Chronic Obstructive Pulmonary Disease Mx
(COPD) Stable COPD
General Mx
Smoking cessation
Definition chronic obstructive pulmonary disease that is characterised
by its irreversibility Annual influenzae vaccination
Associated w/ smoking One-off pneumococcal vaccination
1. Chronic bronchitis (chronic infiltration of respiratory submucosal 1. Bronchodilator = SABA + SAMA 1st line
by inflammatory cells mucous gland hyperplasia + SM For pts who remain breathless/have exacerbations
hypertrophy = ‘Blue bloaters’)
next step (determined by FEV1)
Cough w/ sputum production for at least 3 months in 2
consecutive years FEV1>50% LABA e.g. Salmeterol/ LAMA e.g.
2. Emphysema (Permanently dilated airways distal to terminal tiotropium
bronchioles w/ alveolar destruction + bullae formation FEV1<50% LABA + ICS/ LAMA
Defined histologically + associated w/ α1-antitrypsin deficiency 2. Theophylline (reduced dose w/
(protects against proteases) + increased elastase activity = ‘Pink
macrolide/fluoroquinolone)
puffers’)
Aetiology ‘GASES’ 3. Mucolytics e.g. Carbocisteine
Genetics α1-antitrypsin deficiency loss of protection
Air pollution Acute exacerbations
Smoking Common organisms: Haemophilus influenzae, strep.
Exposure through occupation e.g. coal mining, cadmium, cotton
pneumoniae, Moraxella catarrhalis
Second-hand smoke exposure
1. Increase frequency of bronchodilator/consider giving
Dx Pts > 35 years who are smokers/ex-smokers + have symptoms such via nebuliser
as exertional breathlessness, chronic cough/regular sputum production 2. Give prednisolone 30mg daily for 7-14 days
Ix Post-bronchodilator spirometry to demonstrate airway obstruction: 3. Do not give Abx unless sputum is purulent/ signs of
FEV1/FVC < 0.7
pneumonia
CXR Hyperinflation, bullae, flat hemi-diaphragm, exclude lung ca.
Bloods FBC- exclude secondary polycythaemia
ECG Cor pulmonale Long-term oxygen therapy (LTOT)
Assessment ABG on 2 occasions at least 3 weeks apart w/
Post bronchodilator stable COPD + optimal Mx
FEV1 (of predicted) Stage
FEV1/FVC Offer LTOT pO2 < 7.3kPa OR pO2 7.3-8kPa +
< 0.7 > 80% I – Mild
Secondary polycythaemia
< 0.7 50-79% II – Moderate
Nocturnal hypoxaemia
< 0.7 30-49% III – Severe
< 0.7 < 30% IV – Very severe
Peripheral oedema
Pulmonary HTN
(COPD) Stable COPD
General Mx
Smoking cessation
Definition chronic obstructive pulmonary disease that is characterised
by its irreversibility Annual influenzae vaccination
Associated w/ smoking One-off pneumococcal vaccination
1. Chronic bronchitis (chronic infiltration of respiratory submucosal 1. Bronchodilator = SABA + SAMA 1st line
by inflammatory cells mucous gland hyperplasia + SM For pts who remain breathless/have exacerbations
hypertrophy = ‘Blue bloaters’)
next step (determined by FEV1)
Cough w/ sputum production for at least 3 months in 2
consecutive years FEV1>50% LABA e.g. Salmeterol/ LAMA e.g.
2. Emphysema (Permanently dilated airways distal to terminal tiotropium
bronchioles w/ alveolar destruction + bullae formation FEV1<50% LABA + ICS/ LAMA
Defined histologically + associated w/ α1-antitrypsin deficiency 2. Theophylline (reduced dose w/
(protects against proteases) + increased elastase activity = ‘Pink
macrolide/fluoroquinolone)
puffers’)
Aetiology ‘GASES’ 3. Mucolytics e.g. Carbocisteine
Genetics α1-antitrypsin deficiency loss of protection
Air pollution Acute exacerbations
Smoking Common organisms: Haemophilus influenzae, strep.
Exposure through occupation e.g. coal mining, cadmium, cotton
pneumoniae, Moraxella catarrhalis
Second-hand smoke exposure
1. Increase frequency of bronchodilator/consider giving
Dx Pts > 35 years who are smokers/ex-smokers + have symptoms such via nebuliser
as exertional breathlessness, chronic cough/regular sputum production 2. Give prednisolone 30mg daily for 7-14 days
Ix Post-bronchodilator spirometry to demonstrate airway obstruction: 3. Do not give Abx unless sputum is purulent/ signs of
FEV1/FVC < 0.7
pneumonia
CXR Hyperinflation, bullae, flat hemi-diaphragm, exclude lung ca.
Bloods FBC- exclude secondary polycythaemia
ECG Cor pulmonale Long-term oxygen therapy (LTOT)
Assessment ABG on 2 occasions at least 3 weeks apart w/
Post bronchodilator stable COPD + optimal Mx
FEV1 (of predicted) Stage
FEV1/FVC Offer LTOT pO2 < 7.3kPa OR pO2 7.3-8kPa +
< 0.7 > 80% I – Mild
Secondary polycythaemia
< 0.7 50-79% II – Moderate
Nocturnal hypoxaemia
< 0.7 30-49% III – Severe
< 0.7 < 30% IV – Very severe
Peripheral oedema
Pulmonary HTN
