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ASTHMA & COPDBy Laura Parker
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Learning Objectives
To be able to define Asthma and COPD To have an understanding of the
pathogenesis of each disease and the common causes / risk factors associated
To be able to recognise the presentation of patient with Asthma or COPD
To be able to manage an acute exacerbation of Asthma / COPD
To understand the long term management options available for clinicians for Asthma / COPD
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ASTHMA
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Definition
Asthma: chronic inflammatory disease of the lungs characterised by airway obstruction that is reversible
Extrinsic Immune Onset childhood Eosiniphilia blood & sputum
Intrinsic Abnormal autonomic reulation of airways Onset Adulthood Eosinophilia sputum Assoc w/ chronic bronchitis
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Pathogenesis
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Incidence & Aetiology
• 5.4 million receive treatment UK (~5%)• Most common chronic medical condition
in children
• Risk Factors• Personal history of atopy• Family history of asthma or atopy
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Presentation
SYMTPOMS SIGNS
• Wheeze• Cough• Difficulty breathing• Chest tightness• ?diurnal variation• ?triggers• ?atopy
• Normal between attacks
• Prolonged expiration• Wheeze
Respiratory distress
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Recognising a sick patient…
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Differentials
I G V I T A M I N D
Idiopathic or Iatrogenic
Genetic: Vascular: Infective: Trauma: Autoimmune: Metabollic: Inflammatory: Neoplastic: Degenerative:
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Differentials
Anaphylaxis eg penicillin allergic patient given penicillin
alpha 1 Antitrypsin disease PE, Anaemia Pneumonia, Bronchiectasis Tension pneumothorax Autoimmune: Metabollic: COPD, Asthma Lung Ca Fibrosis
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Investigations
Inpatient• Peak flow• Sputum • Urine• Bloods• ABG• ECG• CXR• Pulmonary Function Tests• +/- further imaging ( CT, HRCT)
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Investigations
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Management: Acute Exacerbation
A,B,C,D,E…• OXYGEN
• Sats 94-98%
• NEBS• BETA AGONIST• IPRATROPIUM
• STERIODSoral / IV • +/-
• IV MgSO4• ABX if suspicious infective exacerbation
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Long Term Management Asthma
Aims: No symptoms during the day No waking at night due to symptoms No exacerbations No need for rescue medication No exercise limitation Normal lung function
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Long Term Management Asthma
Yearly Asthma Review Smoking status Triggers and avoidance Concordance Inhaler technique Stepwise approach….
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Long Term Management Asthma
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COPD
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Definitions
Chronic Obstructive Pulmonary Disease (COPD): collective term for an inflammatory lung disease in which airway obstruction is progressive and only partially reversible by bronchodilators
Chronic Bronchitis: persistent cough with sputum production for > 3months/year for 2 years
Emphysema: permanent enlargement of air spaces distal to the terminal bronchiole due to alveolar septal destruction
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Pathophysiology
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Incidence & Aetiology
Est 3 million people UK Prevalence 1.5% population
Risk factors• SMOKING (effects approx 15% smokers)• Increases with age• More common in men• More common deprived communities
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Presentation
SYMPTOMS SIGNS
• Wheeze• Chronic cough• SOBOE• Regular sputum
production• Frequent winter
'bronchitis”• ? >35yrs old• ?hx of smoking
• Pink puffers / blue bloaters
• Respiratory distress• Hyper-expansion• Hyper-resonant• Prolonged expiration• Wheeze
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Differentials
Anaphylaxis eg penicillin allergic patient given penicillin
alpha-1 Antitrypsin PE, Anaemia Pneumonia, Bronchiectasis Tension pneumothorax Autoimmune: Metabollic: COPD, Asthma Lung Ca Fibrosis
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Investigations
