COPD 2003

Definition Chronic slowly progressive disorder characterised by airway obstruction which does not change much over months.The airway obstruction is largely fixed but partially reversible by bronchodilator therapy

Statistics 1% of UK population Increases with age and urban living Among >65 yr olds Rural areas 10% Urban areas 26% 80% with severe copd are housebound

statistics 115 consultations/GP/year 1 in 8 medical admissions Kills 26,000 people/year

Symptoms Chronic cough Wheeze Breathlessness on exertion Sputum production Progressive symptoms History of smoking for more than 20 pack years

Diagnosis Suggested by history Spirometry – fev1/fvc < 70% Severity – fev1/fev1 exp Cxr excludes other diseases

Differential diagnosis Asthma Lung cancer Chronic heart failure Tuberculosis Bronchiectasis Fibrosing lung disease

Staging Mild fev1 60-80% of predicted Moderate fev1 40-60% of predicted Severe fev1 < 40% predicted

Lifestyle advice Stop smoking Encourage exercise Lung function decline 30mls/yr Lung function decline smokers 60mls/yr Encourage exercise Prevents muscle deconditioning Vaccination – flu, pneumococcal Weight loss

Management Mild - moderate Short acting inhaled beta 2 agoinst Inhaled anticholinergics

Management Severe Steroid trial 30mg prednisolone/day for 2 weeks with spirometry before and after. Positive rsponseis an increase in 200mls of fvc or 15% increase in fev1. An increase > 500mls indicates asthma