{"id":304,"date":"2017-03-26T12:37:57","date_gmt":"2017-03-26T12:37:07","guid":{"rendered":"http:\/\/papergp.com\/index.php\/respiratory\/copd\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"copd","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/respiratory\/copd\/","title":{"rendered":"COPD"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4><strong>Data gathering<\/strong><\/h4>\n<ul>\n<li>Red flags &#8211; SOB at rest, weight loss, haemoptysis, chest pain, ankle swelling, PND<\/li>\n<li>Others &#8211; frequency of chest infections,cough, wheeze, exercise tolerance<\/li>\n<li>Examine &#8211; BMI, sats, RR, respiratory examination, inhaler technique<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4><strong>Clinical management<\/strong><\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li>Spirometry (FEV &lt;80%, FEV1\/FVC &lt;70%)\n<ul>\n<li>severity based on FEV1\n<ul>\n<li>80 &#8211; mild<\/li>\n<li>50-79 &#8211; moderate<\/li>\n<li>30-49 severe<\/li>\n<li>&lt;30 very severe<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>CXR<\/li>\n<li>Bloods &#8211; FBC<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Explanation\n<ul>\n<li>airway narrowing that is not fully reversible, it is often caused by smoking and stopping is the single most effective treatment. Inhalers ease symptoms.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Treatment\n<ul>\n<li>Lifestyle\n<ul>\n<li>smoking cessation, weight loss, exercise<\/li>\n<\/ul>\n<\/li>\n<li>Stepwise\n<ul>\n<li>Step 1\n<ul>\n<li>SABA e.g. salbutamol 100mcg 2 puffs PRN<\/li>\n<\/ul>\n<\/li>\n<li>Step 2\n<ul>\n<li>2 or more exacerbations per year\n<ul>\n<li>Add LABA + ICS e.g. Symbicort 400 1 puff BD<\/li>\n<\/ul>\n<\/li>\n<li>&lt; 2 exacerbations per year\n<ul>\n<li>Add Tiotropium 18mcg OD<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Step 3\n<ul>\n<li>Triple therapy e.g. LABA+ICS+LAMA e.g. Symbicort 400 1 puff BD + Tiotropium 18mcg OD<\/li>\n<\/ul>\n<\/li>\n<li>Step 4\n<ul>\n<li>Add theophyllie e.g. Uniphyllin Continus 200mg BD (increase to 400mg BD if initial lack of response and no SE)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Mucolytics\n<ul>\n<li>if chronic productive cough<\/li>\n<li>carbocisteine 375mg two tablets TDS (reduce to BD when improvement)\n<ul>\n<li>stop after 4 weeks if no benefit<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Long term oxygen\n<ul>\n<li>Consider if sats &lt; 92%<\/li>\n<\/ul>\n<\/li>\n<li>Vaccinations\n<ul>\n<li>annual flu, one off pneumococcal<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Follow Up\n<ul>\n<li>once\/year (twice if severe)\n<ul>\n<li>smoking cessation<\/li>\n<li>inhaler technique<\/li>\n<li>treatment concordance<\/li>\n<li>osteoporosis risk assessment if frequent prednisolone<\/li>\n<li>FEV1, FVC<\/li>\n<\/ul>\n<\/li>\n<li>Refer\n<ul>\n<li>rapid decline in FEV1<\/li>\n<li>consideration of LTOT &#8211; consider if saturations &lt; 92%<\/li>\n<li>severe COPD<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<ul>\n<li>Exacerbations\n<ul>\n<li>presentation: increased breathlessness, increased sputum volume, purulent sputum<\/li>\n<li>increase inhaler frequency<\/li>\n<li>amoxicillin or doxycycline or clarithromycin for 7-14 days<\/li>\n<li>prednisolone 30mg OD for 7-14 days<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Data gathering Red flags &#8211; SOB at rest, weight loss, haemoptysis, chest pain, ankle swelling, PND Others &#8211; frequency of chest infections,cough, wheeze, exercise tolerance Examine &#8211; BMI, sats, RR, respiratory examination, inhaler technique &nbsp; Clinical management Investigations Spirometry (FEV &lt;80%, FEV1\/FVC &lt;70%) severity based on FEV1 80 &#8211; mild 50-79 &#8211; moderate 30-49 severe &hellip; <a href=\"https:\/\/papergp.com\/index.php\/respiratory\/copd\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">COPD<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":300,"menu_order":59,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-304","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/304","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=304"}],"version-history":[{"count":7,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/304\/revisions"}],"predecessor-version":[{"id":2144,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/304\/revisions\/2144"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/300"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=304"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}