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COPD Diagnosis & Management
Anil RamineniSpecialist Respiratory Physiotherapist
Community Respiratory Team
Topics covered
• About COPD • Diagnosis• History and Investigations• Role of Spirometry• High quality Management Strategies• Services available • Other information
Definition
• Chronic Obstructive Pulmonary Disease (COPD) is characterised by airflow obstruction
• airflow obstruction is usually progressive, and not fully reversible
• airflow limitation is usually associated with a chronic inflammatory response of the lungs to noxious particles or gases
Risk Factors
• smoking– in most cases COPD is caused by cigarette smoking
• occupational exposure
• genetic risk of alpha1-antitrypsin deficiency, accounts for less than 1% of cases
• Recurrent chest infections
Diagnosis
Making a diagnosis relies on clinical judgement based on a combination of history, physical examination and confirmation of the presence of airflow obstruction using spirometry (NICE COPD, 2010).
Conditions covered
• Chronic Bronchitis
• Emphysema
• Asthma with chronic airflow obstruction may cause irreversible damage
COPD – Venn Diagram(adapted from ARTP Spirometry standards)
Chronic Bronchitis
Asthma
Emphysema
COPD
AirflowObstruction
COPD Classification based on post bronchodilator Spirometry
Stage
1) Mild
2) Moderate
3) Severe
4) Very Severe
FEV1 % predicted
>80%
50 to 79%
30 to 49%
<30 %
FEV1/FVC ratio
<0.7
<0.7
<0.7
<0.7
Prevalence
• In the UK, an estimated 3
million people are affected by COPD − approximately 2 million of these remain undiagnosed
• the prevalence of COPD in the population is estimated to be between 2% and 4%
• In NDCCG- 2.06%
• National Average 1.89%
• Readmission rates within 30 days- 18.6%
History
• Symptoms
• Age over 35 years
• Risk factors- Smoking, occupational
• Family history
• Quality of life
Differential diagnosis
• Asthma
• Bronchiectasis
• Lung cancer
• Heart problems
Investigations
Early diagnosis is important
All patients should have baseline investigations:
•Spirometry
•Blood tests to check Anaemia or Polycythaemia
•CXR and observations
•Any cardiac investigations if relevant
•QoL
Management• Smoking cessation• Pulmonary rehabilitation• COPD exacerbation management• Others:
Home O2 and nutritional screening
Mental health support
Vaccination
Breath easy support groups
Exercise referral schemes
Pulmonary Rehab• Referral criteria
• New Referral form
• Location and waiting times
• Transport can be provided
• Carers/family members welcome
• Initial assessment
• Post programme signposting
• Repeat Pulmonary rehab programmes
Stenton C Occup Med (Lond) 2008;58:226-227
© The Author 2008. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]
Home Oxygen Screening
If oxygen saturation ≤ 92% on 2 occasions (2-3 weeks apart), refer to oxygen assessment service for long term oxygen therapy (LTOT) assessment
Good Practice:
If FEV1 < 50% of predicted record oxygen saturation annually
If FEV1 < 30% of predicted, record oxygen saturation every 6 months
If Oxygen saturation 93-94% on Pulse Oximetry check every 3 months
Resources
• Derbyshire Medicines Management
• Community Respiratory Team, phone 01246 253067
• Self care diaries
• British Lung foundation
Community Respiratory Team
Specialist Nurses and Physios
Referral criteria:
-Complex patients requiring case mngt
-Requiring Physio input for breathlessness and airway clearance mngt
-Nebuliser assessment
-End stage COPD
References
• Derbyshire JAPC COPD Guidelines (2015) www.derbyshiremedicinesmanagement.nhs.uk
• Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Barcelona: GOLD; 2013.
• Map of medicine. http://mapofmedicine.com• National Institute for Health and Clinical Excellence (NICE).
Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. Clinical guideline 101. London: NICE; 2010.