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ASTHMA & COPD

ASTHMA & COPD. By Laura Parker. Learning Objectives. To be able to define Asthma and COPD To have an understanding of the pathogenesis of each disease and the common causes / risk factors associated To be able to recognise the presentation of patient with Asthma or COPD

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ASTHMA & COPD

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  1. ASTHMA & COPD By Laura Parker

  2. Learning Objectives • To be able to define Asthma and COPD • To have an understanding of the pathogenesis of each disease and the common causes / risk factors associated • To be able to recognise the presentation of patient with Asthma or COPD • To be able to manage an acute exacerbation of Asthma / COPD • To understand the long term management options available for clinicians for Asthma / COPD

  3. asthma

  4. Definition • Asthma: chronic inflammatory disease of the lungs characterised by airway obstruction that is reversible • Extrinsic • Immune • Onset childhood • Eosiniphilia blood & sputum • Intrinsic • Abnormal autonomic reulation of airways • Onset Adulthood • Eosinophilia sputum • Assoc w/ chronic bronchitis

  5. Pathogenesis

  6. Incidence & Aetiology • 5.4 million receive treatment UK (~5%) • Most common chronic medical condition in children • Risk Factors • Personal history of atopy • Family history of asthma or atopy

  7. Presentation SYMTPOMS SIGNS • Wheeze • Cough • Difficulty breathing • Chest tightness • ?diurnal variation • ?triggers • ?atopy • Normal between attacks • Prolonged expiration • Wheeze Respiratory distress

  8. Recognising a sick patient…

  9. Differentials • I • G • V • I • T • A • M • I • N • D • Idiopathic or Iatrogenic • Genetic: • Vascular: • Infective: • Trauma: • Autoimmune: • Metabollic: • Inflammatory: • Neoplastic: • Degenerative:

  10. Differentials • Anaphylaxis eg penicillin allergic patient given penicillin • alpha 1 Antitrypsin disease • PE, Anaemia • Pneumonia, Bronchiectasis • Tension pneumothorax • Autoimmune: • Metabollic: • COPD, Asthma • Lung Ca • Fibrosis

  11. Investigations Inpatient • Peak flow • Sputum • Urine • Bloods • ABG • ECG • CXR • Pulmonary Function Tests • +/- further imaging ( CT, HRCT)

  12. Investigations

  13. Management: Acute Exacerbation A,B,C,D,E… • OXYGEN • Sats 94-98% • NEBS • BETA AGONIST • IPRATROPIUM • STERIODS oral / IV • +/- • IV MgSO4 • ABX if suspicious infective exacerbation

  14. Long Term Management Asthma Aims: • No symptoms during the day • No waking at night due to symptoms • No exacerbations • No need for rescue medication • No exercise limitation • Normal lung function

  15. Long Term Management Asthma • Yearly Asthma Review • Smoking status • Triggers and avoidance • Concordance • Inhaler technique • Stepwise approach….

  16. Long Term Management Asthma

  17. copd

  18. Definitions • Chronic Obstructive Pulmonary Disease (COPD): collective term for an inflammatory lung disease in which airway obstruction is progressive and only partially reversible by bronchodilators • Chronic Bronchitis: persistent cough with sputum production for > 3months/year for 2 years • Emphysema: permanent enlargement of air spaces distal to the terminal bronchiole due to alveolar septal destruction

  19. Pathophysiology

  20. Incidence & Aetiology • Est 3 million people UK • Prevalence 1.5% population • Risk factors • SMOKING (effects approx 15% smokers) • Increases with age • More common in men • More common deprived communities

  21. Presentation symptoms signs • Wheeze • Chronic cough • SOBOE • Regular sputum production • Frequent winter 'bronchitis” • ? >35yrs old • ?hx of smoking • Pink puffers / blue bloaters • Respiratory distress • Hyper-expansion • Hyper-resonant • Prolonged expiration • Wheeze

