logging in or signing up COPD PPT docskg Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 3077 Category: Education License: All Rights Reserved Like it (2) Dislike it (0) Added: October 03, 2010 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: devikapadmanabhuni (9 month(s) ago) plz allow me download ur copd presentation Saving..... Post Reply Close Saving..... Edit Comment Close By: frbishara (9 month(s) ago) please allow me to download your presentations.Regards Saving..... Post Reply Close Saving..... Edit Comment Close By: arshadteacher (14 month(s) ago) Please allow me to download your presentation.Thanks. Saving..... Post Reply Close Saving..... Edit Comment Close By: arshadteacher (14 month(s) ago) Please allow me to download your presentation.Thanks. Saving..... Post Reply Close Saving..... Edit Comment Close By: arshadteacher (14 month(s) ago) Please allow me to download your presentation.Thanks. Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Slide 1: Management of COPD & Acute Exacerbation Dr. Suresh Goyal M. D. Oswal Cancer Hospital Ludhiana Definition Of COPD : Definition Of COPD Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. Slide 3: The Overlap COPD Neutrophils No airway hyperresponsiveness Less bronchodilator response Limited steroid response Wheezy bronchitis 10% Asthma Eosinophils Airway hyperresponsiveness Bronchodilator response Steroid response Slide 4: Ischaemic heart disease Cerebrovascular disease Lower respiratory infection Diarrhoeal disease Perinatal disorders COPD Tuberculosis Measles Road traffic accidents Lung cancer 6th 1990 FUTURE GLOBAL MORTALITY Murray & Lopez: World Bank Global Predictions Nat Med 1998 2020 3rd COPD : COPD 1.2 Billion Smokers All over World 12.36 million adult patients in India (61.6% males) 15% Smokers develops COPD Adults over 30 years : 5% males and 2.7% females History : History Chronic cough Present on most days for at least 3 months in a year for 2 or more consecutive years Usually but not always associated with sputum production Characteristically more in the early morning on waking up Exertional Dysnoea Clinical Signs: Respiratory : Clinical Signs: Respiratory Tachypnoea Use of accessory muscles of respiration Paradoxical chest wall movements Hyperinflation Pursed lip breathing New adventitious sounds Causes of AECB : Causes of AECB Early: S. pneumoniae H. influenzae M. catarrhalis Late: Klebsiella pneumoniae Staphylococci Pseudomonas spp. Differences between COPD and Asthma : Differences between COPD and Asthma Inflammatory Effects Asthma COPD All airways Peripheral airways AHR +++ AHR± Epithelial shedding Epithelial metaplasia Fibrosis+ Fibrosis++ No parenchymal Parenchymal destruction involvement Mucus secretion+ Mucus secretion+++ AJRCCM 1996; 153:530-534; Pharmacol Review 1998;50:515-59 Differences between COPD and Asthma : Differences between COPD and Asthma Inflammatory cells Asthma COPD Mast cells Eosinophils Neutrophils CD4+ cells CD8+ cells Macrophages+ Macrophages++ IL4 & IL5 IL6 & LTB4 AJRCCM 1996; 153:530-534 N. Engl J Med 1997;336:1066-1071 Clinical features of Asthma & COPD : Clinical features of Asthma & COPD Asthma : (reversible) Intermittent symptoms Family history of atopy Childhood onset Significant reversibility in FEV1 Dramatic and excellent response toinhaled steroids COPD : (Partial / irreversible) Slowly, progressive dyspnoea Smokers / Indoor air pollution Onset after 40 years Poor FEV1 reversibility Progressive FEV1 decline Regular bronchodilator essential Inadequate response to inhaled steroid Examination : Examination Pursed lip breathing Barrel shaped chest - increased AP diameter (Normal AP 5:7) Hyper-resonant percussion with obliteration of cardiac dullness Uniform diminished intensity of breath sound with prolonged expiratory phase Inspiratory crepitations and rhonchi Investigations : Investigations Spirometry Chest X-ray ECG / Echo Doppler ABG Lung volumes / diffusion Investigations : Investigations Sputum examination Exclude tuberculosis in suspected patients Chest X-ray Identify alternate diseases (TB, Ca lung, etc.) Detect complications such as cor pulmonale, pneumothorax or pneumonia HRCT HRCT is highly specific for Emphysema. Slide 17: Fletcher C, Peto R: BMJ 1977 Annual Decline in Lung Function FEV1 (% predicted at age 25y) 100 75 50 2525 0 25 50 75 Age Years) Death Disability Non smoker Acute exacerbations : Acute exacerbations Steep decline in Lung Function Lung function declines upto 25% faster in patients with frequent exacerbations Recovery after an AECB is never complete