HomeCopd - Chronic Obstructive Pulmonary Disease
- 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
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