Respiratory COPD/Asthma.

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Pulmonary Function Testing

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Presentation transcript:

Respiratory COPD/Asthma

Spirometry Examples

Spirometry Examples Obstructive Restrictive

Spirometry FEV1-vol of air patient able to exhale in the first second of forced expiration FVC-total vol of air patient can forcibly exhale in one breath FEV1/FVC-ratio of FEV1 to FVC as % FEV1 and FVC expressed as % of predicted normal for a person of same age/sex/height

Spirometry-COPD Post bronchodilator FEV1/FVC <0.7 (base) FEV1% predicted <80% Severity of COPD indicated by extent of FEV1 reduction Asthma may show same abnormality as COPD-use reversibility testing to identify asthma

Spirometry Obstructive pattern; Restrictive pattern; FEV1<80% FVC reduced but less than FEV1 FEV1/FVC <0.7 Restrictive pattern; FEV1 <80% predicted FVC <80% predicted FEV1/FVC normal >0.7

Initial Diagnostic Evaluation Post bronchodilator spirometry (reversibility not usually necessary) CXR FBC for anaemia/polycythemia BMI

COPD

LABA? LAMA? SABA? SAMA? ?

COPD Stepwise Treatment http://www.nice.org.uk/nicemedia/live/13029/49399/49399.pdf

COPD Vs Asthma COPD >35 Risk factor (usually smoking) Exertional SOB Chronic cough Regular sputum Frequent winter bronchitis/wheeze No clinical features of asthma Asthma; >1 of wheeze; cough; SOB; chest tightness Triggers-exercise; viral; emotions; pets Atopic history Fh of atopy/asthma Widespread wheeze Improvement in symptoms with treatment

Asthma Spirometry with reversibility >400ml response to bronchodilator or after 2 week trial of pred 30mg daily Reversibility testing; Salbutamol/ipratropium/terbutaline Or one month trial bronchodilator response with spirometry

Adult Asthma Treatment

Children 5-12y Treatment

<5y Asthma Treatment

Spirometry Answers

William Gibson Moderate COPD Why?

Andrew Pell Severe COPD Why?

Eric Rowland Moderate COPD Why?

Nathan Nelder Asthma Why?

John Smith Moderate COPD Why?

Quiz Time! FEV1 and FEV1/FVC for diagnosis of COPD FEV1% of 30-49% is………COPD Restrictive pattern spirometry looks like….. FEV1 of …….to use inhaled steroids in COPD Example of generic name of starting inhaler for COPD symptoms Step 4 of asthma treatment in children <5y Inhaled steroid dose for children 5-12y in step 2 of asthma treatment What do you add in step 3 of adult asthma treatment?

Things to look at further… NICE guidelines COPD and asthma BTS guidelines Spirometry in practice Gpnotebook.co.uk