COPD topic review What is COPD Chronic Obstructive

COPD topic review

What is COPD? ● Chronic Obstructive Pulmonary Disease ● Common, preventable, and treatable ● Characteristics: ○ chronic airflow limitation ■ ■ due to airway/alveolar abnormalities from exposure to noxious particles/gases small a. w. disease (chronic bronchitis) + parenchymal destruction (emphysema) ○ persistent respiratory symptoms

What causes COPD? ● ● ● ● ● TOBACCO SMOKING Indoor air pollution Occupational exposure Outdoor air pollution Genetics e. g. AATD Age and Gender: eldery & women Socioeconomic status Asthma Chronic bronchitis Respiratory tract infections

When to suspect COPD SYMPTOMS RISKS

Diagnosis ● Spirometry is required. ● Post-bronchodilator FEV 1/FVC < 0. 70 ● Spirometry vs Peak flow measurement

The Refined ABCD Assessment Tool Example: GOLD grade 4, group B

Modified British Medical Research Council (m. MRC)

COPD Assessment Test (CAT)

VENTOLIN

SPIRIVA

BERODUAL COMBIVENT

SERETIDE

Oxygen Therapy

Vaccination INFLUENZA VACCINE PNEUMOCOCCAL VACCINE

COPD with AE Symptom -Dyspnea -Cough -Increase sputum

COPD with AE indication for admit as IPD case

COPD with AE risk factor infection, respiratory irritants, drugs, hypoxia, weather change Ddx asthma, CHF, PE, ACS, pneumothorax, pneumonia

COPD with AE Investigation ● CXR ● EKG ● Optional : CBC , electrolyte, BNP, D-dimer, CTA pulmonary

COPD with AE Tx: ● ● ● O 2 supplement keep O 2 sat = 88 -92% if O 2 sat < 88% or symptom suggestion of hypercapnia ---> ABG EKG monitoring in case with U/D heart disease Bronchodilator ○ Short-acting bronchodilators: q 15 -60 min monitor for side effect if q 15 min Corticosteroids dexamethasone 4 mg IV q 4 -6 h or prednisolone < 40 -60 mg/d po give for 5 -7 days ATB sputum change in color → ATB 5 -7 days ( macrolide , doxycycline , amoxicillin +/- clavulanic acid) or in pneumonia case give IV ATB Methylxanthines (theophylline PO or aminophylline IV) in severe case , narrow therapeutic windows please beware of side effect (arrhythmia, hypotension, N/V , convulsion)

COPD with AE Tx: ● In severe case → Noninvasive Ventilation vs Invasive Ventilation

COPD with AE Tx: ● ICU admission?

COPD with AE ����������������� ● O 2 supplement ���� O 2 sat < 88% ������ pulmonary HT/cor pulmonale (RVH, polycythemia) ● long-acting bronchodilator (LAMA+LABA) start as soon as possible ● ����������� ���� lung cancer, cardiovascular disease, osteoporosis, depression/anxiety, OSA, GERD ● advice ����������� ● ����� MDI ������ ● vaccines ● ��� F/U