COPD

Michelle Taylor

Lecturer Faculty of Health & Social Science

Aims & Objectives

Definition of COPD? Diagnostic labels of COPD What is Airflow Obstruction? Factors to be considered Pathophysiology of contributing factors Signs & symptoms of COPD Diagnosis of COPD Treatment & Management

DefinitionCOPD is – Chronic Obstructive Pulmonary Disease

General term used to describe certain conditions where people have difficulty breathing with long-term affects, that may not be fully reversible and can cause permanent damage to the lungs.

In COPD air sacs lose their elasticity and they collapse or don’t inflate properly

In COPD the breathing tubes are blocked with mucous and become swollen so air cannot move in and out

British Lung Foundation (2011)

Diagnostic labels

Chronic Bronchitis – irritation, inflammation & swelling of the bronchi

Emphysema – affects the bronchi & builds up mucous in the alveoli

Chronic Asthma

Emphysema

Find a diagram of a diseased lung

Airflow Obstruction

Find a picture of airflow obstruction

What is airflow obstruction?

Airflow obstruction is defined as a reduced FEV1 (forced expiratory volume in 1 second)

Forced expiratory volume is the amount of air which can be forcibly exhaled from the lungs in the 1st second of a forced exhalation

Forced Vital Capacity (FVC) is the maximum amount of air you can expel when breathing out

Measured by spirometers

Calculation depends upon gender, age, height, if you are a smoker & level of fitness

Different classifications - FEV1% is between 50 – 80% MILD COPD - FEV1% is between 30 – 49% MODERATE COPD - FEV1% is below 30% SEVERE COPD

NICE (2004)

Factors to consider

Significant airflow obstruction may be present before the individual is aware of it

30,000 people in the UK die of COPD every year

COPD produces symptoms, disability and impaired quality of life

COPD is now the term used for conditions with airflow obstruction once diagnosed as chronic bronchitis and emphysema

Pathophysiology – contributing factors

Recurrent or chronic respiratory problems including wheezing, coughing, infection & the production of phlegm

Allergens – dust & air pollution Hereditary factors - genetic Smoking – pipe, cigar or cigarette Occupational exposure – chemicals & toxic

fumes

Smoking

Smoking is the most important factor in COPD. It impairs cilliary action, causing inflammation in the airway, increased mucous production, alveolar destruction and bronchiolar fibrosis

Signs & Symptoms

Wheezing Coughing Sputum production Shortness of breath/Dyspnoea Chest tightness Barrel chest (lung over-distension) Prolonged expiration - because accessory muscles

are used for inspiration and abdominal muscles are used to force air out of lungs

Decreased breath sounds

Diagnosis

Spirometry Chest X-ray

Ask your patients about the presence of the

following factors Weight loss Effort intolerance Waking at night Ankle swelling Fatigue Occupational hazards Chest pain Haemoptysis

Assessment of severity

This is important as it has indications for treatment and relates to prognosis

True assessment includes the degree of airflow obstruction and disability, frequency of exacerbations and the following prognostic factors

Exercise capacity

BMI

Partial pressure of O2 in arterial blood

Treatment

Eliminate exposure to things that cause COPD

Quit smoking Exercise and

pulmonary rehabilitation

Inhaled medications to open the breathing tubes or decrease the inflammation

Oxygen Pneumococcal and flu

vaccines

Meter dose inhaler (MDI)

Choose appropriate device Educate patients Best evidence for bronchodilators = MDI +

SPACER Regular assessment of ability to use device

should be taken Ensures delivery of the medication to the lungs NB. Spacers MUST be compatible with MDI Rinse mouth after use if using a steroid inhaler

Meter dose inhaler

Management

Inhaled bronchodilator therapy

Short acting B2 agonist – initial treatment for relief of breathlessness and exercise limitation (example ‘salbutamol’)

Effectiveness should be assessed by improvement in symptoms, i.e. Activities of Living, exercise capacity and rapidity of symptom relief

Nebulisers

Consider if symptoms distressing or disabling despite maximal therapy using inhalers. But DISCONTINUE after

Reduction in symptoms Increase in patients ability to undertake

Activities of Living Increase in exercise capacity Improvement in lung function NB. Monitor ability to use and consider

application i.e. mask, mouthpiece?

Still a problem?

Patients who remain symptomatic should be given

Long acting bronchodilators (LAB) once daily (e.g. salmeterol)

LAB should be used if > 2 exacerbations/yr

Consider – patient response, side effects, patients preference, cost

Oxygen (LTOT)

NB – can cause respiratory depression if given inappropriately

Indicated when patients have PaO2 < 7.3 when stable

To benefit, breathe supplemental O2 for at least 15hrs/day

Pulmonary rehabilitation

An MDT programme of care for patients with chronic respiratory impairment that is individually tailored and designed to optimise the individual’s physical and social performance and autonomy

Not for immobile, unstable angina, recent MI

Includes physical training, disease education, nutritional, psychological and behavioural intervention

MDT management

Via assessment - spirometry, O2 needs and aids

Managing - pulmonary rehab, hospital at home/early discharge (ACTRITE, IMPACT) including palliative care, identification of anxiety/depression, dietary, exercise, benefits, travel advice

Self management

Education

Which Lung would YOU prefer??

Summary Discussed the definition of COPD Discussed the diagnostic labels of COPD Described what Airflow Obstruction is Discussed the factors to be considered Described the pathophysiology of contributing

factors Discussed the signs & symptoms of COPD Discussed the diagnosis of COPD Described the treatment & Management