Greater airway inflammation Worse health status High morbidity and mortality Respiratory failure in AECBClinical Features : Respiratory failure in AECBClinical Features Type 1 (Hypoxic failure) Features of hypoxia Tachypnea/ tachycardia Use of accessory respiratory muscles Pursed lip breathing Cyanosis Type 2 (ventilatory failure) Features of hypercapnia Peripheral vasodilation Bounding pulse Flapping tremor Drowsiness – CO2 narcosis Bronchodilators (Short acting) : Bronchodilators (Short acting) Inhaled anti-cholinergics Ipratropium bromide 40 – 80 g qid by pMDI- spacer or 250-500 g qid by nebulizer Inhaled ß agonists Salbutamol 100-200 g by g with pMDI spacer or 2.5-5 mg qid by nebulization Combination of above Methylxanthines controversial Treatment : COPD - Regular inhaled bronchodilators - Anticholinergics are first line - LABAs add-on - Inhaled steroids in severe cases and those having > 2 exacerbations Asthma - Inhaled steroids for all persistent cases - LABAs for moderate to severe - SABA for as needed - Anticholinergics in severe cases Treatment Muscarinic Receptors in the Airways : Muscarinic Receptors in the Airways Ganglion Preganglionic nerve Post-ganglionic nerve Smooth muscle Constriction Dilatation Constriction Dilatation Dilatation Constriction BLOCKADE Tiotropium Bromide : Tiotropium Bromide 18 mcg/dose Single daily dose Selective anticholinergic M3 receptor blocker First-choice bronchodilator for COPD today Use of Inhaled steroids in COPD : Use of Inhaled steroids in COPD Current recommendations (GOLD guidelines): > 2 exacerbations in a year FEV1 < 50% (severe COPD) Meta-analyses of 9 clinical trials: 25% - 30% decrease in exacerbations in patients treated with high dose ICS for > 6 months Theophylline : Theophylline Anticholinergics and LABAs preferred Systemic administration; effect on small airways Anti-inflammatory effects 1 Improves diaphragmatic efficiency 2 1 Barnes PJ ERJ 1994;7:579 - 591 2 Aubier M NEJM 1981;305:249 - 252 What can slow the decline in lung function in COPD? : What can slow the decline in lung function in COPD? Smoking cessation definitely Home oxygen therapy Now Tiotropium ? (long-term study results awaited) Long-term Oxygen Therapy (LTOT) : Long-term Oxygen Therapy (LTOT) Should not be regarded as something to give “when all has failed” Not addictive Does not limit mobility around the house LTOT in COPD : LTOT in COPD Improves survival Indications: pO2 < 55 pO2 55 – 59 with PH, cor pulmonale, polycythaemia, edema from right heart failure or impaired mental state. Destauration during sleep, exercise and high altitude Nonpharmacologic Therapy : Nonpharmacologic Therapy All stages Education Smoking cessation Pulmonary rehabilitation Immunization Nutrition Late Stages Long-term oxygen therapy (LTOT) Surgical options Non-invasive positive pressure ventilation (NIPPV) Nutrition in COPD : Nutrition in COPD Patients may be overweight or underweight , maintaining ideal weight is important (fresh fruit and vegetables) Overweight patients may have IHD, sleep apnoea, while in underweight patients, poor appetite may be due to depression Salt and fluid restriction in Cor pulmonale due to COPD Prevention of bloating after meals which worsens dyspnoea (smaller meals) Simple advice to quit Smoking : Simple advice to quit Smoking Spend 3 minutes Use a family member to help Urges are usually short-lived Get rid of smoking accessories (lighters, ash-trays) Put the money aside you would have spent on cigarettes Avoid situations that increase craving Weight gain is usual Breathing exercises : Breathing exercises Pursed-lip breathing Diaphragmatic breathing Body positioning Indications for Invasive Mechanical Ventilation : Indications for Invasive Mechanical Ventilation NIPPV failure Life threatening hypoxemia PaO2 < 40mmHg PaO2/ FiO2 < 200 mmHg Severe acidosis (pH < 7.25) Hypercapnia (PaCO2 > 60 mmHg) Somnolence, impaired mental status Respiratory arrest CVS complications (hypotension, shock, CHF) Other complications: Metabolic abnormalities, sepsis, pneumonia, PE Surgery for COPD : Surgery for COPD Bullectomy Lung volume reduction surgery Lung transplantation Improved lung function, exercise capacity, dyspnea, health-related quality of life and possibly survival in highly selected pts. Take Home Message : Take Home Message Important for clinicians to Understand that asthma and COPD are two entirely different disorders Appreciate that clinical judgment has a far greater role than investigations in differentiating COPD from asthma Slide 36: Thank you You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
