1. COPD
2003

2. 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

3. 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

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

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

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

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

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

9. 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

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

11. 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