COPD
- Airflow obstruction, progressive and not fully reversible
- As opposed to reversible asthma
Causes
- Smoking
- THE MAIN CAUSE - Exposure to fumes and dust
- Mainly from occupation
Who does COPD mainly affect?
Over 35
Symptoms
- Increasing breathlessness
- Chronic cough
- Regular sputum production
- Persistent wheeze
Asthma vs COPD
Asthma:
- often under 35
- Reversible
- Chronic productive cough is uncommon
- Breathlessness is variable
- Night time symptoms are common
- Atopy related
COPD:
- rarely under 35
- Irreversible
- Chronic productive cough is common
- Breathlessness is persistent and progressive
- Night time symptoms are uncommon
- Not atopy related
How do you know if someone has COPD rather than asthma based on response to a reliever inhaler?
- Asthma - reversibility involved
- COPD - only partially reversible
Diagnosis
- Spirometry
- If FEV1/FVC ratio is < 0.7, then that indicates obstruction
And - Clinical observations
- e.g. symptoms of COPD
- As well as factors e.g. smoking, age - Chest X-ray/CT scan to exclude other potential causes
E.g. Infection, Heart failure
How to measure breathlessness
o Dysnoea score or mMRC
o CAT score (8 questions marked out of 5, less than 10 = not COPD. More than 10 = COPD)
STEP 1
SABA or SAMA
used for quick relief
STEP 2: what does it depend on
- Still experiencing breathlessness
- Depends on whether they show asthmatic features or steroid responsiveness
NICE: What do asthma features/steroid responsiveness mean?
- Any previous, secure diagnosis of asthma or atopy
- A higher blood eosinophil count
- Substantial variation in FEV1
over time (at least 400 ml) - Substantial diurnal variation in peak expiratory flow (at least 20%).
STEP 2: Non-asthmatic
LAMA + LABA
discontinue SAMA
SABA continued throughout
STEP 3: non-asthma
SABA
add on LABA and LAMA
STEP 2: Asthmatic
LABA + ICS
Discontinue SAMA
SABA continued throughout
Step 3: If pt has severe exacerbation or 2+ moderate ones in a year
LAMA + LABA + ICS
Trial for 3 months
SABA continued throughout
LAMA + LABA + ICS examples
- Trimbow (beclomethasone, formoterol, glycopyronnium) SLOWLY AND DEEPLY
- Trelegy (fluticasone, umeclidinium, vilanterol)
If non-asthmatic feels no change after 3 months
Rever back to LAMA + LABA
Further treatment:
1. Oral MR Theophylline
2. Carbocisteine
3. Roflumilast
4. Oxygen
What vaccines should all patients with COPD get and how often?
Annually:
1. Influenza
And
2. Pneumococcal (e.g. PPV or PCV)
COPD Treatment - Rescue packs
- Amoxicillin
- Doxycycline
PO steroids
Prednisolone
30mg daily for 1 week
O2 alert cards
Hypercapnic respiratory failure
- too much CO2 in blood
