management of copd, dr.edi hidayat.pptx

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

management of copd, dr.edi hidayat.pptx

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