Chronic Obstructive Pulmonary Disease

COPD (DAMA in Hindi)

Table of content

Chronic Obstructive Pulmonary Disease

Clinical Features:

Seen more in male than females
More than 50 years of age
Breathlessness (Dyspnoea on exertion) > 2 years duration
Cough with expectoration
Seen in smokers
Present as exacerbation of breathlessness

Physical Examination :

Increase in Respiratory rate, use of accessory muscles of respiration.
Look for cyanosis & features of respiratory failure (flapping tremor, bounding pulses, cyanosis & drowsiness).
Look for elevated JVP, edema (to rule out cor-pulmonale)
Chest-barrel shaped, Air entry reduced bilaterally, expiratory wheeze can be heard.
Crepitations indicate infection.

Investigations :

SpO2
ECG (to rule out cardiac cause)
ABG (to look for respiratory acidosis)
Chest Xray required only if their is suspicion of pneumothorax or malingnacy or pneumonia
Spirometry is needed for definitive diagnosis & long term management is based on post-broncho-dilator FEV1(COPD FEV1<80℅)

Treatment of Acute exacerbation of Chronic Obstructive Pulmonary Disease

Propped up position
Oxygen inhalation if SpO2 <92℅
I/V Deriphyllin 100 mg stat
Inj. Hydrocortisone 100mg IV stat, then Q8H
If orally tolerable, give oral prednisolone 1-2mg/kg (usually 30mg OD for 5 days)
If very severe can give IV Methylprednisolone 125mg Q8H
Nebulisation with ipratropium + Levosalbutamol Q6H/ Q8H
If crepitations present, add antibiotics:- Tab. Azithromycin 500 OD×5 days Or Tab. Mox-Clav 625mg 1-1-1×5days
Oral or I/V Doxofyllin 400 mg Q8H is safe for cardiac arrhythmia prone patients

Indication for Antibiotics :

In the presence of three cardinal symptoms ( increased dyspnoea, sputum volume and sputum purulence) or any two out of the three cardinal symptoms if one of the symptoms is sputum purulence & patient with a need for mechanical ventilation.

Long term management of COPD

(Based on post-bronchodilator FEV1)

Stage 1 FEV1>/=80℅ predicted 1) smoking cessation.

2) Short acting Beta agonist.

eg. Salbutamol MDI

Stage 2 FEV1 50-79℅ 1) Long acting Bronchodilator

eg. Salmeterol MDI 75mcg OD

2) pulmonary rehabilitation.

Stage 3 FEV1 30-49℅ 1) Add acting Bronchodilator

eg. Budesonide + Formoterol

( symbicort) DPI 2 puff BD

2) oxygen if needed

Stage 4 FEV1<30℅ or All the above + surgical treatment.

FEV1<50℅+ Chronic

Respiratory failure

(PAO2<60mmHg+/-

PACO2>50mmHg)

Read more on drugs and side effects- https://drrakeshukeymd.com/drug-use-side-effect/