Post on 20-Jun-2015
COPD AND SMOKING CESSATION
METHODS
PRESENTED BY:
FASAHAT AHMED BUTT (36)
OBJECTIVES What is COPD Related diagnoses Risk factors Pathophysiology Clinical features Investigation Management Prescription Smoking cessation
methods
COPD Preventable and treatable lung
disease with some significant extrapulmonary effects that may contribute to severity in individual patient
Pulmonary component Airflow limitation
(not fully reversible)
Limitation is progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.
RELATED DIAGNOSES Chronic Bronchitis
Cough
Sputum
Emphysema
Enlargement of airspaces distal
to terminal bronchioles with destruction
of their walls (no fibrosis)
RISK FACTORS
Exposures
Tobacco smoke Occupation Lung growth Infections Low SES Nutrition (unclear) Cannabis smoking
Host factors
Genetic factors Airway hyper-reactivity
PATHOPHYSIOLOGY Airway inflammation
Loss of elastic recoil- Airway collapse
CLINICAL FEATURES Cough Sputum production Haemoptysis Breathlessness Pink puffers Blue bloaters Cor pulmonale
BREATHLESSNESSModified MRC dyspnoea scale
Grade Degree of breathlessness related to activities
0 No breathlessness except with strenuous exercise
1 Breathlessness when hurrying on the level or walking up a slight hill
2 Walks slower than contemporaries on level ground because of breathlessness or has to stop for breath when walking at own pace
3 Stops for breath after walking about 100 m or after a few minutes on level ground
4 Too breathless to leave the house, or breathless when dressing or undressing
SIGNS OF COPDPathological conditions
COPD
Shape and deformity of chest
Barrel shaped chest
Movement of chest wall
Diminished all over
Mediastinal displacement
None
Percussion note Normal or hyper-resonant
Breath sounds Diminished vesicular with prolonged expiration
Vocal resonance Normal or reduced
Added sounds Ronchi (may be both inspiratory or expiratory)
INVESTIGATION Chest x-ray:
Cardiac failure
Lung cancer
Bullae
Complete Blood Count:
Alpha1 antiproteinase
Pulmonary Function Test:
Hallmark of COPD is airway obstruction.
(reduction in FEV1 and FEV1/FVC)
Spirometric classification of COPD severity based on post-bronchodilator FEV1
Stage Severity FEV1
1 Mild FEV1/FVC < 0.70FEV1 ≥ 80% predicted
2 Moderate FEV1/FVC < 0.7050% ≤ FEV1< 80% predicted
3 Severe FEV1/FVC < 0.7030% ≤ FEV1 < 50% predicted
4 Very severe FEV1/FVC < 0.70FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic pulmonary failure
Health status questionnaires:
Arterial blood Gases: Demonstrate mild reduction
in blood oxygen levels,
and normal carbon dioxide
levels
Heart Function Tests: Echocardiogram shows the function of the heart, and ECG will demonstrate changes of right heart strain or heart failure (cor pulmonale)
MANAGEMENT
Smoking cessation Bronchodilators Corticosteroids Oxygen therapy Pulmonary rehabilitation Surgical intervention Palliative care
BRONCHODILATORS
ROUTE: Inhaled in preferred Oral bronchodilators
For the management of Breathlessness
Drugs Used: Short acting beta 2 agonist(mild
disease)
Salbutamol
Terbutaline Anticholinergic
Ipratropium
Long acting beta 2 agonist(moderate to severe)
Salmeterol
Formeterol Anticholinergic
Tiotropium bromide
CORTICOSTEROIDS
ICS: frequency and severity of exacerbation
Patient with sever disease (FEV1 <50%)
Oral corticosteroids: Exacerbations
Maintenance therapy
Impaired skeletal muscle function
and Osteoporosis
OXYGEN THERAPY Long term domiciliary oxygen therapy (LTOT):
Provided by oxygen concentrator
Minimum of 15 hours/day
AIM:
The paO2 to at least 8 kPa (60 mmHg) or SaO2 to at least 90%.
Ambulatory oxygen therapy:
In patients who desaturate on exercise & show objective improvement in exercise capacity &/or dyspnoea with oxygen.
SURGICAL INTERVENTION:
Bullectomy Lung Volume Reduction Surgery (LVRS) Lung Transplantation
PULMONARY REHABILITATION
Treatment program that incorporate education and cardiovascular conditions
PALLIATIVE CARE Addressing end-of-life needs is an important, yet
often ignored aspect of care in advanced disease. Morphine preparations: Breathlessness Benzodiazepines (low dose): Anxiety
Rx For Mild COPDName of the patient: (-) Date:
Gender: (-)
Age : (-)
Address : (-)
Rx:
Short acting bronchodilators
Salbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S
Follow up:
Name of physician:
Signature:
Rx For Moderate COPD
Name of the patient: (-) Date:
Gender: (-)
Age : (-)
Address : (-)
Rx:
Short acting bronchodilatorsSalbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S
Long acting bronchodilatorsSalmeterol ( 25mcg) 2-4 puffs twice daily
Long acting anticholinergicsTiotropium (9mcg) inhaler 2 puffs once dailyIpratropium Bromide (Atrovent) 2-3 puffs
Follow up:
Name of physician:
Signature
Rx For Severe COPDName of the patient: (-) Date:
Gender: (-)
Age : (-)
Address : (-)
Rx:
Short acting bronchodilators
Salbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S
Long acting bronchodilators
Salmeterol ( 25mcg) 2-4 puffs twice daily
Inhaled Corticosteroids
Prednisone 60 mg qd for 7 days
Prednisone tapered off over additional 2 weeks
Follow up:
Name of physician:
Signature
Rx For very Severe COPD
Name of the patient: (-) Date:
Gender: (-)
Age : (-)
Address : (-)
Rx:
Short acting bronchodilators
Salbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S
Long acting bronchodilators
Salmeterol ( 25mcg) 2-4 puffs twice daily
Inhaled Corticosteroids
Prednisone 60 mg qd for 7 days
Prednisone tapered off over additional 2 weeks
Follow up:
Name of physician:
Signature
SMOKING CESSATION METHODS
Smokers who are not motivated to try to stop smoking
- Record smoking status at regular intervals- Anti-smoking advice- Encourage change in attitude towards smoking to improve motivation
Motivated light smokers (<10/day)
- Anti-smoking advice- Anti-smoking support programme
Motivated heavy smokers (10-15/day)
- As above plus nicotine replacement therapy (NRT) (minimum 8 weeks)
Motivated heavy smokers (>15/day)
- As above plus bupropion if NRT and behavioural support are unsuccessful and patient remains motivated
HEALTH BENEFITS OF SMOKING CESSATION
PHARMACOLOGICAL TREATMENTo Nicotine Replacement Therapy (NRT)
o Gumo Patcho Inhalero Nasal Sprayo Lozenge
o Bupropion
o Combination Therapy
SUMMARY COPD : Disease state characterized by airflow limitation that
is not fully reversible
It includes: Emphysema and Chronic bronchitis
Risk factors: Exposure and Host factors
C/F: Cough, Haemoptysis, Sputum, Breathlessness, Pink puffers, Blue bloater.
Investigation: Radiograph, CBC, Pulmonary function test, Health status questionnaire, Arterial blood gases, Heart function test.
Management: Bronchodilators, corticosteroids, Pulmonary rehabilitation, Oxygen therapy, Surgical interventions, Palliative care.
Smoking cessation methods
REFERRENCES
DAVIDSON Bedside Techniques (Shabbir) GOOGLE WIKIPEDIA
THANK YOU