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

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

3. 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

4. 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

5. 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).

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

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

8. 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

9. 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%

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

11. Differential diagnosis Asthma Bronchiectasis Lung cancer Heart problems

12. 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

13. 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

14. 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

15. Stenton C Occup Med (Lond) 2008;58:226-227 © The Author 2008. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

16. 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

17. Resources Derbyshire Medicines Management Community Respiratory Team, phone 01246 253067 Self care diaries British Lung foundation

18. 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

19. References Derbyshire JAPC COPD Guidelines (2015) www.derbyshiremedicinesmanagement.nhs.uk Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Barcelona: GOLD; 2013. Map of medicine. http://mapofmedicine.comhttp://mapofmedicine.com 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.