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COPD – UPDATE

COPD – UPDATE. Dr Raj K Rajakulasingam Homerton University Hospital & QMUL. Definition of COPD. Airflow obstruction is defined as reduced FEV 1 /FVC ratio (< 0.7) It is no longer necessary to have an FEV 1 < 80% predicted for definition of airflow obstruction

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COPD – UPDATE

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  1. COPD – UPDATE • Dr Raj K Rajakulasingam • Homerton University Hospital & QMUL

  2. Definition of COPD • Airflow obstruction is defined as reduced FEV1/FVC ratio (< 0.7) • It is no longer necessary to have an FEV1 < 80% predicted for definition of airflow obstruction • If FEV1 is ≥ 80% predicted, a diagnosis of COPD should only be made in the presence of respiratory symptoms, for example breathlessness or cough • COPD produces symptoms, disability and impaired quality of life which may respond to pharmacological and other therapies that have limited or no impact on the airflow obstruction. FEV1 = forced expiratory volume in 1 second FVC = forced vital capacity

  3. Natural History • The Fletcher-Peto Diagram, illustrating the effects of smoking on rate of decline in FEV1

  4. Diagnose COPD Consider a diagnosis of COPD for people who are: • over 35, and • smokers or ex-smokers, and • have any of these symptoms: • - exertional breathlessness • - chronic cough • - regular sputum production, • frequent winter ‘bronchitis’ • Wheeze • And no clinical features of asthma [2004]

  5. Diagnose COPD: Spirometry • Perform spirometry if COPD seems likely [2004] • The presence of airflow obstruction should be confirmed by performing post-bronchodilatorspirometry[new 2010] • Consider alternative diagnoses or investigations in: • - older people without typical symptoms of COPD where the FEV1/FVC ratio is < 0.7 • - younger people with symptoms of COPD where the FEV1/FVC ratio is ≥ 0.7 [new 2010] • All health professionals involved in the care of people with COPD should have access to spirometry and be competent in the interpretation of the results[2004]

  6. Differentiating COPD from asthma: 2 • If diagnostic uncertainty remains, the following findings should be used to help identify asthma: • - FEV1 and FEV1/FVC ratio return to normal with drug therapy • - a very large (>400ml) FEV1 response to bronchodilators or to 30mg prednisolone daily for 2 weeks • - serial peak flow measuremenst showing significant (20% or greater) diurnal or day-to-day variability • - remaining diagnostic uncertainty may be resolved by referral for more detailed investigations • [2004]

  7. Diagnose COPD: assessment of severity • Assess severity of airflow obstruction using reduction in FEV1 * Symptoms should be present to diagnose COPD in people with mild airflow obstruction ** Or FEV1 < 50% with respiratory failure [new 2010]

  8. Managing stable COPD Patient with COPD Assess symptoms/problems Manage those that are present as below Patients with COPD should have access to the wide range of skills available from a multidisciplinary team Palliative care

  9. Managing stable COPD: Promote effective inhaled therapy • In people with stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators as required, offer the following as maintenance therapy: • if FEV1 ≥ 50% predicted: either LABA or LAMA • if FEV1 < 50% predicted: either LABA+ICS in a combination inhaler, or LAMA • Offer LAMA in addition to LABA+ICS to people with COPD who remain breathless or have exacerbations despite taking LABA+ICS,irrespective of their FEV1 ICS = inhaled corticosteroid LABA = long-acting beta2 agonist LAMA = long-acting muscarinic agonist [new 2010]

  10. Managing stable COPD: inhaled therapies

  11. COPD - ICS • Dose of ICS should be equivalent to 1 mg/day • Low dose ineffective.

  12. Managing stable COPD: Oxygen • Clinicians should be aware that inappropriate oxygen therapy in • people with COPD may cause respiratory depression • Use appropriate oxygen therapy: • Long-term oxygen therapy • Ambulatory • Short burst

  13. Managing stable COPD: pulmonary rehabilitation Make available to all appropriate people, including those recently hospitalised for an acute exacerbation Hold at times that suit patients, and in buildings with good access Pulmonary rehabilitation An individually tailored multidisciplinary programme of care to optimise patients’ physical and social performance and autonomy Offer to all patients who consider themselves functionally disabled by COPD Tailor multi-component, multidisciplinary interventions to individual patient’s needs [new 2010]

  14. Multidisciplinary working • COPD care should be delivered by a multidisciplinary team that includes respiratory nurse specialists • Consider referral to specialist departments (not just respiratory physicians) [2004]

  15. Thank you for listening

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