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COPD

COPD. 2003. Definition. Chronic slowly progressive disorder characterised by airway obstruction which does not change much over months.The airway obstruction is largely fixed but partially reversible by bronchodilator therapy. Statistics. 1% of UK population

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COPD

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  1. COPD 2003

  2. Definition • Chronic slowly progressive disorder characterised by airway obstruction which does not change much over months.The airway obstruction is largely fixed but partially reversible by bronchodilator therapy

  3. Statistics • 1% of UK population • Increases with age and urban living • Among >65 yr olds • Rural areas 10% • Urban areas 26% • 80% with severe copd are housebound

  4. statistics • 115 consultations/GP/year • 1 in 8 medical admissions • Kills 26,000 people/year

  5. Symptoms • Chronic cough • Wheeze • Breathlessness on exertion • Sputum production • Progressive symptoms • History of smoking for more than 20 pack years

  6. Diagnosis • Suggested by history • Spirometry – fev1/fvc < 70% • Severity – fev1/fev1 exp • Cxr excludes other diseases

  7. Differential diagnosis • Asthma • Lung cancer • Chronic heart failure • Tuberculosis • Bronchiectasis • Fibrosing lung disease

  8. Staging • Mild fev1 60-80% of predicted • Moderate fev1 40-60% of predicted • Severe fev1 < 40% predicted

  9. Lifestyle advice • Stop smoking • Lung function decline 30mls/yr • Lung function decline smokers 60mls/yr • Encourage exercise • Prevents muscle deconditioning • Vaccination – flu, pneumococcal • Weight loss

  10. Management • Mild - moderate • Short acting inhaled beta 2 agoinst • Inhaled anticholinergics

  11. Management • Severe • Steroid trial • 30mg prednisolone/day for 2 weeks with spirometry before and after. Positive rsponseis an increase in 200mls of fvc or 15% increase in fev1. An increase > 500mls indicates asthma

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