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Resp History
 
 

The COPD History

 
 
 
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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.
  • Ask About

  • 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

  • Ask About

  • 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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