COPD (Chronic Obstructive Pulmonary Disease): Difference between revisions
Rachael Lowe (talk | contribs) No edit summary |
No edit summary |
||
| Line 18: | Line 18: | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
*A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with exertional breathlessness, chronic cough, regular sputum production, frequent winter ‘bronchitis’ or wheeze | |||
*The presence of airflow obstruction should be confirmed by performing post-bronchodilator spirometry. All health professionals involved in the care of people with COPD should have access to spirometry and be competent in the interpretation of the results | |||
== Outcome Measures == | == Outcome Measures == | ||
| Line 26: | Line 28: | ||
== Management / Interventions<br> == | == Management / Interventions<br> == | ||
Exercise prescription is a key component of pulmonary rehabilitation programmes, which are part of the non-pharmacological approach to managing COPD. There is a high level of evidence for the benefits of pulmonary rehabilitation for people with COPD<ref>Roisin RR, Rabe KF, Anzueto A, et al. Global strategy for the diagnosis management, and prevention of chronic obstructive | ====Stopping Smoking==== | ||
Encouraging patients with COPD to stop smoking is one of the most important components of their management. All COPD patients still smoking, regardless of age, should be encouraged to stop, and offered help to do so, at every opportunity | |||
====Exercise==== | |||
Exercise prescription is a key component of pulmonary rehabilitation programmes, which are part of the non-pharmacological approach to managing COPD. There is a high level of evidence for the benefits of pulmonary rehabilitation for people with COPD<ref>Roisin RR, Rabe KF, Anzueto A, et al. Global strategy for the diagnosis management, and prevention of chronic obstructive pulmonaryfckLRdisease. Bethesda, MD: Global Initiative for Chronic Obstructive Lung Disease, 2008; 1–91.</ref> Strength and endurance exercise are endorsed for people with COPD<ref>Skinner, Margot. Strength and endurance exercise endorsed for people with COPD. Physical Therapy Reviews, Volume 14, Number 6, December 2009 , pp. 418-418(1)</ref><br> | |||
Muscles that are required for arm exercise are also involved in movement of the chest wall during respiration and thus the need to breathe often compromises the individual’s ability to undertake daily activities, therefore exercise prescription involving arm exercise needs to be carefully prescribed<ref>Ennis S, Alison J, McKeough Z. The effects of arm endurance and strength training on arm exercise capacity in people with chronic obstructive pulmonary disease. Phys Ther Rev 2009;14(4):226–39.</ref><br> | |||
====Promote effective inhaled therapy==== | |||
In people with stable COPD who remain breathless or have exacerbations despite use of short-acting bronchodilators as required, offer the following as maintenance therapy: | |||
*if forced expiratory volume in 1 second (FEV1)≥50% predicted: either long-acting beta2 agonist (LABA) or long-acting muscarinic antagonist (LAMA) | |||
*if FEV1<50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA | |||
Offer LAMA in addition to LABA + ICS to people with COPD who remain breathless or have exacerbations despite taking LABA + ICS, irrespective of their FEV1 | |||
====Provide pulmonary rehabilitation==== | |||
Pulmonary rehabilitation should be made available to all appropriate people with COPD including those who have had a recent hospitalisation for an acute exacerbation | |||
====Use non-invasive ventilation==== | |||
Non-invasive ventilation (NIV) should be used as the treatment of choice for persistent hypercapnicventilatory failure during exacerbations not responding to medical therapy. It should be delivered by staff trained in its application, experienced in its use and aware of its limitations. When patients are started on NIV, there should be a clear plan covering what to do in the event of deterioration and ceilings of therapy should be agreed. | |||
====Manage exacerbations==== | |||
The frequency of exacerbations should be reduced by appropriate use of inhaled corticosteroids and bronchodilators, and vaccinations | |||
The impact of exacerbations should be minimised by: | |||
*giving self-management advice on responding promptly to the symptoms of an exacerbation | |||
*starting appropriate treatment with oral steroids and/or antibiotics | |||
*use of non-invasive ventilation when indicated | |||
*use of hospital-at-home or assisted-discharge schemes | |||
====Ensure multidisciplinary working==== | |||
COPD care should be delivered by a multidisciplinary team | |||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
Revision as of 13:58, 2 August 2010