COPD PPT docskg Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 3077 Category: Education License: All Rights Reserved Like it (2) Dislike it (0) Added: October 03, 2010 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: devikapadmanabhuni (9 month(s) ago) plz allow me download ur copd presentation Saving..... Post Reply Close Saving..... Edit Comment Close By: frbishara (9 month(s) ago) please allow me to download your presentations.Regards Saving..... Post Reply Close Saving..... Edit Comment Close By: arshadteacher (14 month(s) ago) Please allow me to download your presentation.Thanks. Saving..... Post Reply Close Saving..... Edit Comment Close By: arshadteacher (14 month(s) ago) Please allow me to download your presentation.Thanks. Saving..... Post Reply Close Saving..... Edit Comment Close By: arshadteacher (14 month(s) ago) Please allow me to download your presentation.Thanks. Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Slide 1: Management of COPD & Acute Exacerbation Dr. Suresh Goyal M. D. Oswal Cancer Hospital Ludhiana Definition Of COPD : Definition Of COPD Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. Slide 3: The Overlap COPD Neutrophils No airway hyperresponsiveness Less bronchodilator response Limited steroid response Wheezy bronchitis 10% Asthma Eosinophils Airway hyperresponsiveness Bronchodilator response Steroid response Slide 4: Ischaemic heart disease Cerebrovascular disease Lower respiratory infection Diarrhoeal disease Perinatal disorders COPD Tuberculosis Measles Road traffic accidents Lung cancer 6th 1990 FUTURE GLOBAL MORTALITY Murray & Lopez: World Bank Global Predictions Nat Med 1998 2020 3rd COPD : COPD 1.2 Billion Smokers All over World 12.36 million adult patients in India (61.6% males) 15% Smokers develops COPD Adults over 30 years : 5% males and 2.7% females History : History Chronic cough Present on most days for at least 3 months in a year for 2 or more consecutive years Usually but not always associated with sputum production Characteristically more in the early morning on waking up Exertional Dysnoea Clinical Signs: Respiratory : Clinical Signs: Respiratory Tachypnoea Use of accessory muscles of respiration Paradoxical chest wall movements Hyperinflation Pursed lip breathing New adventitious sounds Causes of AECB : Causes of AECB Early: S. pneumoniae H. influenzae M. catarrhalis Late: Klebsiella pneumoniae Staphylococci Pseudomonas spp. Differences between COPD and Asthma : Differences between COPD and Asthma Inflammatory Effects Asthma COPD All airways Peripheral airways AHR +++ AHR± Epithelial shedding Epithelial metaplasia Fibrosis+ Fibrosis++ No parenchymal Parenchymal destruction involvement Mucus secretion+ Mucus secretion+++ AJRCCM 1996; 153:530-534; Pharmacol Review 1998;50:515-59 Differences between COPD and Asthma : Differences between COPD and Asthma Inflammatory cells Asthma COPD Mast cells Eosinophils Neutrophils CD4+ cells CD8+ cells Macrophages+ Macrophages++ IL4 & IL5 IL6 & LTB4 AJRCCM 1996; 153:530-534 N. Engl J Med 1997;336:1066-1071 Clinical features of Asthma & COPD : Clinical features of Asthma & COPD Asthma : (reversible) Intermittent symptoms Family history of atopy Childhood onset Significant reversibility in FEV1 Dramatic and excellent response toinhaled steroids COPD : (Partial / irreversible) Slowly, progressive dyspnoea Smokers / Indoor air pollution Onset after 40 years Poor FEV1 reversibility Progressive FEV1 decline Regular bronchodilator essential Inadequate response to inhaled steroid Examination : Examination Pursed lip breathing Barrel shaped chest - increased AP diameter (Normal AP 5:7) Hyper-resonant percussion with obliteration of cardiac dullness Uniform diminished intensity of breath sound with prolonged expiratory phase Inspiratory crepitations and rhonchi Investigations : Investigations Spirometry Chest X-ray ECG / Echo Doppler ABG Lung volumes / diffusion Investigations : Investigations Sputum examination Exclude tuberculosis in suspected patients Chest X-ray Identify alternate diseases (TB, Ca lung, etc.) Detect complications such as cor pulmonale, pneumothorax or pneumonia HRCT HRCT is highly specific for Emphysema. Slide 17: Fletcher C, Peto R: BMJ 1977 Annual Decline in Lung Function FEV1 (% predicted at age 25y) 100 75 50 2525 0 25 50 75 Age Years) Death Disability Non smoker Acute exacerbations : Acute exacerbations Steep decline in Lung Function Lung function declines upto 25% faster in patients with frequent exacerbations Recovery after an AECB