L23,24 COPD Wkshop

Question 1

What are things important to chronic (incurable) disease management

Answer 1

• Partnership w patient for engagement, enter a multi disciplinary therapeutic alliance where knowledge and behaviours is influenced
• Patient centered care: personalised, empowering, flexible, holistic.
• Take into account risk factors and determinants of health- stigma around smoking related diseases

Question 2

What is COPD

Answer 2

A progressive disease state of non reversible airflow limitation due to abnormal inflammation (destruction of the parenchyma and fibrosis of airways) caused by noxious particles/gases.

Question 3

What is the clinical criteria to diagnose COPD

Answer 3

1. History of productive cough, dyspnea, cigarette smoking/pollution, coal dust exposure
2. Spirometry: reduced FEV1 and FEV1/FVC <70%
   Higher starting volume because gas trapping due to reduced compliance- emphysema.
   Lower flow rate.

NB: There is less ventilation compared to perfusion

Question 4

What is the treatment plan for COPD

Answer 4

C: confirm diagnosis
O: optimise function depending on severity. This can be inhalers, pul rehab
P: prevent deterioration: smoking cessation
D: develop self-management plan: check for psychosocial problems, refer for pulmonary rehab, help identify own symptoms and action
X: Manage exacerbation, (An acute change in the patients baseline symptoms which may warrant medication change/ hospital admission) Early treatment of the exacerbation.

Treat evident symptoms because COPD can overlap with other diseases

Question 5

What is the main difference between Asthma and COPD

Answer 5

Asthma: early in life onset most, with variable symptoms (stronger at night), other atopic conditions and reversible airflow limitation

COPD: midlife onset, history to noxious gas/dust. Slowly progressive symptoms- stronger dyspnoea during exercise. Largely irreversible airflow limitation.

Question 6

What are the cellular mechanisms of COPD

Answer 6

1. Cigarette smoke triggers
2. Alveolar macrophage and epithelial cells to signal Neutrophils and CD8 T cells
3. Small airway narrowing due to inflammation and alveolar destruction

Question 7

What is pulmonary rehab

Answer 7

• Patient tailored: 6min walk test assesses
• focuses on physical and psychological long term adherence to health enhancing behaviour- reverse the cycle of inactivity.

Question 8

Who goes to Pulmonary rehab

Answer 8

People with chronic respiratory disease with functional limitation: COPD, asthma, bronchiectasis, Interstitial lung disease.
Priority for people post exacerbation

Question 9

What are the 3 activities of pulmonary rehab

Answer 9

Involves aerobic exercise, endurance, strength and balance training,

Education: more understanding on physical and psychological changes - for family too. Benefits of exercise, manage dyspneoa, positive coping, anatomy and physiology.

behaviour change: reduce sedentary behaviour, adherence and compliance with inhalers, symptom monitoring.

Question 10

What is Advance care planning

Answer 10

• Develop and express preference for future care and end of life based on values, options available