Inpatient• Peak flow• Sputum • Urine• Bloods• ABG• ECG• CXR• Pulmonary Function Tests• +/- further imaging ( CT, HRCT)
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Acute Exacerbation COPD
A,B,C,D,E Controlled oxygen therapy
Aim Saturations 88-92% Nebulised bronchodilators Oral corticosteroids
+/- ABX NIV
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Long Term Management of COPD
Multi-Disciplinary Smoking CessationVaccination
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Long Term Management COPD
Mucolytics
Oral bronchodilators eg theophylline (nb narrow therapeutic window)
therapeutic range of theophylline is 10-20 mg/litre
Oxygen LTOT / SBOT
NIV
Surgery: bullectomy, lung volume reduction surgery and lung transplantation
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Learning Objectives
To be able to define Asthma and COPD To have an understanding of the
pathogenesis of each disease and the common causes / risk factors associated
To be able to recognise the presentation of patient with Asthma or COPD
To be able to manage an acute exacerbation of Asthma / COPD
To understand the long term management options available for clinicians for Asthma / COPD
![Page 28: By Laura Parker. To be able to define Asthma and COPD To have an understanding of the pathogenesis of each disease and the common causes / risk factors](https://reader036.vdocument.in/reader036/viewer/2022081519/56649d8a5503460f94a70d0b/html5/thumbnails/28.jpg)
How to Use an Inhaler
1. Remove cap 2. Shake the device3. If you have not used the inhaler for a week or more, or it is the first
time you have used the inhaler, spray it into the air before using to check that it works
4. Hold the inhaler upright with you forefinger on the top5. Big breath out6. Place the mouthpiece in your mouth between your teeth, and close
your lips around it7. Start to breathe in slowly and deeply, at the same time, press down
on the canister releasing a “mist”8. Hold your breath for as long as is comfortable, then breathe out as
normal. 9. If you need 2 puffs, wait 30 seconds then repeat10. Do not release two puffs at the same time11. Replace cap
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Smoking
Accurate HistoryPack year = no. cigarettes smoked per day X no. years smoked
20
Assess “readiness to change”Cessation
Nicotine Replacement Therapy• Patches
• Bupropion (nb reduces seizure threshold)• Varenicline (champix) (nb use in caution in a Pt w/
psych hx)• E-cigarettes: evidence controversial, recent BMJ
article suggest they encourage and glamourize smoking, not available by prescription at present
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Case Study (1)
A 64 year old gentleman presents to A&E with increasing SOB over the last 3 days. This is associated with a cough productive of thick, green sputum. He has a past medical history of “asthma”, but he has smoked 50 cigarettes a day for the past 40 years. Obs: RR 30 O2 sats 85% on 21% HR 120 BP 138/82. O/E he is using his accessory muscles to breathe, bilateral diffuse coarse crepitations and widespread wheeze
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Questions
Differential diagnoses? Initial management? Investigations? Treatment?
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Case Study (2)
Patient is successfully treated for infective exacerbation of COPD and discharged from hospital. You see him in your GP surgery a few weeks later for a medication review. How may you optimise the management of this patient?
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References
http://emedicine.medscape.com/article/296301-overview http://www.patient.co.uk/doctor/bronchial-asthma British Guideline on the Management of Asthma. British Thoracic
Society and the Scottish Intercollegiate Guidelines Network. (Revised January 2012). Available online at http://www.brit-thoracic.org.uk
Regulation in chronic obstructive pulmonary disease: the role of regulatory T-cells and Th17 cells: Nina Lane*, R. Adrian Robins*, Jonathan Corne† and Lucy Fairclough* Clinical Science (2010) 119, (75–86)
Chronic Obstructive Pulmonary Disease (2010). Clinical Gudeline 101. National Institute for Health and Care Excellence. Available online athttp://www.nice.org.uk/CG101
How to use inhaled devices: http://www.medicines.org.uk/guides/pages/how-to-use-your-inhaler-videos
BNF
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THANK YOU FOR LISTENING
Are There Any Questions?