management of copd, dr.edi hidayat.pptx
TRANSCRIPT
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8/10/2019 Management of COPD, dr.Edi Hidayat.pptx
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Oleh dr. Edi Hidayat
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Definition
COPD
a preventable and treatable condition, which is
characterised by chronic slowly progressive airway
obstruction.
It is a major cause of morbidity and the 4th leading cause
of death worldwide;
it is expected to be the 3rd leading cause of death by
2020.
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Studies in Europe estimate the prevalence of COPD to
be approximately 10%.
European studies in people aged >70 years showed a
prevalence of COPD of 20% in men and 15% in women.
COPDGOLD 2013
COPDNational Institute for Health and Care Excellence
(NICE).
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PATHOPHYSIOLOGY
Inhaled cigarette smoke and other noxious particlescause an inflammatory response which inducesparenchymal tissue destruction and narrowing of theperipheral airways leading to progressive airflowobstruction.
Exacerbations of COPD, defined as increased cough,dyspnoea or sputum production, are triggered by factorsincluding infection (bacterial and/or viral) andenvironmental pollutants
Pulmonary hypertension may develop late in the courseof COPD due to hypoxic constriction of small pulmonaryarteries; this may progress to right ventricularhypertrophy and cor pulmonale
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The prevalence of COPD is directly related to the
prevalence of cigarette smoking
Other risk factors for COPD include older age,
occupational exposure to noxious particles, passive
exposure to cigarette smoke, early childhood lung
infections and alpha-1 antitrypsin deficiency.
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DIAGNOSIS and ASSESSMENTA clinical diagnosis of COPD should be considered in any
patient > 35 years with risk factors for COPD, and
symptoms that include dyspnoea, chronic cough or
sputum production
The diagnosis of COPD is based on a combination of
history and physical examination with confirmation of the
diagnosis using spirometry.
The presence of a post-bronchodilator FEV1/FVC < 0.70confirms the presence of persistent airflow limitation of
COPD.
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In addition to spirometry, patients require a chest x-ray toexclude other conditions such as lung cancer and
tuberculosis.
ECG and echocardiography (to assess cardiac status ifthere are clinical features of cor pulmonale.
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MANAGEMENT The main goals in the management of COPD
1.reducing symptoms
2.reducing the rate of lung function decline
3.preventing exacerbations
4.reducing mortality.
multidisciplinary approach involving non-pharmacological
and pharmacological treatment is recommended.
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Non-pharmacological treatment Smoking cessation is the intervention which has the
greatest capacity to influence the natural history of COPD
and is the key intervention for people who continue to
smoke.
Patient education is an essential aspect of COPD
Long-term administration of oxygen therapy (LTOT) (> 15
hours per day) in patients with chronic respiratory failure
has been shown to increase survival in patients withsevere resting hypoxaemia.
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Pharmacological Management
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Management of exacerbations: Exacerbations of COPD can be precipitated by several
factors including respiratory tract infections (viral or
bacterial)
Bronchodilators, corticosteroids and antibiotics
SABAs, with or without SAMAs are usually the preferred
bronchodilators for treatment of an exacerbation
A recent RCT supports the use of 5 days treatment with
oral corticosteroids for exacerbation of COPD, but mostguidelines recommend 30-40mg prednisolone for 7-14
days.
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The choice of antibiotic therapy to use in COPD shouldbe based on the local bacterial resistance pattern
Irish guidelines recommend first line primary care
treatment with amoxicillin or doxycycline or
clarithromycin; combinations of antibiotics are notrequired for COPD
Hospital management includes respiratory support with
oxygen therapy and ventilatory support
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THANKS