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Medicine Notes Clinical Respiratory Notes

Chronic Obstructive Pulmonary Disease Notes

Updated Chronic Obstructive Pulmonary Disease Notes

Clinical Respiratory Notes

Clinical Respiratory

Approximately 29 pages

This series of notes is on clinical respiratory. It includes respiratory basics, physiology, common diseases, treatment and complications. These notes were made using a variety of textbooks, notes from tutorials with consultants and knowledge gained on the ward with doctors. These notes helped me a achieve a good grade of 77% in the end of year exams....

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The following is a more accessible plain text extract of the PDF sample above, taken from our Clinical Respiratory Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Chronic Obstructive Pulmonary Disease (COPD)

  • Epidemiology

    • 3 million in UK

    • 35+

    • 900,000 diagnosed, further 2 million undiagnosed

    • Insidious development symptoms

    • Most not diagnosed until 50s

  • Background

    • Predominately caused by smoking (other things inc. open fires, pollutants, asthma)

      • Not fully reversible

        • Asthma should be 400ml change (20%), but no change for COPD

      • Does not change markedly over several months

      • Usually progressive in long term

    • Exacerbations often occur where there is rapid and sustained worsening of symptoms beyond normal day-to-day variation requiring a change in treatment

  • Definition

    • Airflow obstruction= reduced FEV1/FVC ratio (<0.8)

      • FEV1 decreased; FVC reduced/normal

    • No longer necessary to have FEV<80% predicted

      • If not diagnosis only by resp. symptoms

  • Diagnosis

    • Consider if

      • >35, and

      • Smoker/Ex-smoker, and

      • Has symptoms

        • Exertional breathlessness

          • Flight stairs?/How far?

        • Chronic cough

        • Regular sputum production (yellow/green)

        • Frequent winter 'bronchitis'

        • Wheeze

      • No clinical features of asthma

      • Exacerbations= Symptoms >3 months for 2 years/3 exacerbations a year

    • Spirometry

      • Perform if COPD likely

      • Presence of airflow obstruction should be confirmed by performing post-bronchodilator spirometry

        • Do spirometry

        • 10 puffs salbutamol inhaler using spacer

        • Redo spirometry

        • Asthma= goes up by 400ml (COPD no change)

  • Differentiating COPD from asthma

CLINICAL FEATURES COPD ASTHMA
Smoker or ex-smoker Nearly all Possible
Symptoms <35 Rare Often
Chronic productive cough Common Uncommon
Breathlessness Persistent, progressive Variable
Night time waking SOB Uncommon Common
Significant day-day vary Uncommon Common

  • If diagnostically uncertain, these are for asthma

    • FEV1 and FEV1/FVC ratio return to normal with drugs

    • Large (>400ml) FEV1 response to bronchodilators/30mg pred for 2 weeks

    • Serial peak flow measurements showing significant day-day variability

    • Remaining diagnostic uncertainty cleared by further investigation

  • Severity of COPD

NICE CLINICAL GUIDE
POST BRONCHODILATOR FEV1/FVC FEV1 % PREDICTED POST-BRONCHODILATOR
<0.7 80% Stage 1 (mild)
<0.7 50-79% Stage 2 (moderate)
<0.7 30-49% Stage 3 (severe)
<0.7 <30% Stage 4 (very severe)

  • Managing stable COPD

    • Pathway

      • Patient with COPD

      • Assess symptoms/problems. Manage those present as below

      • Patient with COPD should have access to wide range of skills available from MDT

        • Smoking

          • Tablets

          • Patches

          • Gum

          • Support groups

        • Breathlessness and exercise limitation

        • Frequent exacerbations

        • Respiratory failure

          • T2= CO2 retention

        • Cor pulmonale

          • Hepatomegaly

          • Peripheral oedema

          • Raised JVP

        • Abnormal BMI (<18; >25)

        • Chronic productive cough

        • Anxiety & depression

    • Promote effective inhaled therapy

      • Stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators, offer

        • FEV1 >50% predicted: either LABA or LAMA

        • FEV1 <50% predicted: either LABA & ICS in combo inhaler, or LAMA

      • Offer LAMA in addition to LABA & ICS to people with COPD who remain breathless or have exacerbation despite taking LABA & ICS, irrespective of FEV1

    • Oxygen

      • Clinicians should be aware that inappropriate...

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