COPD AND SMOKING CESSATION

METHODS

PRESENTED BY:

FASAHAT AHMED BUTT (36)

OBJECTIVES What is COPD Related diagnoses Risk factors Pathophysiology Clinical features Investigation Management Prescription Smoking cessation

methods

COPD Preventable and treatable lung

disease with some significant extrapulmonary effects that may contribute to severity in individual patient

Pulmonary component Airflow limitation

(not fully reversible)

Limitation is progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.

RELATED DIAGNOSES Chronic Bronchitis

Cough

Sputum

Emphysema

Enlargement of airspaces distal

to terminal bronchioles with destruction

of their walls (no fibrosis)

RISK FACTORS

Exposures

Tobacco smoke Occupation Lung growth Infections Low SES Nutrition (unclear) Cannabis smoking

Host factors

Genetic factors Airway hyper-reactivity

PATHOPHYSIOLOGY Airway inflammation

Loss of elastic recoil- Airway collapse

CLINICAL FEATURES Cough Sputum production Haemoptysis Breathlessness Pink puffers Blue bloaters Cor pulmonale

BREATHLESSNESSModified MRC dyspnoea scale

Grade Degree of breathlessness related to activities

0 No breathlessness except with strenuous exercise

1 Breathlessness when hurrying on the level or walking up a slight hill

2 Walks slower than contemporaries on level ground because of breathlessness or has to stop for breath when walking at own pace

3 Stops for breath after walking about 100 m or after a few minutes on level ground

4 Too breathless to leave the house, or breathless when dressing or undressing

SIGNS OF COPDPathological conditions

COPD

Shape and deformity of chest

Barrel shaped chest

Movement of chest wall

Diminished all over

Mediastinal displacement

None

Percussion note Normal or hyper-resonant

Breath sounds Diminished vesicular with prolonged expiration

Vocal resonance Normal or reduced

Added sounds Ronchi (may be both inspiratory or expiratory)

INVESTIGATION Chest x-ray:

Cardiac failure

Lung cancer

Bullae

Complete Blood Count:

Alpha1 antiproteinase

Pulmonary Function Test:

Hallmark of COPD is airway obstruction.

(reduction in FEV1 and FEV1/FVC)

Spirometric classification of COPD severity based on post-bronchodilator FEV1

Stage Severity FEV1

1 Mild FEV1/FVC < 0.70FEV1 ≥ 80% predicted

2 Moderate FEV1/FVC < 0.7050% ≤ FEV1< 80% predicted

3 Severe FEV1/FVC < 0.7030% ≤ FEV1 < 50% predicted

4 Very severe FEV1/FVC < 0.70FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic pulmonary failure

Health status questionnaires:

Arterial blood Gases: Demonstrate mild reduction

in blood oxygen levels,

and normal carbon dioxide

levels

Heart Function Tests: Echocardiogram shows the function of the heart, and ECG will demonstrate changes of right heart strain or heart failure (cor pulmonale)

MANAGEMENT

Smoking cessation Bronchodilators Corticosteroids Oxygen therapy Pulmonary rehabilitation Surgical intervention Palliative care

BRONCHODILATORS

ROUTE: Inhaled in preferred Oral bronchodilators

For the management of Breathlessness

Drugs Used: Short acting beta 2 agonist(mild

disease)

Salbutamol

Terbutaline Anticholinergic

Ipratropium

Long acting beta 2 agonist(moderate to severe)

Salmeterol

Formeterol Anticholinergic

Tiotropium bromide

CORTICOSTEROIDS

ICS: frequency and severity of exacerbation

Patient with sever disease (FEV1 <50%)

Oral corticosteroids: Exacerbations

Maintenance therapy

Impaired skeletal muscle function

and Osteoporosis

OXYGEN THERAPY Long term domiciliary oxygen therapy (LTOT):

Provided by oxygen concentrator

Minimum of 15 hours/day

AIM:

The paO2 to at least 8 kPa (60 mmHg) or SaO2 to at least 90%.

Ambulatory oxygen therapy:

In patients who desaturate on exercise & show objective improvement in exercise capacity &/or dyspnoea with oxygen.

SURGICAL INTERVENTION:

Bullectomy Lung Volume Reduction Surgery (LVRS) Lung Transplantation

PULMONARY REHABILITATION

Treatment program that incorporate education and cardiovascular conditions

PALLIATIVE CARE Addressing end-of-life needs is an important, yet

often ignored aspect of care in advanced disease. Morphine preparations: Breathlessness Benzodiazepines (low dose): Anxiety

Rx For Mild COPDName of the patient: (-) Date:

Gender: (-)

Age : (-)

Address : (-)

Rx:

Short acting bronchodilators

Salbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S

Follow up:

Name of physician:

Signature:

Rx For Moderate COPD

Name of the patient: (-) Date:

Gender: (-)

Age : (-)

Address : (-)

Rx:

Short acting bronchodilatorsSalbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S

Long acting bronchodilatorsSalmeterol ( 25mcg) 2-4 puffs twice daily

Long acting anticholinergicsTiotropium (9mcg) inhaler 2 puffs once dailyIpratropium Bromide (Atrovent) 2-3 puffs

Follow up:

Name of physician:

Signature

Rx For Severe COPDName of the patient: (-) Date:

Gender: (-)

Age : (-)

Address : (-)

Rx:

Short acting bronchodilators

Salbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S

Long acting bronchodilators

Salmeterol ( 25mcg) 2-4 puffs twice daily

Inhaled Corticosteroids

Prednisone 60 mg qd for 7 days

Prednisone tapered off over additional 2 weeks

Follow up:

Name of physician:

Signature

Rx For very Severe COPD

Name of the patient: (-) Date:

Gender: (-)

Age : (-)

Address : (-)

Rx:

Short acting bronchodilators

Salbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S

Long acting bronchodilators

Salmeterol ( 25mcg) 2-4 puffs twice daily

Inhaled Corticosteroids

Prednisone 60 mg qd for 7 days

Prednisone tapered off over additional 2 weeks

Follow up:

Name of physician:

Signature

SMOKING CESSATION METHODS

Smokers who are not motivated to try to stop smoking

- Record smoking status at regular intervals- Anti-smoking advice- Encourage change in attitude towards smoking to improve motivation

Motivated light smokers (<10/day)

- Anti-smoking advice- Anti-smoking support programme

Motivated heavy smokers (10-15/day)

- As above plus nicotine replacement therapy (NRT) (minimum 8 weeks)

Motivated heavy smokers (>15/day)

- As above plus bupropion if NRT and behavioural support are unsuccessful and patient remains motivated

HEALTH BENEFITS OF SMOKING CESSATION

PHARMACOLOGICAL TREATMENTo Nicotine Replacement Therapy (NRT)

o Gumo Patcho Inhalero Nasal Sprayo Lozenge

o Bupropion

o Combination Therapy

SUMMARY COPD : Disease state characterized by airflow limitation that

is not fully reversible

It includes: Emphysema and Chronic bronchitis

Risk factors: Exposure and Host factors

C/F: Cough, Haemoptysis, Sputum, Breathlessness, Pink puffers, Blue bloater.

Investigation: Radiograph, CBC, Pulmonary function test, Health status questionnaire, Arterial blood gases, Heart function test.

Management: Bronchodilators, corticosteroids, Pulmonary rehabilitation, Oxygen therapy, Surgical interventions, Palliative care.

Smoking cessation methods

REFERRENCES

DAVIDSON Bedside Techniques (Shabbir) GOOGLE WIKIPEDIA

THANK YOU