1 / 24

Asthma and COPD

Asthma and COPD. Roger Deering + Phil Thirkell. Asthma - Definition. A chronic inflammatory disorder of the airways… S ymptoms usually associated with variable airflow obstruction and an increase in airway response to a variety of stimuli. Obstruction is often reversible . .

roman
Download Presentation

Asthma and COPD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Asthma and COPD Roger Deering+ Phil Thirkell

  2. Asthma - Definition A chronic inflammatory disorder of the airways… Symptoms usually associated with variable airflow obstruction and an increase in airway response to a variety of stimuli. Obstruction is often reversible.

  3. COPD - Definition • Irreversible aspect of • Emphysema • Chronic bronchitis • Asthma • Pulmonary component = airflow limitation (not fully reversible and usually progressive)

  4. Pathology – Asthma • Triggers • Allergens • Air pollution • Infection • Exercise • Smoking • Pets

  5. Pathology – COPD Result = Airflow limitation

  6. Causes of airflow limitation – in simpler terms

  7. Pathology – COPD

  8. Cells involved

  9. Let’s get clinical!

  10. Peak Flow– mainly asthma monitoring at GP and home • Stand up • Breathe out • Maximum breath in • Seal lips around cardboard tube • Blow out as hard and fast as possible • litres/minute • Best of 3 readings • Depends on technique – practice required • Peak flow diary

  11. Spirometry– diagnosis/differentiation of asthma/COPD and monitoring • Forced vital capacity - FVC • Forced expiratory volume in 1 second – FEV1 • GP surgery - nurses trained for spirometry • Predicted FEV1and FVC - Height, Weight, Age, Gender • <80% of predicted for FVC or FEV1is abnormal • FEV1/FVCratio differentiates asthma and COPD • <0.7 = obstructive lung disease • >0.7 = restrictive lung disease Contraindications: recent surgery, ENT disorders, recent pneumothorax, haemoptysis, communicable disease

  12. Reversibility/Bronchoprovocation Reversibility • Give salbutamol and retest FEV1. If increased after salbutamol it’s more likely to be asthma, not COPD • Bronchoprovocation • Checking for hypersensitivity in asthma • Nebulised histamine or methacholinecauses airway constriction, seen in asthma

  13. Obstructive vs. Restrictive • Obstructive • Narrowed airways, reduces the amount of air that can pass through at any time • Reduces FEV1 • e.g. COPD and Asthma • Restrictive • Lungs can’t expand as much, so FVC is reduced • e.g. Interstitial lung diseases, sarcoidosis, obesity

  14. obstructive restrictive

  15. Management of Asthma and COPD • Patient education • symptom recognition • allergen avoidance • exercise • diet • smoking cessation

  16. Asthma

  17. COPD • Stop smoking • β2-agonists • Anti-cholinergics • Steroids • Methylxanthines(theophylline) • Long term oxygen therapy (LTOT) • Infection prevention – flu jab • Rescue packs – steroids + antibiotics

  18. β2-agonists– salbutamol, salmeterol • Reliever inhalers • Relax smooth muscles in airways • Activates G-protein coupled receptors • Tolerance develops SE: tremor, headache, tachycardia

  19. Anti-Cholinergics – ipratropium, tiotropium (inhalers) • Blocks muscarinic receptors (M3) of the parasympathetic NS • Reduces contraction to open airways SE: dry mouth, constipation, urinary retention

  20. Methylxanthines (theophyllines/aminophylline) • ↑ PDE • Need close monitoring • SE: insomnia, nausea, vomiting • Leukotriene Antagonists (montelukast) • Block inflammatory phase • Tablet, used as a preventer • Steroids (beclometasone, prednisolone) • Preventers • Reduce inflammation • Loads of side effects • Inhaled • Oral

  21. Mast Cell Stabilisers (sodium cromoglycate) • Reduces histamine release from mast cells • Monoclonal antibodies (omalizumab) • Binds IgE to stop histamine release from mast cells • Expensive

  22. Asthma Attack Management O– high flow Oxygen S – salbutamol (nebulised) H – hydrocortisone (IV) I – ipratropium (IV) T – theophylline (IV) + intubation

More Related