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Respiratory

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

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  1. Respiratory COPD/Asthma

  2. Spirometry Examples

  3. Spirometry Examples Obstructive Restrictive

  4. 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

  5. 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

  6. 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

  7. Initial Diagnostic Evaluation • Post bronchodilator spirometry (reversibility not usually necessary) • CXR • FBC for anaemia/polycythemia • BMI

  8. COPD

  9. LABA? LAMA? SABA? SAMA? ?

  10. COPD Stepwise Treatment • http://www.nice.org.uk/nicemedia/live/13029/49399/49399.pdf

  11. 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

  12. 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

  13. Adult Asthma Treatment

  14. Children 5-12y Treatment

  15. <5y Asthma Treatment

  16. Spirometry Answers

  17. William Gibson • Moderate COPD • Why?

  18. Andrew Pell • Severe COPD • Why?

  19. Eric Rowland • Moderate COPD • Why?

  20. Nathan Nelder • Asthma • Why?

  21. John Smith • Moderate COPD • Why?

  22. 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?

  23. Things to look at further… • NICE guidelines COPD and asthma • BTS guidelines • Spirometry in practice • Gpnotebook.co.uk

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