ฟื้นฟูเวชปฏิบัติมาตรฐานการดูแลผู้ป่วยกลุ่มโรคทางเดินหายใจ

Chronic obstructive pulmonary

disease

Key points

• COPD ,a common preventable and treatable diseases,is characterized by persistent air flow limitation

• most common risk factor : tobacco smoking

• clinical diagnosis : dyspnea, chronic cough , sputum productive cough

• COPD ,a common preventable and treatable diseases,is characterized by persistent air flow limitation

• progressive and associated with and enhanced chronic inflammatory response in airway and the lung to noxious partial or gases.

• clinical diagnosis : dyspnea, chronic cough , sputum productive cough

• Spirometer : present of post bronchodilator FEV1:FVC < 0.7

What is COPD

• tobacco smoke as well as tobacco environment smoke

• outdoor air pollution

• occupation dust and chemical

• out door air pollution

• Genetic risk factor ??

Course of COPD

severe hereditary deficiency of alpha-1 antitripsin

• Age > 40

• Dyspnea : progressive

• Chronic cough

• Chronic sputum productive cough

• Expose risk factor

• Family history of COPD

Diagnosis of COPD

Spirometry • present of post bronchodilator

FEV1:FVC < 0.7

Differential diagnosis of COPD

Asthma

- Early onset in life - symptom very widely

from day to day - symptom worse at night/early

morning - allergic rhinitis and/or eczema

present - family history of Asthma

• Asses symptom

• Asses airflow limitation using spirometry

• Asses risk of exacerbation

• Asses comorbidity

Assessment of COPD

Assessment of COPD

Treatment of COPD

Non pharmacologic treatment of COPD

• Rehabilitation

• Oxygen therapy

• Ventilator support

• Surgical treatment

• Palliative care , end of life care, hospital care

• vaccine

• Alpha-1 antitripsin augmentation therapy

• Antibiotic

Other treatments of COPD

Formulation and typical dose of COPD medication

Formulation and typical dose of COPD medication

Pharmacologic therapy for stable COPD

• An exacerbation of COPD : an acute event characterized by worsening of the patient’s respiratory system that is beyond normal day-to-day variation and lead to change in medication.

• A most common course : respiratory tract infection( viral or bacterial )

Management of exacerbation

• Arterial blood gas

• CXR

• EKG

• CBC

• Biochem lab

Assess severity

• Supplement Oxygen

• Bronchodilator

• Systemic corticosteroid

• Antibiotic

• Adjective therapy

Treatment options

Asthma

Question ?