Treatment of COPD

Chronic obstructive pulmonary disease Progressive airflow obstruction Not fully reversible No cure - only to reduce symptoms Caused by smoking

> 20 = heavy smoker

Age Gender Occupation Air pollution Genetic factors Socio-economic status

When breathing in particles or gases, it causes inflammation. Inflammation induces: • airflow limitation + trapping • mucus hypersecretion • gas exchange abnormalities

No single diagnostic test Rely on clinical judgement • Patient history (>35 years, risk factors - smoking) • Physical exam - signs + symptoms • Spirometer - confirms airflow obstruction (FEV1/FVC) • X-ray

Breathlessness Chronic cough Regular sputum production Frequent winter chest infections Wheeze

Older patient (>35 years) - onset of symptoms later in life Hyperinflated lungs (air trapped in lungs barrel chest) Wheeze/quiet sounds Pursed-lip breathing Peripheral oedema Cyanosis (blue lips = low O2 levels) Nicotine staining in fingers + nails Underweight

Measure the patient’s lung function It is performed at • time of diagnosis • to reconsider diagnosis after response to treatment FEV<strong>1</strong> - forced expiratory volume in one second FVC - forced vital capacity = maximum volume of air that can be exhaled from the lung Airflow obstruction = <0.7 ratio

Reduce inflammation (do not modify long-term lung function decline) Benefit if FEV1 < 50% + frequent exacerbations • 2+ per year that require antibiotics/oral steroids None are currently licensed for use alone

Pneumonia Adrenal suppression Diabetes Osteoporosis

Patient’s inhaler technique Adherence to therapy Smoking status Attendance + pulmonary rehabilitation Signs of anxiety/depression

Used after failure of previous treatment Anti-inflammatory Need to monitor plasma levels

Long-term oxygen therapy At least 15 hours/day Smokers

Vaccinations e.g. pneumococcal, influenza Mucolytics e.g. carbocysteine

Worsening breathlessness Cough Increased sputum production Change in sputum colour Worsening peripheral oedema

Bronchodilators - increase frequency Oral corticosteroids - prednisolone Antibiotics Oxygen

Give self-management advice Rescue packs Sputum colour