COPD - Chronic Obstructive Pulmonary Disease

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COPD - Chronic Obstructive Pulmonary Disease

By: Ibrahim Machiwala

- Progressive airflow limitation
Partially reversible
- Chronic Bronchitis
Emphysema
- Etiology: Cigarette smoking
-60 yrs old Mrs. X, ex smoker, hypertensive
-Hx of productive cough - 2 months
SOB -1 month
-Excerbation – food intake, exertion etc

History:
SOB
Productive cough
Recurrent acute chest illnesses
Exerbation – cold air, foggy weather, atmospheric pollution etc

Smoking:
Previous episodes
Details of previous admissions
Current treatment

Precipitating factor in this case:
P/E
Tachypnea
Prolonged expiratory time
Expiratory wheezes
Increased AP diameter of chest
Decreased breath sounds (especially upper lung fields)
Distant heart sounds
End stage: accessory muscles, cyanosis, enlarged liver

Stage 0: N Spirometry with symptoms
Stage 1: Mild COPD FEV1>/= 80%
Stage 2: Mod COPD FEV1 30% to 80%
Stage 3:Severe COPD FEV1 <30%

Guidelines from the Global Initiative for Chronic (GOLD) state that the airflow limitation in COPD is characterized by an FEV1 value that is less than 80 percent of the predicted normal valu

Management of the acute exacerbation:
1. O2
2. IV steroid
should not be used d in the community unless - the patient is already on oral corticosteroids;
only if there is a previously documented response
3. Bronchodilators
Neb - better in acute setting
Continuous nebulizer treatments confer no benefit over treatments every 1-2 hours
should avoid subcutaneous beta-agonists
S/E Hypokalemia, tachycardia (occasional)

Anticholinergics:
May decrease secretions
Few side effects

B2 agonists
3 Oral corticosteroids
dose of 30 mg per day for one week.

IF• this is the first presentation of airflow obstruction
• multiple previous admissions in the past five yrs including intensive care unit
. usually given in an intensive therapy unit
• smoking history
. should not normally be continued long term.
4 Antibiotic (maximum of seven days of treatment is sufficient)

Winnipeg” Criteria
• increased breathlessness
• increased sputum volume
• development of purulent sputum

Amoxicillin, Doxycycline, TMP/SMX, Azithromycin, Clarithromycin - all acceptable

Non-Invasive Positive Pressure Ventilation:
• BiPAP!
• Set FiO2, inspiratory (IPAP) and expiratory (EPAP)
• Difference between IPAP and EPAP augments tidal volume, therefore improving minute ventilation. CO2 then gets blown off
• MORTALITY BENEFIT in patients who will tolerate

Mechanical Ventilation:
• Respiratory distress
• Acidemia that does not correct quickly with therapy
• Inability to oxygenate adequately
• Often a clinical decision relative to patient’s work of breathing

Mx Of Stable Pts:

BRONCHODILATORS:
Anticholinergic Agents
Sympathomimetics

THEOPHYLLINE:
INHALED STEROID
ORAL STEROID
COMBO
LONG TERM O2 THERAPY

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About The Author

Dr. D.S. Merchant is a Gold Medalist in (Anatomy & Histology), Resident AKUH, Pakistan. For more information on Chronic Obstructive or visit www.explorearticle.com is a popular website that offers information on Pulmonary Disease, Mesothelioma Symptoms, VHF Solutions, and VHF Medications.

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