COPD

Data gathering

• Red flags – SOB at rest, weight loss, haemoptysis, chest pain, ankle swelling, PND
• Others – frequency of chest infections,cough, wheeze, exercise tolerance
• Examine – BMI, sats, RR, respiratory examination, inhaler technique

Clinical management

• Investigations
  • Spirometry (FEV <80%, FEV1/FVC <70%)
    • severity based on FEV1
      • 80 – mild
      • 50-79 – moderate
      • 30-49 severe
      • <30 very severe
  • CXR
  • Bloods – FBC

• Explanation
  • airway narrowing that is not fully reversible, it is often caused by smoking and stopping is the single most effective treatment. Inhalers ease symptoms.

• Treatment
  • Lifestyle
    • smoking cessation, weight loss, exercise
  • Stepwise
    • Step 1
      • SABA e.g. salbutamol 100mcg 2 puffs PRN
    • Step 2
      • 2 or more exacerbations per year
        • Add LABA + ICS e.g. Symbicort 400 1 puff BD
      • < 2 exacerbations per year
        • Add Tiotropium 18mcg OD
    • Step 3
      • Triple therapy e.g. LABA+ICS+LAMA e.g. Symbicort 400 1 puff BD + Tiotropium 18mcg OD
    • Step 4
      • Add theophyllie e.g. Uniphyllin Continus 200mg BD (increase to 400mg BD if initial lack of response and no SE)
  • Mucolytics
    • if chronic productive cough
    • carbocisteine 375mg two tablets TDS (reduce to BD when improvement)
      • stop after 4 weeks if no benefit
  • Long term oxygen
    • Consider if sats < 92%
  • Vaccinations
    • annual flu, one off pneumococcal

• Follow Up
  • once/year (twice if severe)
    • smoking cessation
    • inhaler technique
    • treatment concordance
    • osteoporosis risk assessment if frequent prednisolone
    • FEV1, FVC
  • Refer
    • rapid decline in FEV1
    • consideration of LTOT – consider if saturations < 92%
    • severe COPD

• Exacerbations
  • presentation: increased breathlessness, increased sputum volume, purulent sputum
  • increase inhaler frequency
  • amoxicillin or doxycycline or clarithromycin for 7-14 days
  • prednisolone 30mg OD for 7-14 days