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CHRONIC
OBSTRUCTIVE
PULMONARY
DISEASECHRONIC
OBSTRUCTIVE
PULMONARY
AIMSOFTHISSESSIONToUnderstandthedefinition DiscusscausesDiscussdiagnosis DiscussManagement/MedicationDiscussOxygenTherapyandenjoy!AIMSOFTHISSESSION【COPD英文教學講解課件】COPD-(42p)【COPD英文教學講解課件】COPD-(42p)
DEFINITION
COPDischaracterisedbyairflowobstruction.
airflowobstructionisusuallyprogressiveItisnotfullyreversibledoesnotchangemarkedlyoverseveralmonths.Thediseaseispre-dominantlycausedbysmoking.
COPD
isanumbrellatermfor
EmphysemaChronicBronchitisSevereChronicAsthmaNICE(2010)COPDisanumbrellatermfor
CHRONICBRONCHITISContinuousinflammationofthecellsliningthebronchiMucoushypersecretionDestructionofthecilia,impairingmucousclearanceleadingtoincreasedriskofinfectionDiagnosedbytheproductionofsputumandcoughonmostdaysforthreemonthsintwoconsecutiveyearsCHRONICBRONCHITIS
EMPHYSEMA
DestructiveofthealveoliandterminalbronchiolesLossofelasticityofsmallerairwaysLossofpatencyofbronchiolesEMPHYSEMADest
CAUSESOFCOPDSMOKING:
90%ofcases,arecausedbysmoking15%aresusceptible.Lungfunctiondeclineis3timesfasterIfsmokingstops,atoneyearFEV1declineisagerelated(Morgan&Britton2003)ALPHA1ANTITRIPSINDEFICIENCY:GENETICFoundinonly1%ofcases.OCCUPATIONALEXPOSURETORESPIRATORYPOLLUTANTS:Chemicals,dust,atmosphericpollutants,inheritedtendencyCAUSESOFCNearly30,000deathsayear-accountingfor5%ofalldeaths,onedeathevery20mins850,000diagnosed–only33%Probably2millionundiagnosed“MissingMillions”(BLF2009)COPDisthefourthmostcommoncauseofdeathafterheartdisease,lungdiseaseandcerebrovasculardiseaseNearly30,000deathsayear-acCOPDistheonlyleadingcauseofdeaththatisincreasinginprevalencewithatotalcost￡850million/yr-24millionworkingdayslost-
CigarettesmokingisthemajorcauseofCOPD90%MortalityfromCOPDisincreasinginwomenwhilereachingaplateauinmenUnlesscurrenttrendsarereversed,COPDmaybecomethebiggestpublichealthproblem.DeathrateoneofworstinEuropeCOPDistheonlyleadingcause【COPD英文教學講解課件】COPD-(42p)
DIAGNOSISOver35SmokerorexsmokernoclinicalfeaturesofasthmaHaveanyofthesesymptoms?exertionalbreathlessnesschroniccoughregularsputumproductionfrequentwinter“bronchitis”Wheeze(NICE2010)DIACOPDORASTHMA?COPDAsthmaSmoker/exsmokerNearlyallPossiblySymptomsunderageof35RareCommonChronicproductivecoughProgressiveandpersistentVariableBreathlessnessProgressiveandpersistentVariableNighttimewakingwithbreathlessnessand/orwheezeUncommonCommonSignificantdiurnalordaytodayvariationUncommonCommonCOPD
SPIROMETRYSpirometrymeasuresthevolumeofairexpiredfromthelungsduringasinglemaximalforcedexpiration.Thekeymeasurementsare:-ForcedVitalcapacity(FVC)ForcedExpiratoryVolumeinonesecond(FEV1)FVC/FEV1RatioSPIR
CLASSIFICATIONOFCOPDMILD FEV1>80%MODERATE FEV150-80%SEVERE FEV130-50%VERYSEVEREFEV1,30%NICEGUIDELINE(2010))CLASSIFICATIONCOPDproducessymptoms,disabilityimpairedqualityoflife-mayrespondtopharmacologicaltherapiesAirflowobstructionwillnotrespondtothesetherapiessobewareofarelianceonSpirometry.COPDproduces
SYMPTOMSASSOCIATEDWITHANEXACERBATION
DYSPNOEAMorebreathlessthannormalReducedexercisetoleranceSPUTUMPRODUCTIONIncreaseinpurulenceSPUTUMVOLUMEIncreaseinnormalamountCOUGH
