  • Broad spectrum antibiotics
  • Oral Steroids- 30mg OD 1-2 weeks

25
Hospitalization
  • Inability to cope at home
  • Poor level of activity or confined to bed.
  • SOB, cyanosis, peripheral oedema.
  • Acute confusion
  • Already on LTOT
  • Rapid rate of onset.
  • Comorbidity- cardiac IDDM
  • Satslt90, ABG- pH lt7.35, PaO2 lt7 kPa.
  • CXR changes

26
GP Follow Up/Review
  • Post exacerbation 4-6/52
  • Post hospitalization- 2/52
  • Severe - 2x year
  • Smoking Status
  • Symptom control on current regime
  • Inhaler technique and treatment review
  • Reinforce lifestyle changes
  • MDT and Pulmonary Rehab
  • FEV1
  • BMI
  • MRC Dysponea score

27
Self management
  • Patient education
  • Symptom recognition
  • Appropriate antibiotic and Prednisolone
  • Adjusting Bronchodilators
  • Knowing when to seek help

28
Palliative care
  • End stage COPD
  • Respect patient wishes
  • Consider Hospice for intensive support
  • Use of opiods and Benzodiazepines for symptom
    control

29
Flying
  • Equivalent to breathing 15 oxygen
  • BTS
  • Assessment of severe COPD patients prior to
    flying
  • Full cardio-resp hx, examination and previous
    flying hx
  • Secondary care- Spirometry and pulse oximetry
  • Hypoxic challenge test assesses the patients
    breathing in 15 oxygen
  • Insurance and need to carry inhalers

30
Patient with COPD
Assess symptoms/problems Manage those that are
present as below
Patients with COPD should have access to the wide
range of skills available from a
multidisciplinary team
Smok Breathlessness exercise limitation Frequent exacerbation Resp failure Cor pulmonale Abnml BMI Chronic prod cough Anxiety Dep
Palliative care
31
Post Reflection
  • Patient
  • 61 year old female
  • Ex-smoker
  • End stage COPD
  • Physicians perspective
  • Early referral
  • Attitudes towards smoking

32
  • The End
About PowerShow.com