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Respiratory. COPD/Asthma. Spirometry Examples. Spirometry Examples. Obstructive. Restrictive. Spirometry. FEV1 -vol of air patient able to exhale in the first second of forced expiration FVC -total vol of air patient can forcibly exhale in one breath FEV1/FVC -ratio of FEV1 to FVC as %
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Respiratory COPD/Asthma
Spirometry Examples Obstructive Restrictive
Spirometry • FEV1-vol of air patient able to exhale in the first second of forced expiration • FVC-total vol of air patient can forcibly exhale in one breath • FEV1/FVC-ratio of FEV1 to FVC as % • FEV1 and FVC expressed as % of predicted normal for a person of same age/sex/height
Spirometry-COPD • Post bronchodilator FEV1/FVC <0.7 (base) • FEV1% predicted <80% • Severity of COPD indicated by extent of FEV1 reduction • Asthma may show same abnormality as COPD-use reversibility testing to identify asthma
Spirometry • Obstructive pattern; • FEV1<80% • FVC reduced but less than FEV1 • FEV1/FVC <0.7 • Restrictive pattern; • FEV1 <80% predicted • FVC <80% predicted • FEV1/FVC normal >0.7
Initial Diagnostic Evaluation • Post bronchodilator spirometry (reversibility not usually necessary) • CXR • FBC for anaemia/polycythemia • BMI
COPD Stepwise Treatment • http://www.nice.org.uk/nicemedia/live/13029/49399/49399.pdf
COPD Vs Asthma • COPD • >35 • Risk factor (usually smoking) • Exertional SOB • Chronic cough • Regular sputum • Frequent winter bronchitis/wheeze • No clinical features of asthma • Asthma; • >1 of wheeze; cough; SOB; chest tightness • Triggers-exercise; viral; emotions; pets • Atopic history • Fh of atopy/asthma • Widespread wheeze • Improvement in symptoms with treatment
Asthma • Spirometry with reversibility • >400ml response to bronchodilator or after 2 week trial of pred 30mg daily • Reversibility testing; • Salbutamol/ipratropium/terbutaline • Or one month trial bronchodilator response with spirometry
William Gibson • Moderate COPD • Why?
Andrew Pell • Severe COPD • Why?
Eric Rowland • Moderate COPD • Why?
Nathan Nelder • Asthma • Why?
John Smith • Moderate COPD • Why?
Quiz Time! • FEV1 and FEV1/FVC for diagnosis of COPD • FEV1% of 30-49% is………COPD • Restrictive pattern spirometry looks like….. • FEV1 of …….to use inhaled steroids in COPD • Example of generic name of starting inhaler for COPD symptoms • Step 4 of asthma treatment in children <5y • Inhaled steroid dose for children 5-12y in step 2 of asthma treatment • What do you add in step 3 of adult asthma treatment?
Things to look at further… • NICE guidelines COPD and asthma • BTS guidelines • Spirometry in practice • Gpnotebook.co.uk