SYMPTOMSASSOCIINVESTIGATIONSChestXrayArterialbloodgas–canaidmedicaldiagnosisECGFBC,UreaandElectrolytesTheophyllinelevelsifappropriateSputummicroscopy/cultureifpurulentINVESTIGATIONS
OBSERVATIONS/MONITORINGRESPIRATORYrate/rhythm/workload/equalO2Sats–90-92%Colourskin,lips,nails(clubbing)Patientabletospeakinsentences/wordsornotatallTemp/Pulse/BPConfusionurineoutputPeripheraloedemaDepression/lethargyAssessneedforNIV/IVNotneeded-PEFROBSERVATIONS/MONITORINTREATMENTRegularbronchodilatortherapy(considerIVaminophyllineifpoorresponsetonebs)Continue/startOralantibioticsContinue/startoralPrednisolone(continueinhaledsteroidsalsoastakes7–10daystokickin)Oxygentherapyas
prescribed
(dependantonbloodgasresultandSatsO2)NoninvasiveVentilationTREATMENT【COPD英文教學講解課件】COPD-(42p)
NURSINGMANAGEMENTLiasewithmultidisciplinaryteammemberstoprovidespecialisedcare.Diseaseprocess/progressionInhalers/medicationSmokingcessationNutritionNURSINGMANAGEMENTPulmonaryrehab/CommunityMatron/Breathlessnessclinic/SupportgroupVaccinationsPhysiotherapist-Breathingexercises,expectoration,copingmechanisms,energyconservationBenefitsFurtherexacerbations-ExacerbationselfmanagementplanandstandbyantibioticsandsteroidsPulmonaryrehab/CommunityMatPREDISCHARGEMANAGEMENTSpirometryBloodgasFullknowledgeoftreatment–correctinhalertechniqueSelfmanagementplanreantibioticsandsteroidsathomeFUappt-withRespiratoryNursesifO2indicatedRefertoPulmonaryrehabChecksmokingstatusPREDISCHARGEMANAGEMENT
ENDofLIFE?PalliativecareregisterAdvanceddirectives/PPC/AssessmentofconcernsHospice/dayhospitalENDo【COPD英文教學講解課件】COPD-(42p)
COMPLICATIONSOFCOPD.
RESPIRATORYFAILURECORPULMONALE
POLYCYTHAEMIAPULMONARYEMBOLIDEPRESSION/ANXIETYCOMPLICATIONSOFCOPD.R
RESPIRATORYFAILURETYPE1RespiratoryFailurePaO2below8Kpa(60.80mmHg)withnormal/lowPaCO2TYPE2RespiratoryFailure:PaO2,below8kpa(60.8mmHg)andincreasedPaCO2above6.5kPa(49.4mmHg)RESPIRATORYFAILURE
AIMSOFTHERAPYPreventfurtherdiseaseprogressionRelievesymptomsImproveexercisecapacityMaintainbestqualityoflifePreventexacerbationsAIMSOFTHERAPYPreven
MEDICATIONS
BronchodilatorsshouldbetheinitialtreatmentAssesseffectivenessbyimprovementinsymptomsADLexercisecapacityrapidityofreliefofsymptomsNote-FEV1willnotreflectanysignificantimprovementMEDICATIONS
Bro
MEDICATIONSIfsymptomspersistaddLongactinganticholinergic.Long-actingB2agonistMEDICATIONSIfsympt
MEDICATIONSInhaledsteroids-forallCOPDpts?MethylxanthinesAntidepressantsMucolyticsMEDICATIONSInTREATMENTFACTORSAFFECTINGCONCORDANCEOFINHALEDMEDICATIONSDrugregime -Toocomplex -Frequencyofdosing -Unsuitableinhalerierheumatic,elderlyLackofnoticeableimmediatebenefiteginhaledsteroidsandlongactingbronchodilatorsMultipleprescriptioncharges
TREATMENTFACTORSAFFECTINGC
NONTREATMENTFACTORSLackofunderstandingoftreatmentinclackofclearinstructionsFearofsideeffectsDislike/distrustofhealthserviceReluctancetoacceptdiagnosisPreferenceforalternativetherapiesLackofsocialsupport/familycircumstancesLanguage,readingoreyesightdifficultiesNONTREA【COPD英文教學講解課件】COPD-(42p)LONGTERMOXYGENTHERAPYLTOTisconsideredinpatientswith
PaO2of7.3kPawhenstableorPaO2of7.3–8kPawithoneofthefollowing:secondarypolycytheamianocturnalhypoxaemia,peripheraloedemaorpulmonaryhypertensionSevereairflowobstruction–FEV1<30%LONGTERMOXYGENTHERAPerformedinsecondarycareInitial-6weekspostexacerbation,clinicallystableSecondassessment–3-4weekslaterwithtrialofoxygenLTOTshouldbeusedforatleast15hrs/dayviaaconcentratorinstalledbycompanyASSESSMENTPerformedinsecondarycare
