英文精品课件chronicobstructive pulmonary

Chronic Obstructive Pulmonary Disease Core Clinical Topics MDFMR 12/08 Why do we care? Fourth leading cause of death in the US Half of cases undiagnosed Objectives Diagnose COPD accurately Manage chronic COPD symptoms in an evidenced-based manner Review interpretation of PFTs / spirometry Be empowered to help your patients quit smoking! More objectives Instruct patients in proper MDI use Learn indications & benefits of pulm rehab Practice OMT for chronic lung disease Review management dilemmas in COPD Reflect on your own management of COPD patients Practice board review questions COPD Case Find a partner and review the case of Sharon Blackbreath Write down your answers. Turning them in counts for your attendance today. Case - Key History Points Age less than 40 years Daily sxs cough and sputum Significant smoking history Significant second hand smoke Occupational exposure? Old furnace? PMH - bronchitis Case - Questions to ask Does she use a spacer Does the Combivent help sxs Ever tried to quit smoking before? Ever past PFTs or peak flows? Family history of lung disease? TB exposure? Case Differential Dx COPD how severe? Interstitial lung disease Previously undiagnosed asthma? Carbon monoxide poisoning Tuberculosis Upper airway obstruction Cardiac disease Case Diagnostic testing Diagnosis of COPD is made by PFTs No role for screening asymptomatic pts No evidence to support CXR or CT Consider alpha-1 antitrypsin if age 80% predicted Moderate FEV1 50-80% predicted Severe FEV1 30-50% predicted Very severe FEV1 30% predicted COPD Symptom Management Mild Short-acting bronchodilator Moderate Long-acting bronchodilator Severe Steroid inhaler, Theophylline Home O2, Pulm rehab Everyone Quit smoking, Flu & PNVX Case Next steps Interpret PFTs severe COPD Smoking cessation Smoking cessation Review MDI use with spacer Flu shot, consider PNVX Switch to Spiriva and cont Albuterol prn Consider adding inhaled steroid Remember Smoking cessation is the only intervention in COPD that slows the rate of decline of lung function. You have the power Time spent talking with patients improves their suc