CSIM2.91 – COPD and Pulmonary Hypertension Terminology Chronic bronchitis

Chronic or recurrent excessive mucus secretion in the bronchial tree. Emphysema

An increase beyond the normal in the size of the air spaces distal to the terminal bronchiole accompanied by destruction of their walls and without obvious fibrosis.

Airway obstruction Reduced FEV1 and FEV1/FVC ratio

Spirometry Forced expiratory volume in one second (FEV1). This is the amount of air you can blow out within one second.

With normal lungs and airways you can normally blow out most of the air from your lungs within one second. Forced vital capacity (FVC). The total amount of air that you blow out in one breath. FEV1 divided by FVC (FEV1/FVC). Of the total amount of air that you can blow out in one breath, this is the

proportion that you can blow out in one second

COPD 1. Produces symptoms, disability and impaired QOL which may respond to pharmacological and other

therapies which have limited or no impact on the airflow obstruction

2. An irreversible condition 3. Treatment aim: 1) Cure, 2) disease modification, 3) prognostic benefit, 4) symptomatic control

Criteria for dx: a. Established history of COPD b. Aged 40–80 years inclusive

e. FEV1 < 60% predicted (pre-bronchodilator)f. FEV1/FVC ratio ≤ 70%

c. Smoking history ≥ 10 pack yearsd. Reversibility < 10% in predicted FEV1

g. Able to use AccuhalerTM

Symptoms Signs Cough Sputum Dyspnoea Wheeze

Tachypnoea Use of accessory muscles of respiration Hyperinflation Cricosternal distance reduced (<3cm) Reduced expansion Resonant/hyper resonant on percussion note

Tests 1. CXR: hyperinflation (>6 anterior ribs), flat hemidiaphragms, large central pulmonary arteries, peripheral

vascular markings, bullae 2. FBC: PCV^ 3. ABG: PaO2 reduced +- hypercapnia4. Lung function: Spirometry

Pulmonary Rehabilitation 1. Improves exercise tolerance 2. Reduces dyspnoea 3. Improves QOL4. Trend towards reduced hospitalisations

Pulmonary Hypertension A type of high blood pressure that affects arteries in the lungs and in the heart.

Cor Pulmonale Long term oxygen therapy (LTOT) is indicated in patients with COPD

1. PaO2 < 7.3 kPa when stable or2. PaO2 < 8 kPa when stable and one of;

a. secondary polycythaemia, b. nocturnal hypoxaemia (oxygen saturation of arterial blood [SaO2] less than 90% for more than

30%of time), c. peripheral oedemad. pulmonary hypertension