英文ppt课件

COPD Shane OReilly COPD Service Clinical Lead What is COPD Chronic Obstructive Pulmonary Disease is an umbrella term used to describe different conditions that have similar symptoms and causes. The two main conditions under the umbrella are chronic bronchitis and emphysema. COPD Obstructive Main cause of breathlessness. 3 components to obstruction Inflammation Bronchoconstriction Phlegm Pathology Irritation of the airways causes inflammatory response. Smoking causes elastase to be released from the inflammatory mediators. Elastase starts to break down the elastic nature of the airways. It is the continual nature of the irritation that causes the long term inflammation and damage to the airways Pathology Chronic Bronchitis Affects the bronchioles. Irritation causes chronic inflammation. Reduction in size of lumen Increased airflow resistance Increased number of goblet cells Less compliant lungs Greater effort to breathe Pathology Emphysema Inflammation affecting the alveoli. Scar tissue formation following inflammatory process Destruction of alveolar walls. Reduction in surface area for gas exchange. Damaged membrane for gas transfer Scar tissue leads to restriction and reduced lung compliance Diagnosis History Age Smoking Cough Phlegm Short of Breath Spirometry COPD and Asthma COPD Asthma Smoker or ex- smoker Nearly All Possible Symptoms under age 45 Rare Often Chronic productive cough Common Uncommon Breathlessness Persistent and progressive Variable Night time waking with breathlessness and or wheeze Uncommon Common Significant diurnal or day to day variability of symptoms Uncommon Common Spirometry FEV1 Forced Expiratory Volume in one second FVC Forced Vital Capacity FEV1/FVC Ratio Below 70% for obstruction NICE 80% Mild 50 80% Moderate 30 - 50% Severe 30% Very Severe Clinical Features Shortness of breath Cough Phlegm Chest infections Reduction in exercise tolerance Weight gain or loss Cor pulmonale Treatment Smoking Cessation Pharmacology Oxygen Pulmonary Rehabilitation Self management advice and education NIV Stopping smoking at any age has beneficial effects on the lung function of patients with COPD. Srivastava P et al. BMJ 2006;332:1324-1326 2006 by British Medical Journal Publishing Group Inhaled Therapy Short acting Beta 2 agonist Short acting Anticholonergic Long acting Beta 2 agonist Long acting Anticholonergic Combination long acting Beta 2 agonist and corticosteroid Oral Therapy Theophyllines Corticosteroids Prophylactic Antibiotics Oxygen Severe patients may require long term oxygen Initial indication is if SpO2 is less than 92% CBG done oxygen ordered if PaO2 is less than 7.3 Kpa Short burst oxygen is given to some patients who are palliative or get symptomatic relief Oxygen Sensitive Patients Some patients are oxygen sensitive providing uncontrolled or high levels of oxygen and cause respiratory acidosis Patients should be on Venturi masks as much as possible to reduce the risk If patients are above the target saturations and are having more oxygen than normal then it is sensible to gradually reduce this down Pulmonary Rehabilitation Exercise programme Twice a week for eight weeks Improve strength and physical fitness Improved quality of life, exercise tolerance and ADLs Reduction in healthcare costs Education and Self Management Exacerbation recognition and management Inhaler technique Breathlessness management Chest clearance Energy conservation Anxiety Management Dietetic advice Non Invasive Ventilation Indicated for patients who have developed respiratory acidosis pH 7.35 Aim to blow off the carbon dioxide and therefore increase pH Normally as a result of respiratory muscle pump failure Severe COPD patients live on edge of respiratory capacity when well Some patients now home ventilated with positive effects Summary Predominantly smoking related disease Characterised by narrowing of the airways causing obstruction Stopping smoking is most important intervention Treatment can slow down progression and symptoms can improve Palliative Care Supportive care in the community for those identified as end stage COPD Facilitation of patients expressing their wishes Timely and appropriate intervention that has been discussed with the patient. Identify The first stage is identification Would it be a surprise if your patient was to die within the next year Prognostic indicators Last Days of Life First Days of Death Death 1 year1 year Advancing disease Bereavement 6 months 1 2 3 5 North West End of Life Care Model Increasing decline 4 GSF/ACP LCP Assess Assessment of potential future needs and having discussions with the patient about what these may be Social care Equipment and adaptations Ceiling of treatment Preferred pl