COPD
Risk Factors
Smoking (top RF)
Indoor cooking fuel (toxin)
Alpha-1 antitrypsin def
Pathogenesis
Clinical Features
Investigations
Management
Non pharm (slow progression)
Pharm
NOTE: Chronic bronchitis pt insensitive to hypercapnia, relies on hypoxic drive for respiratory effort. Watch out when giving supplementary O2
Surgery
Vaccination
COPD-X
C onfirm Diagnosis (Spirometry, PiKo-6, COPD-6)
O ptimise Function (drugs, technique, exercise, ?refer to resp physician)
P revent Deterioration (cease smoking, exercise, vaccinations)
D evelop self mx and support network (GPMP, education, allied health/ other professions, COPD action plan)
Manage e X acerbations (++ bronchodilators, ICS, reassess daily, consider hospital admission)
Source
Dr Greg Haug 2014
Harrison's 18th Ed 2011
www.copd-x.org.au 2015
Smoking (top RF)
Indoor cooking fuel (toxin)
Alpha-1 antitrypsin def
Pathogenesis
- Chronic bronchitis --> Inflammation of airways --> airway narrowing --> inc RR --> as COPD pt takes longer to exhale, lung vol inc --> high residual vol -->
- Emphesema --> lose elastin --> exhale --> alveoli close prematurely
- Poor sputum ejection due to ciliary damage
Clinical Features
- Exertional Dyspnoea
- Productive cough
- Wheeze (due narrow airways)
- Can be asymptomatic (50% lung capacity lost before sx appear)
Investigations
- Spirometry (should do for all smokers >35y)
- Dx of COPD = FEV1 <80% predicted + FEV1/FVC <70%
- Then FEV1 >70% = mild; 50-70% = mod, 25-50% = severe, <25% = very severe
- ABG
Management
Non pharm (slow progression)
- Stop smoking
- Multidisciplinary pulmonary rehab
- Oxygen only for hypoxia (PaO2 < 55mm Hg) for 15/24
Pharm
- Sx reliever (no mortality benefit)
- SAB2A (2 puffs PRN) --> does not relieve sx as well
- SAanticholinergics (2 puffs PRN) - ipratropium (atrovent)better than Salbutamol
- LAanticholinergics - tiotropium (spiriva) **do not combine with SAanticholinergics**
- LAB2A - salmeterol (Serevent/ Seretide), eformeterol (Symbicort) **Not useful during acute exacerbations**
- Inhaled corticosteroids - reduce exacerbation freq
- Acute exacerbation
- SAB2A +/- SAanticholinergics
- O2 (SaO2 88-92% if type 2 ARDS, 94-98% if type 1 ARDS)
- OCS (not used in maintenance due to risk/benefit)
NOTE: Chronic bronchitis pt insensitive to hypercapnia, relies on hypoxic drive for respiratory effort. Watch out when giving supplementary O2
Surgery
- Lung transplant
- Lung volume reduction surgery (specific indications)
Vaccination
- Flu + pneumococcal
COPD-X
C onfirm Diagnosis (Spirometry, PiKo-6, COPD-6)
O ptimise Function (drugs, technique, exercise, ?refer to resp physician)
P revent Deterioration (cease smoking, exercise, vaccinations)
D evelop self mx and support network (GPMP, education, allied health/ other professions, COPD action plan)
Manage e X acerbations (++ bronchodilators, ICS, reassess daily, consider hospital admission)
Source
Dr Greg Haug 2014
Harrison's 18th Ed 2011
www.copd-x.org.au 2015