Thursday, 29 May 2008

COPD

Observe:

  • Sputum pot
  • Respiratory rate
  • Use of accessory muscles
  • Pursed lips
  • Nicotine stain
  • Bounding pulse
  • Cyanosis
  • JVP

Guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) state that the airflow limitation in COPD is characterized by :

FEV1 value that is < 80 % of the predicted normal value.

FEV1:FVC ratio of < 0.70

how would you invesgate this patient?

what are the Treatment options?

treatment can be divided into acute and chronic presentation.

Treatment of exacerbation:

  1. Neublized bronchodilator
  2. Antibiotics
  3. Oxygen
  4. Steroids
  5. role of non-ivasive ventlation.
always remeber to mention about:
physiotherapy,smoking cessation,vaccination and pul rehab.

Indications for LTOT:

1-ABG’s measured in clinically stable patient on optimal medical therapy, on at least two occasions 3 weeks apart.

2- Pao2 < 7.3 (irrespective of PaCo2)

3- Pao2 7.3-8 + pul hypertension

Peripheral oedema

Nocturnal hypoxaemia

4-patient stopped smoking.

Oxygen should be used at least 15 hours per day at 2-4 litres/min

To achieve Pao2 >8 without unacceptable rise in PaCo2


Indication for lung transplant:

  1. Untreatable end-stage pulmonary disease of any etiology
  2. Absence of other significant medical diseases
  3. Substantial limitation of daily activities
  4. Limited life expectancy
  5. Ambulatory patient with rehabilitation potential
  6. Acceptable nutritional status
  7. Satisfactory psychosocial profile and emotional support system

2 comments:

  1. investigations for COPD:
    FBC for polycythemia
    oxygen sat looking for hypoxia
    ABGs looking for type II respiratory failure
    in young individuals consider alfa1 antitrypsin def
    spirometry looking for obstructive airway disease and lung volumes and transfer factor,which would show air traping and reduce gas exchange respectively.
    HRCT if the patient is a candidate for lung volume reduction, transplant or if diagnosis in doubt.

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  2. diagnosis of COPD:
    Ask about the three cardinal symptoms:
    1-Increased shortness of breath
    2-Increased cough
    3-Increased sputum volume or purulence.

    Look for the following factors, which are associated with increased severity of an exacerbation:
    -The magnitude of the reduction of the FEV1
    Increased duration of, worsening of, or new symptoms
    -Number of previous exacerbations and admissions to hospital
    -Presence of other comorbid conditions
    -Low socioeconomic status.

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