COPD

Monday, 30 March 2015

10:53 PM

Chronic Obstructive Pulmonary Disease

Clinically defined as:

Chronic Bronchitis (have a moist cough + production of white sputum> 3months)
Emphysema - evidence of destruction of alveoli walls.

GOLD definition:
A common preventable disease with very persistent limited airflow that is
progressive and
associated with enhanced chronic inflammatory response in the air ways & lungs

Clinical presentation:
Dypsnoea- that is progressively worsening over time
Cough +white sputum
Wheeze
Chest tightness
Reduced exercise tolerance

RF:

SMOKING
Exposure to chemicals
o
Indoor- poor ventilation
o
Burning fossil fuels

o
2ndary to workplace chemical exposure
FHx
o
-1 anti-trypsin deficiency
Factors that affect lung growth during gestation/ childhood

Investigations:

Assess acute respiratory function

O2 saturation (pulse oximetry)

o
88-90% ok for chronic disease
ABGs
o
PaO2<60 mmHg
Respiratory
o
PaCO2>50mmHg

failure!!

Baseline bloods

CBE
EUC

Assess comorbid state:

ECG
Glucose (for diabetes)

Assess pulmonary function:

Pulmonary function tests

o
Spirometry
o
Lung volumes
o
DLCO
Should show an obstructive picture that is suggestive of

COPD/ emphysema
CXR
o
Rule out other DDxs for dyspnoea
o
Assess degree of hyperinflation
o
Look for signs of acute exacerbation

Management
Severity of COPD is dependent on 3 factors:

Severity of symptoms
No. of exacerbations per year & the requirement for hospitalisation
Pulmonary function tests (esp. FEV1)

Lifestyle management of
COPD:
For ALL patients regardless of
severity

STOP SMOKING

Counselling
Nicotine replacement

Pulmonary rehabilitation

Flu & Pneumococcal

vaccine

Stabilise patient BEFORE treating COPD (ie. Address acute exacerbation

first)

ACUTE EXACERBATIONS:
1.

Assess severity of
exacerbations

** Purulent sputum
1.

ABGs
Pulse oximetry
CXR
ECGs (to exclude cardiac causes)

Empirical Abx

Supplemental Oxygen
If patient is hypoxaemic (PaO2 is reduced)
Aim for 88-92%

1.

Bronchodilators
SABA

1.

salbutamol

Systemic Corticosteroids
40mg prednisone/day for 5 days
Reduces:

Recovery time
Improves lung function
Arterial hypoxaemia (PaO2)

Adjunct Therapies

Fluid balance
Diuretics
Nutritional aspects
DVT prophylaxis
clexane

STABLE COPD:
General terms: the use of Long-acting anticholinergic/ 2- agonist is preferred if
possible (for more severe disease)

Severity of

Recommended

Examples

disease

treatment

Mild

Short Acting 2-agonist PRN

or

Salbutamol

Short Acting anticholinergic

PRN

Moderate

LABA or Long acting

anticholinergic

Tiotropium (Spiriva)

Severe

Inhaled corticosteroid +
LABA or

Symbicort (combo)

Long acting anticholinergic

Very Severe

Inhaled Corticosteroid +LABA

Long acting anticholinergic

Obstructive picture:
FEV1/FVC
FEV1
FVC

Lung volumes:
TLC
RV
IC:

Theophylline:
Tiotropium
Symbicort