SHORTBURSTOXYGENNoevidencetosupportitsuseinCOPD.Usedmoreforsymptomreliefinfibrosis/palliativecareforshortburstsonlybycylinderCanbeprescribedbyGPSHORTBURST
AMBULATORYOXYGENEvidenceofdesaturationonexercise6minwalktestmonitoredbysaturations.Lightweightcylinders+/-conserverdeviceAMBULATORYOXYCHRONIC
OBSTRUCTIVE
PULMONARY
DISEASE
EndCHRONIC
OBSTRUCTIVE
PULMONARY
RESPIRATORYNURSESALISONCALVERTRLI/WGHEXT3608/5611MOBILE07917240710SARAHJEWELLFGHPAGERVIASWITCHEXT1502HELENBOOTHRLIBLEEP767EXT3608RESPIRATORYNURSESCHRONIC
OBSTRUCTIVE
PULMONARY
DISEASECHRONIC
OBSTRUCTIVE
PULMONARY
AIMSOFTHISSESSIONToUnderstandthedefinition DiscusscausesDiscussdiagnosis DiscussManagement/MedicationDiscussOxygenTherapyandenjoy!AIMSOFTHISSESSION【COPD英文教學講解課件】COPD-(42p)【COPD英文教學講解課件】COPD-(42p)
DEFINITION
COPDischaracterisedbyairflowobstruction.
airflowobstructionisusuallyprogressiveItisnotfullyreversibledoesnotchangemarkedlyoverseveralmonths.Thediseaseispre-dominantlycausedbysmoking.
COPD
isanumbrellatermfor
EmphysemaChronicBronchitisSevereChronicAsthmaNICE(2010)COPDisanumbrellatermfor
CHRONICBRONCHITISContinuousinflammationofthecellsliningthebronchiMucoushypersecretionDestructionofthecilia,impairingmucousclearanceleadingtoincreasedriskofinfectionDiagnosedbytheproductionofsputumandcoughonmostdaysforthreemonthsintwoconsecutiveyearsCHRONICBRONCHITIS
EMPHYSEMA
DestructiveofthealveoliandterminalbronchiolesLossofelasticityofsmallerairwaysLossofpatencyofbronchiolesEMPHYSEMADest
CAUSESOFCOPDSMOKING:
90%ofcases,arecausedbysmoking15%aresusceptible.Lungfunctiondeclineis3timesfasterIfsmokingstops,atoneyearFEV1declineisagerelated(Morgan&Britton2003)ALPHA1ANTITRIPSINDEFICIENCY:GENETICFoundinonly1%ofcases.OCCUPATIONALEXPOSURETORESPIRATORYPOLLUTANTS:Chemicals,dust,atmosphericpollutants,inheritedtendencyCAUSESOFCNearly30,000deathsayear-accountingfor5%ofalldeaths,onedeathevery20mins850,000diagnosed–only33%Probably2millionundiagnosed“MissingMillions”(BLF2009)COPDisthefourthmostcommoncauseofdeathafterheartdisease,lungdiseaseandcerebrovasculardiseaseNearly30,000deathsayear-acCOPDistheonlyleadingcauseofdeaththatisincreasinginprevalencewithatotalcost￡850million/yr-24millionworkingdayslost-
CigarettesmokingisthemajorcauseofCOPD90%MortalityfromCOPDisincreasinginwomenwhilereachingaplateauinmenUnlesscurrenttrendsarereversed,COPDmaybecomethebiggestpublichealthproblem.DeathrateoneofworstinEuropeCOPDistheonlyleadingcause【COPD英文教學講解課件】COPD-(42p)
DIAGNOSISOver35SmokerorexsmokernoclinicalfeaturesofasthmaHaveanyofthesesymptoms?exertionalbreathlessnesschroniccoughregularsputumproductionfrequentwinter“bronchitis”Wheeze(NICE2010)DIACOPDORASTHMA?COPDAsthmaSmoker/exsmokerNearlyallPossiblySymptomsunderageof35RareCommonChronicproductivecoughProgressiveandpersistentVariableBreathlessnessProgressiveandpersistentVariableNighttimewakingwithbreathlessnessand/orwheezeUncommonCommonSignificantdiurnalordaytodayvariationUncommonCommonCOPD