Original Editor - Your name will be added here if you created the original content for this page.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Clinically Relevant Anatomy
[edit | edit source]
add text here relating to clinically relevant anatomy of the condition
Mechanism of Injury / Pathological Process
[edit | edit source]
add text here relating to the mechanism of injury and/or pathology of the condition
Clinical Presentation[edit | edit source]
add text here relating to the clinical presentation of the condition
Diagnostic Procedures[edit | edit source]
- A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with exertional breathlessness, chronic cough, regular sputum production, frequent winter ‘bronchitis’ or wheeze
- The presence of airflow obstruction should be confirmed by performing post-bronchodilator spirometry. All health professionals involved in the care of people with COPD should have access to spirometry and be competent in the interpretation of the results
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
[edit | edit source]
Stopping Smoking[edit | edit source]
Encouraging patients with COPD to stop smoking is one of the most important components of their management. All COPD patients still smoking, regardless of age, should be encouraged to stop, and offered help to do so, at every opportunity
Exercise[edit | edit source]
Exercise prescription is a key component of pulmonary rehabilitation programmes, which are part of the non-pharmacological approach to managing COPD. There is a high level of evidence for the benefits of pulmonary rehabilitation for people with COPD[1] Strength and endurance exercise are endorsed for people with COPD[2]
Muscles that are required for arm exercise are also involved in movement of the chest wall during respiration and thus the need to breathe often compromises the individual’s ability to undertake daily activities, therefore exercise prescription involving arm exercise needs to be carefully prescribed[3]
Promote effective inhaled therapy[edit | edit source]
In people with stable COPD who remain breathless or have exacerbations despite use of short-acting bronchodilators as required, offer the following as maintenance therapy:
- if forced expiratory volume in 1 second (FEV1)≥50% predicted: either long-acting beta2 agonist (LABA) or long-acting muscarinic antagonist (LAMA)
- if FEV1<50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA
Offer LAMA in addition to LABA + ICS to people with COPD who remain breathless or have exacerbations despite taking LABA + ICS, irrespective of their FEV1
Provide pulmonary rehabilitation[edit | edit source]
Pulmonary rehabilitation should be made available to all appropriate people with COPD including those who have had a recent hospitalisation for an acute exacerbation
Use non-invasive ventilation[edit | edit source]
Non-invasive ventilation (NIV) should be used as the treatment of choice for persistent hypercapnicventilatory failure during exacerbations not responding to medical therapy. It should be delivered by staff trained in its application, experienced in its use and aware of its limitations. When patients are started on NIV, there should be a clear plan covering what to do in the event of deterioration and ceilings of therapy should be agreed.
Manage exacerbations[edit | edit source]
The frequency of exacerbations should be reduced by appropriate use of inhaled corticosteroids and bronchodilators, and vaccinations
The impact of exacerbations should be minimised by:
- giving self-management advice on responding promptly to the symptoms of an exacerbation
- starting appropriate treatment with oral steroids and/or antibiotics
- use of non-invasive ventilation when indicated
- use of hospital-at-home or assisted-discharge schemes
Ensure multidisciplinary working[edit | edit source]
COPD care should be delivered by a multidisciplinary team
Differential Diagnosis
[edit | edit source]
add text here relating to the differential diagnosis of this condition
Key Evidence[edit | edit source]
add text here relating to key evidence with regards to any of the above headings
Resources
[edit | edit source]
add appropriate resources here
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Recent Related Research (from Pubmed)[edit | edit source]
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ Roisin RR, Rabe KF, Anzueto A, et al. Global strategy for the diagnosis management, and prevention of chronic obstructive pulmonaryfckLRdisease. Bethesda, MD: Global Initiative for Chronic Obstructive Lung Disease, 2008; 1–91.
- ↑ Skinner, Margot. Strength and endurance exercise endorsed for people with COPD. Physical Therapy Reviews, Volume 14, Number 6, December 2009 , pp. 418-418(1)
- ↑ Ennis S, Alison J, McKeough Z. The effects of arm endurance and strength training on arm exercise capacity in people with chronic obstructive pulmonary disease. Phys Ther Rev 2009;14(4):226–39.
