Overview
Chronic obstructive pulmonary disease is a severely functionally limiting condition primarily affecting previous tobacco smokers. Management is targeted to the severity of the disease, and underpinned by smoking cessation.
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- Diagnosis - when their COPD was diagnosed, risk factors
- Severity - symptoms, FEV1, exacerbations
- Management - lifestyle, pharmacologic, supportive, surgical
- Complications - respiratory, cardiovascular, haematologic
Risk Factors for COPD
- Smoking
- Occupational exposure - coal, toluene (plastics)
- Environmental air pollution
- Alpha-1 antitrypsin deficiency
Severity of COPD
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- Symptoms - exertional dyspnoea, cough, chest tightness
- Spirometry results - FEV1, FVC
- Exacerbations - frequency, ED visits, hospital admissions, ICU admissions
- Hypoxia - saturations, home oxygen
- CO2 retention
Complications
Complications of COPD
Disease-Related
- Pneumonia
- Cor pulmonale
- Pulmonary hypertension
- Pneumothorax
- Respiratory failure
- Polycythaemia
Treatment-Related
- Cushing's syndrome (steroids)
- Oral candidiasis (steroids)
- Tremor (beta agonists)
Management
Pearls
- Smoking cessation has the greatest ability to influence the course of COPD
- Tailor pharmacologic options to the severity of disease
- Ensure that the patient has an exacerbation management plan in place
Management Strategies
Lifestyle Measures
- Smoking cessation
- Pulmonary rehab
- Nutritional support
- Develop social support
Pharmacologic
- Long-acting beta agonists (LABAs) - salmeterol, formoterol, indacaterol
- Long-acting anti-muscarinic agents (LAMAs) - tiotropium, aclidinium, umeclidinium, glycopyrronium
- LAMA / LABA combinations - tiotropium / olodaterol, aclidinium / formoterol, glycopyrronium / indacaterol, umeclidinium / vilanterol
- Inhaled corticosteroid (ICS) / LABA combinations - budesonide / formoterol, fluticasone / salmeterol, fluticasone / formoterol, fluticasone / vilanterol
- LAMA / LABA / ICS combination - fluticasone / umeclidinium / vilanterol
Supportive Measures
- Home oxygen
- Vaccinations - influenza, pneumococcal
Surgical Options
- Lung volume reduction surgery
- Lung transplantation
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