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Asthma and COPD

Asthma and COPD. Roger Deering + Phil Thirkell. Asthma - Definition. A chronic inflammatory disorder of the airways… S ymptoms usually associated with variable airflow obstruction and an increase in airway response to a variety of stimuli. Obstruction is often reversible . .

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Asthma and COPD

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  1. Asthma and COPD Roger Deering+ Phil Thirkell

  2. Asthma - Definition A chronic inflammatory disorder of the airways… Symptoms usually associated with variable airflow obstruction and an increase in airway response to a variety of stimuli. Obstruction is often reversible.

  3. COPD - Definition • Irreversible aspect of • Emphysema • Chronic bronchitis • Asthma • Pulmonary component = airflow limitation (not fully reversible and usually progressive)

  4. Pathology – Asthma • Triggers • Allergens • Air pollution • Infection • Exercise • Smoking • Pets

  5. Pathology – COPD Result = Airflow limitation

  6. Causes of airflow limitation – in simpler terms

  7. Pathology – COPD

  8. Cells involved

  9. Let’s get clinical!

  10. Peak Flow– mainly asthma monitoring at GP and home • Stand up • Breathe out • Maximum breath in • Seal lips around cardboard tube • Blow out as hard and fast as possible • litres/minute • Best of 3 readings • Depends on technique – practice required • Peak flow diary

  11. Spirometry– diagnosis/differentiation of asthma/COPD and monitoring • Forced vital capacity - FVC • Forced expiratory volume in 1 second – FEV1 • GP surgery - nurses trained for spirometry • Predicted FEV1and FVC - Height, Weight, Age, Gender • <80% of predicted for FVC or FEV1is abnormal • FEV1/FVCratio differentiates asthma and COPD • <0.7 = obstructive lung disease • >0.7 = restrictive lung disease Contraindications: recent surgery, ENT disorders, recent pneumothorax, haemoptysis, communicable disease

  12. Reversibility/Bronchoprovocation Reversibility • Give salbutamol and retest FEV1. If increased after salbutamol it’s more likely to be asthma, not COPD • Bronchoprovocation • Checking for hypersensitivity in asthma • Nebulised histamine or methacholinecauses airway constriction, seen in asthma

  13. Obstructive vs. Restrictive • Obstructive • Narrowed airways, reduces the amount of air that can pass through at any time • Reduces FEV1 • e.g. COPD and Asthma • Restrictive • Lungs can’t expand as much, so FVC is reduced • e.g. Interstitial lung diseases, sarcoidosis, obesity

  14. obstructive restrictive

  15. Management of Asthma and COPD • Patient education • symptom recognition • allergen avoidance • exercise • diet • smoking cessation

  16. Asthma

  17. COPD • Stop smoking • β2-agonists • Anti-cholinergics • Steroids • Methylxanthines(theophylline) • Long term oxygen therapy (LTOT) • Infection prevention – flu jab • Rescue packs – steroids + antibiotics

  18. β2-agonists– salbutamol, salmeterol • Reliever inhalers • Relax smooth muscles in airways • Activates G-protein coupled receptors • Tolerance develops SE: tremor, headache, tachycardia

  19. Anti-Cholinergics – ipratropium, tiotropium (inhalers) • Blocks muscarinic receptors (M3) of the parasympathetic NS • Reduces contraction to open airways SE: dry mouth, constipation, urinary retention

  20. Methylxanthines (theophyllines/aminophylline) • ↑ PDE • Need close monitoring • SE: insomnia, nausea, vomiting • Leukotriene Antagonists (montelukast) • Block inflammatory phase • Tablet, used as a preventer • Steroids (beclometasone, prednisolone) • Preventers • Reduce inflammation • Loads of side effects • Inhaled • Oral

  21. Mast Cell Stabilisers (sodium cromoglycate) • Reduces histamine release from mast cells • Monoclonal antibodies (omalizumab) • Binds IgE to stop histamine release from mast cells • Expensive

  22. Asthma Attack Management O– high flow Oxygen S – salbutamol (nebulised) H – hydrocortisone (IV) I – ipratropium (IV) T – theophylline (IV) + intubation

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