COPD Diagnosis & Management

Anil RamineniSpecialist Respiratory Physiotherapist

Community Respiratory Team

Topics covered

• About COPD • Diagnosis• History and Investigations• Role of Spirometry• High quality Management Strategies• Services available • Other information

Definition

• Chronic Obstructive Pulmonary Disease (COPD) is characterised by airflow obstruction

• airflow obstruction is usually progressive, and not fully reversible

• airflow limitation is usually associated with a chronic inflammatory response of the lungs to noxious particles or gases

Risk Factors

• smoking– in most cases COPD is caused by cigarette smoking

• occupational exposure

• genetic risk of alpha1-antitrypsin deficiency, accounts for less than 1% of cases

• Recurrent chest infections

Diagnosis

Making a diagnosis relies on clinical judgement based on a combination of history, physical examination and confirmation of the presence of airflow obstruction using spirometry (NICE COPD, 2010).

Conditions covered

• Chronic Bronchitis

• Emphysema

• Asthma with chronic airflow obstruction may cause irreversible damage

COPD – Venn Diagram(adapted from ARTP Spirometry standards)

Chronic Bronchitis

Asthma

Emphysema

COPD

AirflowObstruction

COPD Classification based on post bronchodilator Spirometry

Stage

1) Mild

2) Moderate

3) Severe

4) Very Severe

FEV1 % predicted

>80%

50 to 79%

30 to 49%

<30 %

FEV1/FVC ratio

<0.7

<0.7

<0.7

<0.7

Prevalence

• In the UK, an estimated 3

million people are affected by COPD − approximately 2 million of these remain undiagnosed

• the prevalence of COPD in the population is estimated to be between 2% and 4%

• In NDCCG- 2.06%

• National Average 1.89%

• Readmission rates within 30 days- 18.6%

History

• Symptoms

• Age over 35 years

• Risk factors- Smoking, occupational

• Family history

• Quality of life

Differential diagnosis

• Asthma

• Bronchiectasis

• Lung cancer

• Heart problems

Investigations

Early diagnosis is important

All patients should have baseline investigations:

•Spirometry

•Blood tests to check Anaemia or Polycythaemia

•CXR and observations

•Any cardiac investigations if relevant

•QoL

Management• Smoking cessation• Pulmonary rehabilitation• COPD exacerbation management• Others:

Home O2 and nutritional screening

Mental health support

Vaccination

Breath easy support groups

Exercise referral schemes

Pulmonary Rehab• Referral criteria

• New Referral form

• Location and waiting times

• Transport can be provided

• Carers/family members welcome

• Initial assessment

• Post programme signposting

• Repeat Pulmonary rehab programmes

Stenton C Occup Med (Lond) 2008;58:226-227

© The Author 2008. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Home Oxygen Screening

If oxygen saturation ≤ 92% on 2 occasions (2-3 weeks apart), refer to oxygen assessment service for long term oxygen therapy (LTOT) assessment

Good Practice:

If FEV1 < 50% of predicted record oxygen saturation annually

If FEV1 < 30% of predicted, record oxygen saturation every 6 months

If Oxygen saturation 93-94% on Pulse Oximetry check every 3 months

Resources

• Derbyshire Medicines Management

• Community Respiratory Team, phone 01246 253067

• Self care diaries

• British Lung foundation

Community Respiratory Team

Specialist Nurses and Physios

Referral criteria:

-Complex patients requiring case mngt

-Requiring Physio input for breathlessness and airway clearance mngt

-Nebuliser assessment

-End stage COPD

References

• Derbyshire JAPC COPD Guidelines (2015) www.derbyshiremedicinesmanagement.nhs.uk

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Barcelona: GOLD; 2013.

• Map of medicine. http://mapofmedicine.com• National Institute for Health and Clinical Excellence (NICE).

Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. Clinical guideline 101. London: NICE; 2010.