8/14/2019 Update COPD 2010
1/24
01/22/10 1
COPD
Chronic Obstructive P ulmonary Disease
Dr.Sathaporn Kunnathum
19 January 2010
8/14/2019 Update COPD 2010
2/24
The world will provide you with
stones every day; what you buildout of it is you outlook - A Bridge or a Wall.
Anonymous
01/22/10 2
8/14/2019 Update COPD 2010
3/24
01/22/10 3
COPD
airflow limitationsnot fully reversible
progressive
8/14/2019 Update COPD 2010
4/24
01/22/10 4
Pathologicconditions
chronic obstructive bronchitisemphysema, andmucus plugging
8/14/2019 Update COPD 2010
5/24
01/22/10 5
Risk factorCigarette smoking accounts for mostcases of COPD
Occupational dusts and chemicalAir pollutionFactor during gestation and childhood
8/14/2019 Update COPD 2010
6/24
01/22/10 6
Acuteexacerbate
Infections
Air pollutionTemperature
8/14/2019 Update COPD 2010
7/24
CXR finding
Chronicbronchitis
Emphysema
01/22/10 7
8/14/2019 Update COPD 2010
8/24
01/22/10 8
8/14/2019 Update COPD 2010
9/24
01/22/10 9
8/14/2019 Update COPD 2010
10/24
01/22/10 10
Advance in drugtherapy
Antismoking Measures New Bronchodilators
Antibiotics Oxygen Corticosteroids
8/14/2019 Update COPD 2010
11/24
01/22/10 11
ors are themainstay of current drugtherapy forCOPD.
8/14/2019 Update COPD 2010
12/24
01/22/10 12
Antibiotics
Acute exacerbations of COPD are commonlyassumed to be due to bacterial infection.Exacerbations may be due to viral infections of the upper respiratory tract or may benoninfective, so that antibiotic treatment is notalways warranted.
8/14/2019 Update COPD 2010
13/24
01/22/10 13
Oxygen
Long-term oxygen therapy:reduced mortality
improvement in quality of life in patientswith severe COPD and chronichypoxemia (partial pressure of arterialoxygen,
8/14/2019 Update COPD 2010
14/24
01/22/10 14
Oxygen does notincrease survival inpatients with lesssevere hypoxemia.
8/14/2019 Update COPD 2010
15/24
01/22/10 15
CorticosteroidsReduce the frequency of exacerbationImprove health status for symptomatic patients
8/14/2019 Update COPD 2010
16/24
01/22/10 16
Indication for
admitRR > 30PR > 110
PEFR < 100Still dyspnea after treatment
8/14/2019 Update COPD 2010
17/24
01/22/10 17
GOLD Workshop Report
Four Components of COPD Management -www.goldcopd.com
GOLD Workshop Report
Four Components of COPD Management -www.goldcopd.com
1. Assess and monitor disease
2. Reduce risk factors
3. Manage stable COPDq Educationq Pharmacologicq Non-pharmacologic
1. Manage exacerbations
1. Assess and monitor disease
2. Reduce risk factors
3. Manage stable COPDq Educationq Pharmacologicq Non-pharmacologic
1. Manage exacerbations
8/14/2019 Update COPD 2010
18/24
01/22/10 18
Management oCOPDStage 0: At Risk
anagement oCOPDStage 0: At Risk
Characteristics RecommendedTreatment
Risk factorsChronic symptoms
- cough- sputum
No spirometricabnormalities
Adjust risk factors Immunizations
8/14/2019 Update COPD 2010
19/24
01/22/10 19
Management oCOPDStage I: Mild COPD
anagement oCOPDStage I: Mild COPD
Characteristics RecommendedTreatment
FEV 1/FVC < 70 % FEV 1 > 80 % predicted With or without
symptoms
Short-actingbronchodilator asneeded
8/14/2019 Update COPD 2010
20/24
01/22/10 20
COPDStage II: ModerateCOPD
COPDStage II: ModerateCOPD
Characteristics RecommendedTreatment
FEV 1/FVC < 70%50% < FEV 1< 80%predicted
With or without symptoms
Treatment with one or more long-actingbronchodilatorsRehabilitation
8/14/2019 Update COPD 2010
21/24
01/22/10 21
COPDStage III: SevereCOPD
COPDStage III: SevereCOPD
Characteristics RecommendedTreatment
FEV 1/FVC < 70%30% < FEV 1 < 50%predicted
With or without symptoms
Treatment with one or more long-actingbronchodilatorsRehabilitationInhaled glucocortico-steroids if repeatedexacerbations(>3/year)
8/14/2019 Update COPD 2010
22/24
01/22/10 22
COPDStage IV: VerySevere COPD
COPDStage IV: VerySevere COPD
Characteristics RecommendedTreatment
FEV 1/FVC < 70%FEV 1 < 30% predictedor presence of
respiratory failure or right heart failure
Treatment with one or more long-acting bronchodilatorsInhaled glucocorticosteroids if repeated exacerbations (>3/year)Treatment of complicationsRehabilitationLong-term oxygen therapy if respiratory failureConsider surgical options
8/14/2019 Update COPD 2010
23/24
01/22/10 23
Goal of treatment
Relief of symptomsImproved exercise toleranceImproved health statusPrevention and treatment of complicationsPrevention and treatment of exacerbationsPrevention of disease progressionReduced mortality
8/14/2019 Update COPD 2010
24/24
01/22/10 24
COPD with AE
Please give the detail for management At Nachueak ER