GEM - respiratory problems - chronic obstructive pulmonary disease (COPD) and oxygen therapy

COPD is a chronic, slowly progressive disorder characterised by airways obstruction (FEV1 < 80% predicted and FEV1/FVC ratio < 70%) which does not change markedly over several months. The impairment of lung function is largely fixed but is partially reversible by bronchodilator or other therapy. Environmental pollution and smoking contribute to the increasing incidence of COPD. COPD is an important cause of activity limitation in the population.

Some introductory points:

• in which patients should the diagnosis of COPD be suspected?
• how is COPD classified?
  • GPN reference
• what about reversibility testing in COPD?
  • GPN reference
• what is:
  • FEV1 GPN reference
  • FVC GPN reference
  • PEF - what about the relationship between PEF and pulmonary fibrosis? GPNreference
  • what may cause and increased FEV1/FVC ratio? GPN reference
    
    
• Is there evidence for the use of long-term steroids in COPD
• GPN reference

Exacerbations of COPD

• Factors which favour treatment in hospital
  • not able to cope at home
  • severe beathlessness
  • general condition is poor/ deteriorating
  • level of activity is poor/confined to bed
  • cyanosis is present
  • worsening peripheral oedema
  • impaired level of consciousness
  • patients is already receiving long term oxygen therapy
  • patient is living alone/ not coping
  • acute confusion is present
  • exacerbation has had a rapid rate of onset
  • there is significant comorbidity particularly cardiac disease and insulin-dependent diabetes
  • SaO2 < 90%
  • changes on the chest radiograph are present
  • arterial pH level < 7.35
  • arterial PaO2 < 7 kPa
• what initial management is indicated for COPD?
  • GPN reference
• what about choice of antibiotic?
  • GPN reference

When is referal from primary care appropriate?

• GPN reference

Oxygen Therapy

Long term Oxygen Therapy (LTOT) refers to the provision of oxygen therapy for continuous use at home for patients with chronic hypoxaemia (PaO2 at or below 7.3 kPa, (55mHg))

• oxygen flow rate must be sufficient to raise the waking oxygen tension above 8 kPa, (60 mmHg)
• LTOT is likely to be life long
• LTOT is usually given for at least 15 hours daily, to include night time, in view of the presence of worsening arterial hypoxaemia during sleep
• what clinical situations might require LTOT?
• does the level of PaCO2 influence provision of LTOT?
• is LTOT therapy ever indicated for PaO2 >= 7.3 kPa
  • GPN reference

Ambulatory oxygen therapy

• refers to the provision of oxygen therapy during exercise and activities of daily living ambulatory
• oxygen therapy can be prescribed in patients on long term oxygen therapy (LTOT), who are mobile and need to or can leave the home on a regular basis
• ambulatory oxygen has been shown to be effective in increasing exercise capacity and reducing breathlessness in patients with exercise arterial oxygen desaturation, defined as a fall in SaO2 of 4% to a value <90%
• more details...GPN reference

Short burst oxygen therapy

• what is short burst oxygen therapy?
• what period of time would short burst oxygen therapy generally be use for?
• GPN reference

Additional reading

COPD section on GPnotebook

Reference:

1. Royal College of General Practitioners. Curriculum Statement 15.8 Respiratory problems.