2. 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
3. Definition
COPD 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)
4. Diagnostic labels
Chronic Bronchitis –
irritation, inflammation
& swelling of the
bronchi
Emphysema – affects
the bronchi & builds up
mucous in the alveoli
Chronic Asthma
7. 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
8. 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)
9. 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
10. 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
11. 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
12. 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
14. 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
15. 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
16. 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
17. 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
19. 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
20. 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?
21. 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
22. 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
23. 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
24. 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
26. 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