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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,CHRONIC OBSTRUCTIVEPULMONARY,AIMS OF THIS SESSION,To,Understand the definition,Discuss causes,Discuss diagnosis,Discuss Management/Medication,Discuss Oxygen Therapy,and enjoy!,AIMS OF THIS SESSION,【COPD英文教学讲解课件】COPD-(42p),【COPD英文教学讲解课件】COPD-(42p),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),COPD is an umbrella term for,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,CHRONIC BRONCHITIS,EMPHYSEMA,Destructive of the alveoli and terminal bronchioles,Loss of elasticity of smaller airways,Loss of patency of bronchioles,EMPHYSEMA Dest,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,CAUSES OF C,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,Nearly 30,000 deaths a year-ac,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,COPD is the only leading cause,【COPD英文教学讲解课件】COPD-(42p),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),DIA,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,COPD,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,SPIR,CLASSIFICATION OF COPD,MILDFEV1 80%,MODERATEFEV1 50-80%,SEVEREFEV1 30-50%,VERY SEVERE FEV1,30%,NICE GUIDELINE(2010),CLASSIFICATION,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,.,COPD produces,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,SYMPTOMS ASSOCI,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,INVESTIGATIONS,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,OBSERVATIONS/MONITORIN,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,TREATMENT,【COPD英文教学讲解课件】COPD-(42p),NURSING MANAGEMENT,Liase with multi disciplinary team members to provide specialised care.,Disease process/progression,Inhalers/medication,Smoking cessation,Nutrition,NURSING MANAGEMENT,Pulmonary rehab/Community Matron/Breathlessness clinic/Support group,Vaccinations,Physiotherapist-Breathing exercises,expectoration,coping mechanisms,energy conservation,Benefits,F
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