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COPD + ASTHMA. Matt Wong + Sheila Murphy Dec 13 th 2011. CONTENTS. AKT MINI EXAM NICE – COPD GUIDELINES BTS ASTHMA GUIDELINES INHALER TECHNIQUE QOF SPIROMETRY CSA EXERCISE. AKT. Which of the following are used in assessing the severity of COPD? A. Body mass index (BMI) B. Age - PowerPoint PPT Presentation
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Matt Wong + Sheila MurphyDec 13th 2011
AKT MINI EXAMNICE COPD GUIDELINESBTS ASTHMA GUIDELINESINHALER TECHNIQUEQOFSPIROMETRYCSA EXERCISE
Which of the following are used in assessing the severity of COPD? A. Body mass index (BMI)B. AgeC. Medical Research Council (MRC) dyspnoea score D. Smoking pack year historyE. Lung function
Which of the following statements apply to COPD?A. It is more common in those from upper social classesB. It is often seen as a co-morbidity in patients with ischaemic heart disease and lung cancerC. Mortality from COPD is evenly spread across the UK as a wholeD. The estimated prevalence of COPD in patients over 40 years of age is 9-10%
What percentage of patients will die within 3 months of admission for a COPD-related condition?A. 33%B. 50%C. 5%D. 20%
Pulmonary rehabilitation should be offered to:A. All patients with moderate or severe COPDB. All patients with COPD irrespective of their MRC scoreC. Patients who are poorly motivatedD. All patients who meet the referral criteria regardless of their inhaled drug therapyE. Patients with an MRC dyspnoea score of 3 or more unless they are on long-term oxygen therapy (LTOT)
Which of the following statements about oxygen therapy in COPD exacerbations are true?A. It should be given to all patientsB. It should be started at 100% until the oxygen saturation is >95%C. It should be monitored by pulse oximetry until access to full arterial or capillary blood gases are availableD. In patients on LTOT it should be given at the same rate as they receive at home
1. A, C, E2. B, D3. E4. B5. C, D6. A, C, E7. C, D8. 39. D
Consider COPD in smokers >35 and with exertional SOB, chronic cough, regular sputum production, winter bronchitis, wheezeNo features of asthma unproductive cough, diurnal variation, night-time waking with wheeze/breathlessnessAsk about: weight loss, fatigue, exercise tolerance, chest pain, night waking, haemoptysis, ankle swelling, occupational hazards
Post-bronchodilator spirometryCXR FBC anaemia/polycythaemiaBMI
FEV1/FVC < 0.7 = COPDStage 1-5 mild to very severe based on FEV1 % >80% is mild 30% - 50% severe People must be symptomatic to make diagnosis!
Grade 1 not troubled by SOB except on exerciseGrade 2 SOB when hurrying/walking up hillGrade 3 walks slower on level ground due to SOB, or has to stop when walking at own paceGrade 4 stops for breath after 100m or a few mins on ground levelGrade 5 too breathless to leave the house or breathless when dressing
Smoking cessation for allStart treatment once diagnosis confirmedPulmonary rehabFor those with disability/recent admission
SABA : short acting B agonist salbutamol
LABA : long acting B agonistsalmeterol
SAMA : short acting muscarinic antagonistipratropium
LAMA : long acting muscarinic antagonist Tiotropium
ICS : inhaled corticosteroidsBeclometasone, fluticasone, budesonide
TheophyllineIf inhaled therapy ineffective/cant be used
Oral steroidsMaintenance steroids not recommended, but if severe COPD may be necessary, aim for low dose and monitor for osteoporosis30mg for 7-14 days in exacerbations
LTOT used for 15 hours/dayAssess need for LTOT if FEV1
Increase frequency of broncholdilator use/consider use of nebuliserPrescribe oral abx if sputum purulent/clinical signs of peumoniaSteroid 30mg 7-14 days
Self-ManagementStart abx/steroid if SOB increases/interferes with ADLsAbx if sputum purulentAdjust bronchodilator to control symptoms
Salbutamol CFC Free 100mcg/dose 3 / 200 dosesIpratropium 20 mcg5 / 200 dosesSalmeterol 50 mcg29 / 60doses/ 1 monthSalmeterol 50 mcg and fluticasone35 / 60 doses/ 1 monthTiotropium32 / 30 doses/ 1 month
Contains a pressurised inactive gas that propels a dose of drug in each 'puff'
ADVmost widely used inhalerquick to use, small, and convenient to carry
DISADVneeds good co-ordination to press the canister, and breathe in fully at the same time
Used with pressurised MDIs
The spacer between the inhaler and the mouth holds the drug like a reservoir when the inhaler is pressed
Valve at the mouth end ensures that the drug is kept within the spacer until you breathe in. When you breathe out, the valve closes.
Adv No need to have good co-ordination to use a spacer device.
A facemask can be fitted on to some types of spacers, instead of a mouthpiece. This is sometimes done for young children and babies who can then use the inhaler simply by breathing in and out normally through the mask.
Alternatives to the standard MDIDon't require you to press a canister on top
Bottom 3 are dry powder inhalers.Dose is triggered by breathing in at the mouthpiece. You need to breathe in fairly hard to get the powder into your lungs. AccuhalersClickhalersEasyhalersNovolizersTurbohalersdiskhalers Twisthalers
ADV - Require less co-ordination than the standard MDI. DISADV - They tend to be slightly bigger than the standard MDI.Autohaler
Practice register of patients with COPD% with COPD in whom diagnosis has been confirmed by spirometry with reversibility testing % with COPD with record of smoking status in the previous 15m% with COPD who smoke, who have been offered smoking cessation advice or referral to a specialist service, where available in last 15 months% with COPD with a record of FEV1 in the previous 27m% with COPD with record that inhaler technique has been checked in the preceding 27m % with COPD who have had influenza immunisation in the preceding 1 September to 31 March
PROMPTS: MRC Dysponea Score, FEV1, REVIEW EVERY 15mOUR PRACTICE:Inhaler technique, sats, smoking, exacerbations, immunisations, depression
*Answers a,c,e*B, d*e*b*C,d*A,c,e*C,d *******Reduce dose of aminophylline if using macrolides or ciprofloxacin to treat exacerbation***Answers a,c,e***Answers a,c,e*