【copd英文】copd (42p)

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,CHRONIC OBSTRUCTIVEPULMONARYDISEASE,AIMS OF THIS SESSION,To,Understand the definition,Discuss causes,Discuss diagnosis,Discuss Management/Medication,Discuss Oxygen Therapy,and enjoy!,DEFINITION,COPD is characterised by airflow obstruction.,air flow obstruction is usually progressive,It is not fully reversible,does not change markedly over several months,.,The disease is pre-dominantly caused by smoking.,COPD,is an umbrella term for,Emphysema,Chronic Bronchitis,Severe Chronic Asthma,NICE (2010),CHRONIC BRONCHITIS,Continuous inflammation of the cells lining the bronchi,Mucous hypersecretion,Destruction of the cilia, impairing mucous clearance leading to increased risk of infection,Diagnosed by the production of sputum and cough on,most days for three months in two consecutive years,EMPHYSEMA,Destructive of the alveoli and terminal bronchioles,Loss of elasticity of smaller airways,Loss of patency of bronchioles,CAUSES OF COPD,SMOKING:,90 % of cases,are caused by smoking,15% are susceptible.,Lung function decline is 3 times faster,If smoking stops, at one year FEV1 decline is age related (Morgan & Britton 2003),ALPHA 1 ANTITRIPSIN DEFICIENCY,:GENETIC,Found in only 1% of cases.,OCCUPATIONAL EXPOSURE TO RESPIRATORY POLLUTANTS,:,Chemicals, dust, atmospheric pollutants, inherited tendency,Nearly 30,000 deaths a year-accounting for 5% of all deaths, one death every 20 mins,850,000 diagnosed only 33%,Probably 2 million undiagnosed,“Missing Millions”(BLF 2009),COPD is the fourth most common cause of death after heart disease, lung disease and cerebrovascular disease,COPD is the only leading cause of death that is increasing in prevalence with a total cost 850 million/yr- 24 million working days lost-,Cigarette smoking is the major cause of COPD 90%,Mortality from COPD is increasing in women while reaching a plateau in men,Unless current trends are reversed, COPD may become the biggest public health problem.,Death rate one of worst in Europe,DIAGNOSIS,Over 35,Smoker or ex smoker,no clinical features of asthma,Have any of these symptoms ?,exertional breathlessness,chronic cough,regular sputum production,frequent winter “bronchitis”,Wheeze (NICE 2010),COPD OR ASTHMA ?,COPD,Asthma,Smoker/ex smoker,Nearly all,Possibly,Symptoms under age of 35,Rare,Common,Chronic productive cough,Progressive and persistent,Variable,Breathlessness,Progressive and persistent,Variable,Night time waking with breathlessness and/or wheeze,Uncommon,Common,Significant diurnal or day to day variation,Uncommon,Common,SPIROMETRY,Spirometry measures the volume of air expired from the lungs during a single maximal forced expiration. The key measurements are:-,Forced Vital capacity (FVC),Forced Expiratory Volume in one second (FEV1),FVC/FEV1 Ratio,CLASSIFICATION OF COPD,MILDFEV1 80%,MODERATEFEV1 50-80%,SEVEREFEV1 30-50%,VERY SEVERE FEV1,30%,NICE GUIDELINE (2010),COPD,produces,symptoms,disability,impaired quality of life- may respond to pharmacological therapies,Airflow obstruction will not respond to these therapies so beware,of a reliance on Spirometry,.,SYMPTOMS ASSOCIATED WITH AN EXACERBATION,DYSPNOEA,More breathless than normal,Reduced exercise tolerance,SPUTUM PRODUCTION,Increase in purulence,SPUTUM VOLUME,Increase in normal amount,COUGH,INVESTIGATIONS,Chest X ray,Arterial blood gas can aid medical diagnosis,ECG,FBC, Urea and Electrolytes,Theophylline levels if appropriate,Sputum microscopy/culture if purulent,OBSERVATIONS/MONITORING,RESPIRATORY,rate/rhythm/workload/equal,O2 Sats 90-92%,Colour skin, lips, nails(clubbing),Patient able to speak in sentences/words or not