Station1_issues in COPD

The most important factor in reducing long-term progression of COPD is to STOP SMOKING.

Patients must stop smoking and they should have support with this and the offer of buproprion or NRT.

(NICE, evidence level B).

PULMONARY REHAB

if functionally disabled by COPD

(usually MRC grade 3 and above)

A programme includes

physical training,
disease education,
nutritional, psychological and behavioural intervention.

What Types Of Activities Are Included In Pulmonary Rehabilitation?

Breathing Retraining/Ventilatory Muscle Training:
Ventilatory muscle training (VMT) specifically targets the muscles used for breathing. The goal of VMT is to help reduce breathlessness and make ti easier to stay alive.

Exercise Training:
Participants may use several types of equipment, including a treadmill, stationary bicycle, arm bicycle, and stepping machines. Heart rate, blood pressure, and oxygen level will be monitored throughout the session.

Disease Education:
Education sessions give the participant and their family members or friends a comprehensive look at pulmonary disease management. Topics include proper nutrition, medications, stress management, handling emergencies how to simplify work tasks, and an introduction of the home-exercise program.

LTOT

a PaO2 less than 7.3 kPa when stable

a PaO2 greater than 7.3 and less than 8 kPa when stable and one of:
secondary polycythaemia,
nocturnal hypoxaemia,
peripheral oedema or pulmonary hypertension.

To get the benefits of LTOT,

supplemental oxygen for at least 15 hours per day.

The need for oxygen therapy should be assessed in patient with:

• severe airflow obstruction (FEV1 less than 30% predicted)
• cyanosis
• polycythaemia
• peripheral oedema
• raised jugular venous pressure
• oxygen saturations less than or equal to 92% breathing air.

Also consider in moderate airflow obstruction (FEV1 30–49% predicted)

NIV Non-invasive ventilation

Adequately treated patients with chronic hypercapnic

ventilatory failure who have required assisted ventilation

during an exacerbation

who are hypercapnic or acidotic on LTOT should be

referred to a specialist centre for consideration of longterm NIV.

SURGERY

Patients who are breathless, and have a single large bulla

on a CT scan and an FEV1 less than 50% predicted

consider BULLECTOMY.

LVRS or LUNG TRANSPLANT

To Those with severe COPD,

marked restrictions of their activities of daily living despite

maximal medical therapy

lung volume reduction surgery

if they meet all of the following criteria:

• FEV1 more than 20% predicted
• PaCO2 less than 7.3 kPa
• upper lobe predominant emphysema
• TLCO more than 20% predicted.

assessment for lung transplantation

Considerations include:

• age
• FEV1
• PaCO2
• homogeneously distributed emphysema on CT scan
• elevated pulmonary artery pressures with progressive deterioration.
Comobidities
Local protocol

Ref. NICE guideline,feb2004

updated guideline Jun 2010@http://guidance.nice.org.uk/CG101/QuickRefGuide/pdf/English

Cases for PACES