Respiratory 2 check 2016 Flashcards
Diagnostic criteria
FEV1/FVC ratio - airflow limitation that persists after bronchodilator
Look at FEV1/FVC ( < LLN for obstruction)
then, FEV1 or FVC ( post bronchodilator > 12 % or >200 ml)
If > 200 ml post bronchodilator improvement - suggests COPD with co existing BA
Risk factors for COPD
Genetic - α-1 antitrypsin deficiency
Others BA smoking outdoor air pollution biomass fuels (coal, animal dung, wood) occupational contaminants (diesel, organic dust, chemicals) tuberculosis
aging, lower SES
Mx for COPD and BA
1) SABA and LABA/ICS combination
add
2) LAMA
Mx of COPD alone
SABA
LAMA or LABA
LAMA/LABA combination
SAMA/LAMA or 2 LAMA should NOT be used together
Multimorbidity that affects COPD patients?
CVS - ischaemic heart disease • peripheral vascular disease, AF RS - lung cancer, pulmonary hypertension • cor pulmonale • sleep apnoea GORD Osteoporosis *cardioselective beta-blockers being safe and indicated for patients with COPD and IHD or heart failure.
Additional advice/mx
Education and action plan.
GPMP and goals
smoking reduction or cessation
immunisation to prevent influenza and pneumococcus
physical activity - pulmonary rehabilitation
Weight reduction/nutrition and MH issues
fracture prevention
optimise medication
Referral - Hospital ?
- inability to eat or sleep
- inability to cope at home
- altered mental status
- cyanosis
- inadequate response to ambulatory treatment
- newly occurring arrhythmia
- high-risk comorbid condition.
Referral to resp physician
clarifying the diagnosis
optimising therapy when there has been a poor response
starting oxygen therapy
surgical intervention
Pall care referral
- severe, recurrent hospital admissions
- long-term O2 therapy
- right heart failure
- anorexia
- weight loss
- depression
- recurrent infections
