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COPD - Coggle Diagram
COPD
Managing Stable COPD
https://www.nice.org.uk/guidance/ng115/resources/visual-summary-treatment-algorithm-pdf-6604261741
https://www.nice.org.uk/guidance/ng56
Smoking Cessation
Inhaled therapies
Short acting Beta2 agonists (SABA)
Inhaled Corticosteroids
Long-acting beta2 agonists (LABA)
Long-Acting Muscarinic Antagonists (LAMA)
Inhaler technique
Consider nebulisers for people with distressing or disabling breathlessness despite maximal therapy using inhalers
Oral Therapies
Oral corticosteroids - not recommended long term but sometimes required in advanced disease, should be low dose
Theophylline - can be used in some patients but needs carefully monitored - plasma levels / drug interactions
Mucolytics i.e. Carboscisteine / NACSYS
Prophylactic antibiotics
i.e. Azithromycin - be aware of side effects, need to check ECG (prolonged QT interval)
LTOT / ambulatory O2
NIV for chronic hypercapnic resp failure
Self Management
Managing anxiety related to breathlessness
Chest clearance
Future Care Planning
Pulmonary Rehabilitation
Lifestyle
Third Sector Support - CHSS / Asthma & Lung UK
Vaccinations
MDT
Physio
OT
Dietician
Pharmacy
RNS
Lung Volume Reduction Surgery
Signs & Symptoms
Progressive
Exacerbations
Exertional breathlessness
Chronic cough
Over 35
Regular sputum production
Frequent winter 'bronchitis'
Smoking biggest risk factor
Wheeze
Airflow obstruction
Clinical Assessment
Environment - Inhalers, oxygyen, cigarettes?
Auscultation - wheeze (insp/exp), reduced air entry, crackles
LL oedema
Elevated JVP - cor pulmonale?
Observations and NEWS score
Hands - cyanosed? Clubbing? Fine tremor? Tar staining?
Altered mental state / GCS
Pallor, distressed. talking in sentences, increased WOB, use of accessory muscles, cyanosed, coughing, wheeze, cachexic
Chest wall shape and size - barrel chest - hyperinflation
Evidence of weight loss / malnutrition. BMI
Clinical History
Over 35
Smoking history (pack years)
weight loss
exercise tolerance
ankle swelling
fatigue
Occupational history
Exacerbation
Review inhaler technique / need for spacer. Consider need for nebulisers
Consider treatment at home Vs need for hospital admission
Sputum culture
Infective - Abx and Steroids, usually Doxycycline and Prednisolone for 5 days
Non-infective - oral corticosteroids - usually Pred 30mg for 5 days but if need longer then requires reducing dose
In hospital - CXR, ABG's, ECG, FBC/U&E's/CRP
https://www.nice.org.uk/guidance/ng114
Chronic Bronchitis
Chronic cough and sputum production for at least 3 months of 2 consecutive yrs in the absence of other diseases
Bronchial epithelium becomes chronically inflamed, hypertrophy of the mucus glands and increased number of goblet cells
Increased mucus viscosity and production, difficulty in expectorating
Cilia are destroyed and impaired efficiency of mucociliary escalator
Pooling of mucus leads to greater susceptibility of infection
Recurrent infection and inflammation over time leads to irreversible structural damage to the walls of the airways
MRC scale
2.Short of breath when hurrying or walking up a slight hill
Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace
Stops for breath after walking about 100 metres or after a few minutes on level ground
Too breathless to leave the house, or breathless when dressing or undressing
Not troubled by breathlessness except on strenuous exercise
Investigation
Must have spirometery
Post bronchodilator to confirm diagnosis of COPD
FEV1/FVC ratio below 0.7
Clinical History
Chest X-Ray
Full Blood Count
BMI
Emphysema
Characterised by abnormal dilatation of the terminal air spaces distal to the terminal bronchioles, with destruction of their wall and loss of lung elasticity
Caused predominantly be smoking- irritant and results in low grade inflammation of the airways and alveoli.
Alpha -1 antitrypsin enzyme deficiency - genetic risk factor for COPD
Inflammatory cells (macrophages and neutrophils) produce a proteolytic enzyme known as elastases, which destroys elastin
Guidelines
https://www.nice.org.uk/guidance/NG115
https://goldcopd.org/2024-gold-report/
https://www.nice.org.uk/guidance/ng115/resources/visual-summary-treatment-algorithm-pdf-6604261741
https://www.nice.org.uk/guidance/ng114