COPD Diagnosis & Management Anil Ramineni Specialist Respiratory Physiotherapist Community Respiratory Team

Topics covered About COPD Diagnosis History and Investigations Role of Spirometry High quality Management Strategies Services available Other information

Definition Chronic Obstructive Pulmonary Disease (COPD) is characterised by airflow obstruction airflow obstruction is usually progressive, and not fully reversible airflow limitation is usually associated with a chronic inflammatory response of the lungs to noxious particles or gases

Risk Factors smoking– in most cases COPD is caused by cigarette smoking occupational exposure genetic risk of alpha1-antitrypsin deficiency, accounts for less than 1% of cases Recurrent chest infections

Diagnosis Making a diagnosis relies on clinical judgement based on a combination of history, physical examination and confirmation of the presence of airflow obstruction using spirometry (NICE COPD, 2010).

Conditions covered Chronic Bronchitis Emphysema Asthma with chronic airflow obstruction may cause irreversible damage

COPD – Venn Diagram (adapted from ARTP Spirometry standards) Chronic Bronchitis Asthma Emphysema COPD Airflow Obstruction

COPD Classification based on post bronchodilator Spirometry Stage 1) Mild 2) Moderate 3) Severe 4) Very Severe FEV1 % predicted >80% 50 to 79% 30 to 49% <30 % FEV1/FVC ratio <0.7

Prevalence In the UK, an estimated 3 million people are affected by COPD − approximately 2 million of these remain undiagnosed the prevalence of COPD in the population is estimated to be between 2% and 4% In NDCCG- 2.06% National Average 1.89% Readmission rates within 30 days- 18.6%

History Symptoms Age over 35 years Risk factors- Smoking, occupational Family history Quality of life

Differential diagnosis Asthma Bronchiectasis Lung cancer Heart problems

Investigations Early diagnosis is important All patients should have baseline investigations: Spirometry Blood tests to check Anaemia or Polycythaemia CXR and observations Any cardiac investigations if relevant QoL

Management Smoking cessation Pulmonary rehabilitation COPD exacerbation management Others: Home O2 and nutritional screening Mental health support Vaccination Breath easy support groups Exercise referral schemes

Pulmonary Rehab Referral criteria New Referral form Location and waiting times Transport can be provided Carers/family members welcome Initial assessment Post programme signposting Repeat Pulmonary rehab programmes

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Home Oxygen Screening If oxygen saturation ≤ 92% on 2 occasions (2-3 weeks apart), refer to oxygen assessment service for long term oxygen therapy (LTOT) assessment Good Practice: If FEV1 < 50% of predicted record oxygen saturation annually If FEV1 < 30% of predicted, record oxygen saturation every 6 months If Oxygen saturation 93-94% on Pulse Oximetry check every 3 months

Resources Derbyshire Medicines Management Community Respiratory Team, phone Self care diaries British Lung foundation

Community Respiratory Team Specialist Nurses and Physios Referral criteria: -Complex patients requiring case mngt -Requiring Physio input for breathlessness and airway clearance mngt -Nebuliser assessment -End stage COPD

References Derbyshire JAPC COPD Guidelines (2015) Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Barcelona: GOLD; Map of medicine. National Institute for Health and Clinical Excellence (NICE). Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. Clinical guideline 101. London: NICE; 2010.