COPD - revision notes PDF

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COPD https://cks.nice.org.uk/topics/chronic-obstructive-pulmonary-disease/ [NICE guideline ref] Definition: Chronic obstructive pulmonary disease (COPD) is a common, treatable (but not curable) and largely preventable lung condition. It is characterised by persistent respiratory symptoms and airflow obstruction which is usually progressive and not fully reversible. Symptoms:  Respiratory distress: tachypnoea, breathlessness on exertion  Abnormal posture: patients may lean forward and rest their arms on the table to ease breathing  Drowsiness: flapping tremor and mental confusion (these are features of elevated carbon dioxide levels)  Other signs include being underweight, ankle oedema, cyanosis (blue-ish skin), hyperinflation of the chest, downward displacement of the liver Diagnosis:  COPD should be suspected in people aged over 35 years, who have a risk factor and symptoms including exertional breathlessness, chronic/recurrent cough, or regular sputum production.  A post bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) of less than 0.7 on spirometry confirms persistent airflow obstruction.  Investigations (including chest X-ray and full blood count) should be arranged to exclude other causes of symptoms. Management:  All COPD pts should be offered pneumococcal and influenza vaccination  As initial inhaled therapy for COPD, a short-acting bronchodilator (SABA), or short-acting muscarinic antagonist (SAMA) for use as needed (to relieve breathlessness and improve exercise tolerance) should be offered. 

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If symptoms are not controlled, long-acting bronchodilators (LABAs), long-acting muscarinic antagonists (LAMAs), or inhaled corticosteroids (ICSs), and add on therapies may be considered in a stepwise approach — choice of treatment depends on the specific clinical situation. ICSs should be prescribed in combination with a long-acting bronchodilator and are associated with an increased risk of pneumonia. Consider the need for an antibiotic taking into account: o Severity of symptoms (particularly sputum colour changes and increase in volume or thickness beyond normal). o Risk of complications. o Previous sputum culture and susceptibility results. o Risk of antimicrobial resistance and current antibiotic prophylaxis (treatment should be with an antibiotic from a different class). First choice oral antibiotics include:

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o Amoxicillin 500 mg three times a day for 5 days. o Doxycycline 200 mg on first day, then 100mg once a day for 5-day course in total. o Clarithromycin 500 mg twice a day for 5 days. Consider: o Mucolytic therapy: Consider in people with a chronic productive cough. o Pneumococcal vaccination and an annual influenza vaccination should be offered to all patients with COPD. o Antivirals for influenza: zanamivir and oseltamivir are recommended for the treatment of at-risk adults who present with influenza-like illness o Oxygen therapy o Physiotherapy o Pulmonary rehabilitation...