Introducing
Your new presentation assistant.
Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.
Trending searches
GOLD guidelines 2017 Classification
and Treatment updates
In summery the new refined ABCD assesment facilitates grouping and helps better tailor COPD therapy to suit patients needs
Mr Smith remains un group D due to his exacerbation history.
However his Treatment Recommendations change profoundly.
The New Assessment Separate Spirometry from ABCD
Both Patient would've been in group D in the prior Classification
Mrs brown is only grouped in group D due to her lung function
but with a high symptom load and no exacerbation...
Mrs Brown is regrouped into group B
Consequently her Treatment Recommendation change significantly
WISDOM TRIAL
Physical Examination
The sensitivity of physical examination in detecting mild to moderate COPD is relatively poor, but physical signs are quite specific and sensitive for severe disease. Findings in severe disease include the following:
Sponsored By Boehringer Ingelheim
Dr. Youssef Moussa
Family Medicine MD.
2018
Six-Minute Walking Distance
The distance walked in 6 minutes (6MWD) is a good predictor of all-cause and respiratory mortality in patients with moderate COPD. [2, 3] Patients with COPD who desaturate during the 6MWD have a higher mortality rate than do those who do not desaturate.
Consequently, this test is used as a part of the BODE index (body mass index, obstruction [FEV1], dyspnea [modified Medical Research Council dyspnea scale], and exercise capacity [6MWD]), [28] which was designed to help predict mortality in COPD patients.
Many patients with long-standing COPD develop secondary pulmonary hypertension from chronic hypoxemia and vascular remodeling.
Findings of severe pulmonary hypertension on echocardiogram or cardiac catheterization warrant further workup.
Two-Dimensional Echocardiography
High-resolution CT (HRCT) scanning is more sensitive than standard chest radiography and is highly specific for diagnosing emphysema (outlined bullae are not always visible on a radiograph).
Computed Tomography
Chest Radiography
As demonstrated in the images below, frontal and lateral chest radiographs of patients with emphysema reveal signs of hyperinflation, including flattening of the diaphragm, increased retrosternal air space, and a long, narrow heart shadow. Rapidly tapering vascular shadows accompanied by hyperlucency of the lungs are other signs of emphysema.
Chronic bronchitis is associated with increased bronchovascular markings and cardiomegaly.
With complicating pulmonary hypertension, the hilar vascular shadows are prominent, with possible right ventricular enlargement and opacity in the lower retrosternal air space.
BNP is secreted by the ventricles of the heart when there is increased stretch of the myocytes (ie, in CHF).
By measuring BNP, it was thought that the ability to differentiate between CHF and COPD exacerbations would become much easier. However, clinical observation and research have shown that in cases of mild CHF exacerbation, differentiation between CHF and COPD is still not straightforward.
New biomarkers such as pro-BNP peptide assays are in development and may prove helpful in differentiating COPD from CHF exacerbations in the future
B-Type Natriuretic Peptide
The pathogens cultured most frequently during exacerbations are Streptococcus pneumoniae and Haemophilus influenzae.
Moraxella catarrhalis is also a common organism, and Pseudomonas aeruginosa can be seen in patients with severe obstruction.
Sputum Evaluation
Measure alpha1-antitrypsin (AAT) in all patients younger than 40 years or in those with a family history of emphysema at an early age.
The diagnosis of severe AAT deficiency is confirmed when the serum level falls below the protective threshold value of 11 mmol/L (ie, in the range of 3-7 mmol/L).
Specific phenotyping is reserved for patients in whom serum levels are 7-11 mmol/L or when genetic counseling or family analysis is needed.
Alpha1-Antitrypsin
Patients with COPD tend to retain sodium. In addition, serum potassium should be monitored carefully, because diuretics, beta-adrenergic agonists, and theophylline act to lower potassium levels.
Beta-adrenergic agonists also increase renal excretion of serum calcium and magnesium, which may be important in the presence of hypokalemia.
Serum Chemistries
Arterial blood gas (ABG) analysis provides the best clues as to acuteness and severity of disease exacerbation.
Patients with mild COPD have mild to moderate hypoxemia without hypercapnia. As the disease progresses, hypoxemia worsens and hypercapnia may develop, with the latter commonly being observed as the FEV1 falls below 1 L/s or 30% of the predicted value. Lung mechanics and gas exchange worsen during acute exacerbations.
In general, renal compensation occurs even in chronic CO2 retainers (ie, bronchitics); thus, pH usually is near normal.
Generally, consider any pH below 7.3 to be a sign of acute respiratory compromise.
Arterial Blood Gas Analysis
The value of patient history and physical examination was addressed in the 2011 update to the (ACP/ACCP/ATS/ERS) guideline for diagnosis and management of stable COPD.
According to the 2011 guideline, a history of more than 40 pack-years of smoking was the best single predictor of airflow obstruction; however, the most helpful information was provided by a combination of the following 3 signs :
Patients typically present with a combination of signs and symptoms of
chronic bronchitis,
emphysema, and
reactive airway disease.
These include cough, worsening dyspnea, progressive exercise intolerance, sputum production, and alteration in mental status.
Symptoms include the following:
Productive cough or acute chest illness
Breathlessness
Wheezing
Thanks for your Attention
Low Risk
More Symptoms
Low Risk
Less Symptoms
Low Risk
More Symptoms