StableCOPD MD - Management of Stable COPD Dr.M.Ravikiran...

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1 Management of Stable COPD Dr.M.Ravikiran Definition GOLD Airflow limitation { not fully reversible { progressive { abnormal inflammatory response to noxious particles or gases
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2 Definition contd. . ATS Airflow limitation due to chronic bronchitis or emphysema ± generally progressive ± airway hyperreactivity ± partially reversible Airflow Limitation Reversibility >12 >10 >12 in FEV1 % > 200ml > 200ml in FEV1 GOLD ERS ATS
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3 Consider COPD if Chronic Present intermittently or every day cough Often present throughout the day seldom only nocturnal Sputum Any pattern of chronic sputum production Dyspnoea Progressive (worsens over time) Persistent (present every day) Worse on exercise Worse during respiratory infections H/ o Tobacco smoke Exposure occupational dusts and chemicals,smoke from home cooking and heating fuels 4 components of COPD management { Assess and monitor disease { Reduce risk factors { Manage stable COPD { Manage exacerbations
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4 Diagnosis { Symptoms + spirometry { Management of COPD largely symptom driven { Only an imperfect relationship between the degree of airflow limitation and symptoms Measurement of Airflow Limitation Spirometry { Gold standard for diagnosis and assessment of COPD { Postbronchodilator FEV1 < 80% of predicted value + FEV1/FVC < 70% - confirms airflow limitation that is not fully reversible { FEV1/FVC more sensitive FEV1/FVC < 70% - early sign of airflow limitation when FEV1 remains normal ( 80% predicted)
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5 Measurement of Airflow Limitation If spirometry unavailable o PEF good substitute if spirometry not available In COPD PEF may underestimate degree of airways obstruction o Prolongation of FET > 6 sec crude guide to FEV1/FVC ratio < 50% o 6 minute walking test performed by measuring distance covered in 6 minutes when patient walks at his/her own speed (under physician supervision) o can be performed at the primary care level Bronchodilator reversibility testing { To help rule out a diagnosis of asthma { To establish a patient’s best attainable lung function { To gauge a patient’s prognosis. Post BDR FEV1 more reliable prognostic marker than pre-BDR FEV1 IPPB study degree of bronchodilator response inversely related to rate of FEV1 decline in COPD patients
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6 Bronchodilator reversibility testing { To assess potential response to treatment Significant in FEV1 more likely to benefit from bronchodilators and glucocorticosteroids in FEV1 not significant may still benefit from long-term bronchodilator therapy Bronchodilator reversibility testing { 400 ug ß2-agonist / 80 ug anticholinergic / the two combined { FEV1 30-45 mts after bronchodilator given Results in FEV1 > 200 ml > 12% above pre-bronchodilator FEV1
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7 Measurement of Airflow Limitation { Ratio of inspiratory to total lung capacity - an independent risk factor for mortality in patients with COPD * { This ratio may be a better assessment tool than FEV1 { Inspiratory capacity and lung volumes may better reflect the functional response and the improvement
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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StableCOPD MD - Management of Stable COPD Dr.M.Ravikiran...

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