at all,Temp/Pulse/BP,Confusion,urine output,Peripheral oedema,Depression/lethargy,Assess need for NIV/IV,Not needed- PEFR,TREATMENT,Regular bronchodilator therapy,(consider IV aminophylline if poor response to nebs),Continue/start Oral antibiotics,Continue/start oral Prednisolone,(continue inhaled steroids also as takes 7 10 days to kick in),Oxygen therapy as,prescribed,(dependant on blood gas result and Sats O2),Non invasive Ventilation,NURSING MANAGEMENT,Liase with multi disciplinary team members to provide specialised care.,Disease process/progression,Inhalers/medication,Smoking cessation,Nutrition,Pulmonary rehab/Community Matron/Breathlessness clinic/Support group,Vaccinations,Physiotherapist-Breathing exercises, expectoration, coping mechanisms, energy conservation,Benefits,Further exacerbations- Exacerbation self management plan and standby antibiotics and steroids,PRE DISCHARGE MANAGEMENT,Spirometry,Blood gas,Full knowledge of treatment correct inhaler technique,Self management plan re antibiotics and steroids at home,FU appt-with Respiratory Nurses if O2 indicated,Refer to Pulmonary rehab,Check smoking status,END of LIFE?,Palliative care register,Advanced directives/PPC/Assessment of concerns,Hospice/day hospital,COMPLICATIONS OF COPD,.,RESPIRATORY FAILURE,COR PULMONALE,POLYCYTHAEMIA,PULMONARY EMBOLI,DEPRESSION / ANXIETY,RESPIRATORY FAILURE,TYPE 1,Respiratory Failure,PaO2 below 8Kpa(60.80mmHg) with normal/low PaCO2,TYPE 2 Respiratory Failure,:,PaO2, below 8kpa(60.8mmHg) and increased PaCO2 above 6.5kPa( 49.4mmHg),AIMS OF THERAPY,Prevent further disease progression,Relieve symptoms,Improve exercise capacity,Maintain best quality of life,Prevent exacerbations,MEDICATIONS,Bronchodilators should be the initial treatment,Assess effectiveness by,improvement in symptoms,ADL,exercise capacity,rapidity of relief of symptoms,Note - FEV1 will not reflect any significant improvement,MEDICATIONS,If symptoms persist add,Long acting anticholinergic.,Long-acting B2 agonist,MEDICATIONS,Inhaled steroids - for all COPD pts?,Methylxanthines,Antidepressants,Mucolytics,TREATMENT FACTORS AFFECTING CONCORDANCE OF INHALED MEDICATIONS,Drug regime,- Too complex,- Frequency of dosing,- Unsuitable inhaler ie rheumatic, elderly,Lack of noticeable immediate benefit eg inhaled steroids and long acting bronchodilators,Multiple prescription charges,NON TREATMENT FACTORS,Lack of understanding of treatment inc lack of clear instructions,Fear of side effects,Dislike/distrust of health service,Reluctance to accept diagnosis,Preference for alternative therapies,Lack of social support/family circumstances,Language, reading or eyesight difficulties,LONG TERM OXYGEN THERAPY,LTOT is considered in patients with,PaO2 of 7.3kPa when stable or,PaO2 of 7.3 8kPa with one of the following :,secondary polycytheamia,nocturnal hypoxaemia,peripheral oedema or pulmonary hypertension,Severe airflow obstruction FEV130%,Performed in secondary care,Initial - 6 weeks post exacerbation, clinically stable,Second assessment 3-4 weeks later with trial of oxygen,LTOT should be used for at least 15hrs/day via a concentrator installed by company,ASSESSMENT,SHORT BURST OXYGEN,No evidence to support its use in COPD . Used more for,symptom relief in fibrosis /palliative care,for short bursts only,by cylinder,Can be prescribed by GP,AMBULATORY OXYGEN,Evidence of desaturation on exercise,6 min walk test monitored by saturations.,Lightweight cylinders +/- conserver device,CHRONIC OBSTRUCTIVEPULMONARYDISEASEEnd,RESPIRATORY NURSES,ALISON CALVERT RLI/WGH EXT 3608/5611,MOBILE 07917240710,SARAH JEWELL FGH PAGER VIA SWITCH EXT,1502,HELEN BOOTH RLI BLEEP 767 EXT 3608,