is never complete Greater airway inflammation Worse health status High morbidity and mortality Respiratory failure in AECBClinical Features : Respiratory failure in AECBClinical Features Type 1 (Hypoxic failure) Features of hypoxia Tachypnea/ tachycardia Use of accessory respiratory muscles Pursed lip breathing Cyanosis Type 2 (ventilatory failure) Features of hypercapnia Peripheral vasodilation Bounding pulse Flapping tremor Drowsiness – CO2 narcosis Bronchodilators (Short acting) : Bronchodilators (Short acting) Inhaled anti-cholinergics Ipratropium bromide 40 – 80 g qid by pMDI- spacer or 250-500 g qid by nebulizer Inhaled ß agonists Salbutamol 100-200 g by g with pMDI spacer or 2.5-5 mg qid by nebulization Combination of above Methylxanthines controversial Treatment : COPD - Regular inhaled bronchodilators - Anticholinergics are first line - LABAs add-on - Inhaled steroids in severe cases and those having > 2 exacerbations Asthma - Inhaled steroids for all persistent cases - LABAs for moderate to severe - SABA for as needed - Anticholinergics in severe cases Treatment Muscarinic Receptors in the Airways : Muscarinic Receptors in the Airways Ganglion Preganglionic nerve Post-ganglionic nerve Smooth muscle Constriction Dilatation Constriction Dilatation Dilatation Constriction BLOCKADE Tiotropium Bromide : Tiotropium Bromide 18 mcg/dose Single daily dose Selective anticholinergic M3 receptor blocker First-choice bronchodilator for COPD today Use of Inhaled steroids in COPD : Use of Inhaled steroids in COPD Current recommendations (GOLD guidelines): > 2 exacerbations in a year FEV1 < 50% (severe COPD) Meta-analyses of 9 clinical trials: 25% - 30% decrease in exacerbations in patients treated with high dose ICS for > 6 months Theophylline : Theophylline Anticholinergics and LABAs preferred Systemic administration; effect on small airways Anti-inflammatory effects 1 Improves diaphragmatic efficiency 2 1 Barnes PJ ERJ 1994;7:579 - 591 2 Aubier M NEJM 1981;305:249 - 252 What can slow the decline in lung function in COPD? : What can slow the decline in lung function in COPD? Smoking cessation definitely Home oxygen therapy Now Tiotropium ? (long-term study results awaited) Long-term Oxygen Therapy (LTOT) : Long-term Oxygen Therapy (LTOT) Should not be regarded as something to give “when all has failed” Not addictive Does not limit mobility around the house LTOT in COPD : LTOT in COPD Improves survival Indications: pO2 < 55 pO2 55 – 59 with PH, cor pulmonale, polycythaemia, edema from right heart failure or impaired mental state. Destauration during sleep, exercise and high altitude Nonpharmacologic Therapy : Nonpharmacologic Therapy All stages Education Smoking cessation Pulmonary rehabilitation Immunization Nutrition Late Stages Long-term oxygen therapy (LTOT) Surgical options Non-invasive positive pressure ventilation (NIPPV) Nutrition in COPD : Nutrition in COPD Patients may be overweight or underweight , maintaining ideal weight is important (fresh fruit and vegetables) Overweight patients may have IHD, sleep apnoea, while in underweight patients, poor appetite may be due to depression Salt and fluid restriction in Cor pulmonale due to COPD Prevention of bloating after meals which worsens dyspnoea (smaller meals) Simple advice to quit Smoking : Simple advice to quit Smoking Spend 3 minutes Use a family member to help Urges are usually short-lived Get rid of smoking accessories (lighters, ash-trays) Put the money aside you would have spent on cigarettes Avoid situations that increase craving Weight gain is usual Breathing exercises : Breathing exercises Pursed-lip breathing Diaphragmatic breathing Body positioning Indications for Invasive Mechanical Ventilation : Indications for Invasive Mechanical Ventilation NIPPV failure Life threatening hypoxemia PaO2 < 40mmHg PaO2/ FiO2 < 200 mmHg Severe acidosis (pH < 7.25) Hypercapnia (PaCO2 > 60 mmHg) Somnolence, impaired mental status Respiratory arrest CVS complications (hypotension, shock, CHF) Other complications: Metabolic abnormalities, sepsis, pneumonia, PE Surgery for COPD : Surgery for COPD Bullectomy Lung volume reduction surgery Lung transplantation Improved lung function, exercise capacity, dyspnea, health-related quality of life and possibly survival in highly selected pts. Take Home Message : Take Home Message Important for clinicians to Understand that asthma and COPD are two entirely different disorders Appreciate that clinical judgment has a far greater role than investigations in differentiating COPD from asthma Slide 36: Thank you