  22. Differentials • Anaphylaxis eg penicillin allergic patient given penicillin • alpha-1 Antitrypsin • PE, Anaemia • Pneumonia, Bronchiectasis • Tension pneumothorax • Autoimmune: • Metabollic: • COPD, Asthma • Lung Ca • Fibrosis

  23. Investigations • Inpatient • Peak flow • Sputum • Urine • Bloods • ABG • ECG • CXR • Pulmonary Function Tests • +/- further imaging ( CT, HRCT)

  24. Acute Exacerbation COPD A,B,C,D,E • Controlled oxygen therapy • Aim Saturations 88-92% • Nebulised bronchodilators • Oral corticosteroids • +/- • ABX • NIV

  25. Long Term Management of COPD • Multi-Disciplinary • Smoking Cessation • Vaccination

  26. Long Term Management COPD • Mucolytics • Oral bronchodilators eg theophylline (nb narrow therapeutic window) • therapeutic range of theophylline is 10-20 mg/litre • Oxygen • LTOT / SBOT • NIV • Surgery: bullectomy, lung volume reduction surgery and lung transplantation

  27. Learning Objectives • To be able to define Asthma and COPD • To have an understanding of the pathogenesis of each disease and the common causes / risk factors associated • To be able to recognise the presentation of patient with Asthma or COPD • To be able to manage an acute exacerbation of Asthma / COPD • To understand the long term management options available for clinicians for Asthma / COPD

  28. How to Use an Inhaler • Remove cap • Shake the device • If you have not used the inhaler for a week or more, or it is the first time you have used the inhaler, spray it into the air before using to check that it works • Hold the inhaler upright with you forefinger on the top • Big breath out • Place the mouthpiece in your mouth between your teeth, and close your lips around it • Start to breathe in slowly and deeply, at the same time, press down on the canister releasing a “mist” • Hold your breath for as long as is comfortable, then breathe out as normal. • If you need 2 puffs, wait 30 seconds then repeat • Do not release two puffs at the same time • Replace cap

  29. Smoking Accurate History Pack year =no. cigarettes smoked per day X no. years smoked 20 Assess “readiness to change” Cessation • Nicotine Replacement Therapy • Patches • Bupropion (nb reduces seizure threshold) • Varenicline (champix) (nbuse in caution in a Ptw/ psych hx) • E-cigarettes: evidence controversial, recent BMJ article suggest they encourage and glamourize smoking, not available by prescription at present

  30. Case Study (1) A 64 year old gentleman presents to A&E with increasing SOB over the last 3 days. This is associated with a cough productive of thick, green sputum. He has a past medical history of “asthma”, but he has smoked 50 cigarettes a day for the past 40 years. Obs: RR 30 O2 sats 85% on 21% HR 120 BP 138/82. O/E he is using his accessory muscles to breathe, bilateral diffuse coarse crepitations and widespread wheeze

  31. Questions • Differential diagnoses? • Initial management? • Investigations? • Treatment?

  32. Case Study (2) Patient is successfully treated for infective exacerbation of COPD and discharged from hospital. You see him in your GP surgery a few weeks later for a medication review. How may you optimise the management of this patient?

  33. References • http://emedicine.medscape.com/article/296301-overview • http://www.patient.co.uk/doctor/bronchial-asthma • British Guideline on the Management of Asthma. British Thoracic Society and the Scottish Intercollegiate Guidelines Network. (Revised January 2012). Available online at http://www.brit-thoracic.org.uk • Regulation in chronic obstructive pulmonary disease: the role of regulatory T-cells and Th17 cells: Nina Lane*, R. Adrian Robins*, Jonathan Corne† and Lucy Fairclough*Clinical Science (2010) 119, (75–86) • Chronic Obstructive Pulmonary Disease (2010). Clinical Gudeline 101. National Institute for Health and Care Excellence. Available online athttp://www.nice.org.uk/CG101 • How to use inhaled devices: http://www.medicines.org.uk/guides/pages/how-to-use-your-inhaler-videos • BNF

  34. THANK YOU FOR LISTENING Are There Any Questions?

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