1、COPDShane OReillyCOPD Service Clinical Lead.What is COPD Chronic Obstructive Pulmonary Disease is an umbrella term used to describe different conditions that have similar symptoms and causes. The two main conditions under the umbrella are chronic bronchitis and emphysema.COPD Obstructive Main cause
2、of breathlessness. 3 components to obstruction Inflammation Bronchoconstriction Phlegm.Pathology Irritation of the airways causes inflammatory response. Smoking causes elastase to be released from the inflammatory mediators. Elastase starts to break down the elastic nature of the airways. It is the
3、continual nature of the irritation that causes the long term inflammation and damage to the airways.Pathology Chronic Bronchitis Affects the bronchioles. Irritation causes chronic inflammation. Reduction in size of lumen Increased airflow resistance Increased number of goblet cells Less compliant lu
4、ngs Greater effort to breathe.Pathology Emphysema Inflammation affecting the alveoli. Scar tissue formation following inflammatory process Destruction of alveolar walls. Reduction in surface area for gas exchange. Damaged membrane for gas transfer Scar tissue leads to restriction and reduced lung co
5、mpliance .Diagnosis History Age Smoking Cough Phlegm Short of Breath Spirometry.COPD and AsthmaCOPDAsthma Smoker or ex-smokerNearly AllPossibleSymptoms under age 45RareOftenChronic productive coughCommonUncommonBreathlessnessPersistent and progressiveVariableNight time waking with breathlessness and
6、 or wheezeUncommonCommonSignificant diurnal or day to day variability of symptomsUncommonCommon.Spirometry FEV1 Forced Expiratory Volume in one second FVC Forced Vital Capacity FEV1/FVC Ratio Below 70% for obstruction NICE 80% Mild 50 80% Moderate 30 - 50% Severe 30% Very Severe.Clinical Features Sh
7、ortness of breath Cough Phlegm Chest infections Reduction in exercise tolerance Weight gain or loss Cor pulmonale.Treatment Smoking Cessation Pharmacology Oxygen Pulmonary Rehabilitation Self management advice and education NIV.Stopping smoking at any age has beneficial effects on the lung function
8、of patients with COPD.Srivastava P et al. BMJ 2006;332:1324-13262006 by British Medical Journal Publishing Group.Inhaled Therapy Short acting Beta 2 agonist Short acting Anticholonergic Long acting Beta 2 agonist Long acting Anticholonergic Combination long acting Beta 2 agonist and corticosteroid.O
9、ral Therapy Theophyllines Corticosteroids Prophylactic Antibiotics.Oxygen Severe patients may require long term oxygen Initial indication is if SpO2 is less than 92% CBG done oxygen ordered if PaO2 is less than 7.3 Kpa Short burst oxygen is given to some patients who are palliative or get symptomati
10、c relief .Oxygen Sensitive Patients Some patients are oxygen sensitive providing uncontrolled or high levels of oxygen and cause respiratory acidosis Patients should be on Venturi masks as much as possible to reduce the risk If patients are above the target saturations and are having more oxygen tha
11、n normal then it is sensible to gradually reduce this down.Pulmonary Rehabilitation Exercise programme Twice a week for eight weeks Improve strength and physical fitness Improved quality of life, exercise tolerance and ADLs Reduction in healthcare costs.Education and Self Management Exacerbation rec
12、ognition and management Inhaler technique Breathlessness management Chest clearance Energy conservation Anxiety Management Dietetic advice.Non Invasive Ventilation Indicated for patients who have developed respiratory acidosis pH 7.35 Aim to blow off the carbon dioxide and therefore increase pH Norm
13、ally as a result of respiratory muscle pump failure Severe COPD patients live on edge of respiratory capacity when well Some patients now home ventilated with positive effects .Summary Predominantly smoking related disease Characterised by narrowing of the airways causing obstruction Stopping smokin
14、g is most important intervention Treatment can slow down progression and symptoms can improve .Palliative Care Supportive care in the community for those identified as end stage COPD Facilitation of patients expressing their wishes Timely and appropriate intervention that has been discussed with the
15、 patient.Identify The first stage is identification Would it be a surprise if your patient was to die within the next year Prognostic indicators.Last Days of LifeFirst Days of DeathDeath1 year1 yearAdvancing diseaseBereavement6 months1235Increasing decline4GSF/ACPLCP.Assess Assessment of potential f
16、uture needs and having discussions with the patient about what these may be Social care Equipment and adaptations Ceiling of treatment Preferred place of care Patients can indicate what treatments they would like to have however they cannot indicate what they do not want unless it is in a legal document Power of attorney.Plan Advanced care plan Anticipatory Drugs Rapid discharge. Any Questions.
