COPD, its presentation in a GP, risk factors, management, referrals.

1. COPD

2. COPD
= Chronic Bronchitis + Emphysema
Affects airways (Bronchi) Affects air sacs (alveoli)

3. Chronic Bronchitis
presence of a chronic productive cough for
3 months during each of the 2 consecutive
years with other causes of cough being
excluded.

4. Emphysema
abnormal, permanent enlargement of the
air spaces distal to the terminal bronchioles,
accompanied by destruction of their walls

5. Signs + Symptoms
• Productive cough
• Yellow sputum
• Shortness of breath,
especially on exertion
• Wheezing
• Hyper-inflated or ‘Barreled-
chest’
• Higher than normal BP and
PR
• Weight loss
• Tiredness
• Fatigue
• Chest tightness
• Depression
• Swollen ankles
• Cyanosis
• Using accessory muscle for
breathing
• ± Chest pain
• ± Haemoptysis

6. Risk Factors
• SMOKING
• Genes (α-antitrypsin deficiency)
• Occupational exposure to dusts and chemicals
• Older age

7. Assessing Patients
Take clinical history:
“Are you a SMOKER”

8. Assessing Patients
Ascultate:
•Diminished breath sounds
•Long expiratory time
•Wheezing

9. Assessing Patients
Spirometry
. Spirometry is used to confirm the diagnosis

10. Other tests
Refer patient to specialist for other tests:
•Chest X-rays
•Blood test
•ECG
•Echocardiogram
•Peak flow test
•Blood oxygen level
•Blood test for α-1-antitrypsin
•CT test

11. Referrals
•Diagnostic uncertainty
•Suspected severe COPD
•Individual requests 2nd
opinion
•Onset of cor pulmonale
•Assessment for oxygen therapy, long-
term nebuliser therapy or oral
corticosteroid therapy
•Symptoms disproportionate to lung
function deficit
•Frequent infections
•Haemoptysis
•Rapid decline in FEV1
•Assessment for pulmonary
rehabilitation
•Assessment for lung volume reduction
surgery or lung transplantation
•Dysfunctional breathing
•Onset of symptoms at age under 40
years or with a family history of α-1-
antitrypsin deficiency

12. Differential Diagnosis
• Congestive heart failure
• Pneumonia
• Pleural effusion
• Pneumothorax
• Pulmonary embolism
• Cardiac ischaemia
• Cardiac arrhythmia
• Upper airway obstruction

13. Management
(at a GP)
Prevention:
STOP SMOKING!

14. Medications:
•Short-acting bronchodilator inhalers
1. β2-agonist inhalers, such as salbutamol and terbutaline
2. Antimuscarinic inhalers, such as ipratropium
•Long-acting bronchodilator inhalers
1. β2-agonist inhalers, such as salbutamol and terbutaline
2. Antimuscarinic inhalers, such as tiotropium, glycopyronium
and aclidinium
Management

15. Medications:
• Steroid inhalers
• Theophylline
• Mucolytics such as carbocisteine
• Antibiotics, if any chest infections
Management

16. Vaccinations:
Pneumoccocal and Influenza vaccinations should be offered
Can exacerbate the symptoms of COPD and vice versa
Management

17. mild or moderate COPD at least once a year
and those with very severe COPD at least
twice a year.
Follow-up

18. Assess: smoking status, adequacy of
symptom control, presence of
complications, effects of drug treatments,
inhaler techniques
Follow-up

19. Measure: FEV1 and FVC using spirometry
and SaO2 for severe COPD patients
Follow-up

20. Protect your lungs
QUIT SMOKING!!!!