What is COPD?
COPD is an umbrella term encompassing the older terms chronic bronchitis and emphysema.
What is the cause of COPD?
Smoking
What are the features of COPD?
- cough: often productive
- dyspnoea
- wheeze
- in severe cases, right-sided heart failure may develop resulting in peripheral oedema
What investigations confirm the diagnosis of COPD?
Spirometry:
FEV1/FVC ratio less than 70%
How is the severity of COPD graded?
Using spirometry FEV1 results:
- Mild Stage 1 >80% FEV1
- Moderate Stage 2 50-79% FEV1
- Severe Stage 3 30-49%
- Very severe stage 4 <30%
What is the management of stable COPD?
General:
- Smoking cessation
- Flu vaccine and pneumococcal vaccine
- pulmonary rehabilitation
Inhalers:
*1st line: SABA or SAMA
*2nd add in no asthmatic features
>add LABA + LAMA
*2nd add in if asthmatic features
>LABA + ICS
*3rd offer triple therapy
>LAMA, LABA, ICS
Consideration:
- Prophylactic abs
- Mucolytics if chronic productive cough
- long term oxygen therapy
What features should be assessed when considering a patient for long term oxygen therapy in COPD?
- Severe airflow obstruction FEV1 <30%
- Cyanosis
- Polycuthaemia
- peripheral oedema
- Raised JVP
- Oxygen sats less than 92% on room aim
How is the assessment completed for considering a patient with COPD for LTOT?
*Assessment is done by measuring arterial blood gases on 2 occasions at least 3 weeks apart in patients with stable COPD on optimal management
What features qualify a patient for LTOT?
*patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
What are some examples of mucolytics?
Carbocisteine
What are examples of SAMA (short acting muscarinic/anticholinergic agents)?
Ipratropium