SPIROMETRYSpirometrymeasuresthevolumeofairexpiredfromthelungsduringasinglemaximalforcedexpiration.Thekeymeasurementsare:-ForcedVitalcapacity(FVC)ForcedExpiratoryVolumeinonesecond(FEV1)FVC/FEV1RatioSPIR
CLASSIFICATIONOFCOPDMILD FEV1>80%MODERATE FEV150-80%SEVERE FEV130-50%VERYSEVEREFEV1,30%NICEGUIDELINE(2010))CLASSIFICATIONCOPDproducessymptoms,disabilityimpairedqualityoflife-mayrespondtopharmacologicaltherapiesAirflowobstructionwillnotrespondtothesetherapiessobewareofarelianceonSpirometry.COPDproduces
SYMPTOMSASSOCIATEDWITHANEXACERBATION
DYSPNOEAMorebreathlessthannormalReducedexercisetoleranceSPUTUMPRODUCTIONIncreaseinpurulenceSPUTUMVOLUMEIncreaseinnormalamountCOUGH
SYMPTOMSASSOCIINVESTIGATIONSChestXrayArterialbloodgas–canaidmedicaldiagnosisECGFBC,UreaandElectrolytesTheophyllinelevelsifappropriateSputummicroscopy/cultureifpurulentINVESTIGATIONS
OBSERVATIONS/MONITORINGRESPIRATORYrate/rhythm/workload/equalO2Sats–90-92%Colourskin,lips,nails(clubbing)Patientabletospeakinsentences/wordsornotatallTemp/Pulse/BPConfusionurineoutputPeripheraloedemaDepression/lethargyAssessneedforNIV/IVNotneeded-PEFROBSERVATIONS/MONITORINTREATMENTRegularbronchodilatortherapy(considerIVaminophyllineifpoorresponsetonebs)Continue/startOralantibioticsContinue/startoralPrednisolone(continueinhaledsteroidsalsoastakes7–10daystokickin)Oxygentherapyas
prescribed
(dependantonbloodgasresultandSatsO2)NoninvasiveVentilationTREATMENT【COPD英文教學講解課件】COPD-(42p)
NURSINGMANAGEMENTLiasewithmultidisciplinaryteammemberstoprovidespecialisedcare.Diseaseprocess/progressionInhalers/medicationSmokingcessationNutritionNURSINGMANAGEMENTPulmonaryrehab/CommunityMatron/Breathlessnessclinic/SupportgroupVaccinationsPhysiotherapist-Breathingexercises,expectoration,copingmechanisms,energyconservationBenefitsFurtherexacerbations-ExacerbationselfmanagementplanandstandbyantibioticsandsteroidsPulmonaryrehab/CommunityMatPREDISCHARGEMANAGEMENTSpirometryBloodgasFullknowledgeoftreatment–correctinhalertechniqueSelfmanagementplanreantibioticsandsteroidsathomeFUappt-withRespiratoryNursesifO2indicatedRefertoPulmonaryrehabChecksmokingstatusPREDISCHARGEMANAGEMENT
ENDofLIFE?PalliativecareregisterAdvanceddirectives/PPC/AssessmentofconcernsHospice/dayhospitalENDo【COPD英文教學講解課件】COPD-(42p)
COMPLICATIONSOFCOPD.
RESPIRATORYFAILURECORPULMONALE
POLYCYTHAEMIAPULMONARYEMBOLIDEPRESSION/ANXIETYCOMPLICATIONSOFCOPD.R
RESPIRATORYFAILURETYPE1RespiratoryFailurePaO2below8Kpa(60.80mmHg)withnormal/lowPaCO2TYPE2RespiratoryFailure:PaO2,below8kpa(60.8mmHg)andincreasedPaCO2above6.5kPa(49.4mmHg)RESPIRATORYFAILURE
AIMSOFTHERAPYPreventfurtherdiseaseprogressionRelievesymptomsImproveexercisecapacityMaintainbestqualityoflifePreventexacerbationsAIMSOFTHERAPYPreven
MEDICATIONS
BronchodilatorsshouldbetheinitialtreatmentAssesseffectivenessbyimprovementinsymptomsADLexercisecapacityrapidityofreliefofsymptomsNote-FEV1willnotreflectanysignificantimprovementMEDICATIONS
Bro
MEDICATIONSIfsymptomspersistaddLongactinganticholinergic.Long-actingB2agonistMEDICATIONSIfsympt
MEDICATIONSInhaledsteroids-forallCOPDpts?MethylxanthinesAntidepressantsMucolyticsMEDICATIONSInTREATMENTFACTORSAFFECTINGCONCORDANCEOFINHALEDMEDICATIONSDrugregime -Toocomplex -Frequencyofdosing -Unsuitableinhalerierheumatic,elderlyLacko
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