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COPD

Chronic Obstructive P ulmonary Disease

Dr.Sathaporn Kunnathum

19 January 2010

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The world will provide you with

stones every day; what you buildout of it is you outlook - A Bridge or a Wall.

Anonymous

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COPD

airflow limitationsnot fully reversible

progressive

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Pathologicconditions

chronic obstructive bronchitisemphysema, andmucus plugging

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Risk factorCigarette smoking accounts for mostcases of COPD

Occupational dusts and chemicalAir pollutionFactor during gestation and childhood

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Acuteexacerbate

Infections

Air pollutionTemperature

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CXR finding

Chronicbronchitis

Emphysema

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Advance in drugtherapy

Antismoking Measures New Bronchodilators

Antibiotics Oxygen Corticosteroids

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ors are themainstay of current drugtherapy forCOPD.

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Antibiotics

Acute exacerbations of COPD are commonlyassumed to be due to bacterial infection.Exacerbations may be due to viral infections of the upper respiratory tract or may benoninfective, so that antibiotic treatment is notalways warranted.

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Oxygen

Long-term oxygen therapy:reduced mortality

improvement in quality of life in patientswith severe COPD and chronichypoxemia (partial pressure of arterialoxygen,

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Oxygen does notincrease survival inpatients with lesssevere hypoxemia.

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CorticosteroidsReduce the frequency of exacerbationImprove health status for symptomatic patients

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Indication for

admitRR > 30PR > 110

PEFR < 100Still dyspnea after treatment

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GOLD Workshop Report

Four Components of COPD Management -www.goldcopd.com

GOLD Workshop Report

Four Components of COPD Management -www.goldcopd.com

1. Assess and monitor disease

2. Reduce risk factors

3. Manage stable COPDq Educationq Pharmacologicq Non-pharmacologic

1. Manage exacerbations

1. Assess and monitor disease

2. Reduce risk factors

3. Manage stable COPDq Educationq Pharmacologicq Non-pharmacologic

1. Manage exacerbations

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Management oCOPDStage 0: At Risk

anagement oCOPDStage 0: At Risk

Characteristics RecommendedTreatment

Risk factorsChronic symptoms

- cough- sputum

No spirometricabnormalities

Adjust risk factors Immunizations

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Management oCOPDStage I: Mild COPD

anagement oCOPDStage I: Mild COPD

Characteristics RecommendedTreatment

FEV 1/FVC < 70 % FEV 1 > 80 % predicted With or without

symptoms

Short-actingbronchodilator asneeded

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COPDStage II: ModerateCOPD

COPDStage II: ModerateCOPD

Characteristics RecommendedTreatment

FEV 1/FVC < 70%50% < FEV 1< 80%predicted

With or without symptoms

Treatment with one or more long-actingbronchodilatorsRehabilitation

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COPDStage III: SevereCOPD

COPDStage III: SevereCOPD

Characteristics RecommendedTreatment

FEV 1/FVC < 70%30% < FEV 1 < 50%predicted

With or without symptoms

Treatment with one or more long-actingbronchodilatorsRehabilitationInhaled glucocortico-steroids if repeatedexacerbations(>3/year)

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COPDStage IV: VerySevere COPD

COPDStage IV: VerySevere COPD

Characteristics RecommendedTreatment

FEV 1/FVC < 70%FEV 1 < 30% predictedor presence of

respiratory failure or right heart failure

Treatment with one or more long-acting bronchodilatorsInhaled glucocorticosteroids if repeated exacerbations (>3/year)Treatment of complicationsRehabilitationLong-term oxygen therapy if respiratory failureConsider surgical options

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Goal of treatment

Relief of symptomsImproved exercise toleranceImproved health statusPrevention and treatment of complicationsPrevention and treatment of exacerbationsPrevention of disease progressionReduced mortality

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COPD with AE

Please give the detail for management At Nachueak ER