Thursday, July 20, 2017

Approach To A Patient With Chronic Obstructive Pulmonary Disease (COPD)



Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation due to impedance to expiratory airflow, mucosal edema, infection, bronchospasm and bronchoconstriction due to decreased lung elasticity.

Smoking is the main cause, but others are chronic asthma, α-1 antitrypsin deficiency and chronic infection (eg bronchiectasis).

History
Exertional dyspnoea, cough, and sputum are usual complaints.
Ask about:
• Present treatment including inhalers, steroids, antibiotics, theophyllines, nebulizers, opiate analgesia, and home O 2 treatment.
• Past history: inquire about previous admissions and co-morbidity.
• Exercise tolerance: how far can they walk on the flat without stopping? How many stairs can they climb? Do they get out of the house?
• Recent history: ask about wheeze and dyspnoea, sputum volume and color. Chest injuries, abdominal problems and other infections may cause respiratory decompensation.
• Read the hospital notes: have there been prior ICU assessments? Has the respiratory consultant advised whether ICU would be appropriate?

Examination

  • Examine for dyspnoea, tachypnoea, accessory muscle use, and lip-pursing.
  • Look for hyperinflation (‘barrel chest’) and listen for wheeze or coarse crackles (large airway secretions). 
  • Cyanosis, plethora (due to secondary polycythaemia) and right heart failure (cor pulmonale) suggest advanced disease. 
  • Look for evidence of hypercarbia: tremor, bounding pulses, peripheral vasodilatation, drowsiness, or confusion.
  • Check for evidence of other causes of acute dyspnoea, particularly: asthma, pulmonary edema, pneumothorax , Pulmonary embolism. Remember that these conditions may co-exist with COPD.

Investigations
• SpO 2 , respiratory rate, pulse rate, BP,  Temperature , and peak flow (if possible).
• Chest X ray (look for pneumothorax, hyperinflation, bullae, and pneumonia).
• ECG.
• ABG (or capillary blood gas), documenting the FiO 2 . Use pCO 2 to guide O 2 therapy.
• CBC, U&E, glucose, theophylline levels and, if pneumonia is suspected and/or pyrexial, blood cultures, CRP, and pneumococcal antigen.
• Send sputum for microscopy and culture if purulent.

Treatment

  • Give O 2 — remember that hypercapnoea with O 2 is multifactorial. The aim is to maintain SpO 2 88–92 % without precipitating respiratory acidosis or worsening hypercapnoea . 
  • If the patient is known to have COPD and is drowsy or has a documented history of previous hypercapnoeic respiratory failure, give FiO 2 of 28 % via a Venturi mask and obtain ABG. Titrate up the FiO 2 with serial ABG sampling until the minimum FiO 2 that achieves SpO 2 88–92 % .
  • Reduce inhaled oxygen concentration if SpO 2 > 92 % .

Give bronchodilators and steroids
• Give nebulized salbutamol 5mg or terbutaline 5–10 mg.
• Consider adding nebulized ipratropium 0.5mg.
• Use O 2 driven nebulizers unless the patient has hypercapnoeic, acidotic COPD, in which case use nebulizers driven by compressed air, supplemented by O 2 via nasal prongs at 1–4 L/min.
• Give steroids (eg prednisolone 30 mg PO stat or IV hydrocortisone 100 mg).

Other drug treatments
• Give antibiotics (eg amoxicillin, tetracycline, or clarithromycin) if the patient reports increased purulent sputum, or there is clinical evidence of pneumonia and/or consolidation on chest X ray.
• Consider IV aminophylline or salbutamol if there is an inadequate response to nebulized bronchodilators.
• Consider naloxone if the patient is taking an opioid analgesic that may cause respiratory depression.

18 comments:

  1. COPD is a obstructive lung disease.It occurs breathing problems.It becomes worsen over time.People who have this disease need to take consultant for copd treatment

    ReplyDelete
    Replies
    1. Eleven months ago I was diagnosed with chronic obstructive pulmonary disease (COPD). I have had asthma all my life. I have just been to the doctors and seen a senior nurse who has told me I no longer have this lung conditions because Total Cure Herbal Foundation has given me a good health while using their prescription. My breathing is totally great and I don't feel I need the COPD inhaler anymore,i actually found the herbal foundation on guessbook i managed to give a try on the their herbs which totally save me from this chronic disease..Id like for you to give a try also by contacting them on
      https://totalcureherbalfou5.wixsite.com/herbal/contact Totalcureherbalfoundation@gmail.com.

      Delete
    2. My twin sister was diagnosed with COPD few years ago. She was on a trial for some months. It turned out that the drug she was given was not a placebo, but the real thing and it was working. Then they pulled the plug on it saying it was not viable! So. they got her on another trial, that trial also was cancelled after a while. 2017 I ordered COPD herbal remedy from Best Health Herbal Centre online and they shipped it to me. She only used the COPD herbal remedy for 5 weeks, all her symptoms disappeared, she stopped wearing oxygen and my family doctor confirmed her, COPD free now. Is almost 5 months now, no more COPD. Please fellow oxygen user's or COPD patients, don't hesitate to purchase this incredible product via email : chiefdrlucky@gmail.com .Whats App or call +2349065398067

      Delete
    3. I have been sick with bronchitis and a sinus infection for about 6 to 7 weeks now. I have been to the doctors twice and the emergency room. I have been put on three different antibiotics, prednisone, an albuterol inhaler, and I take herbal health remedies foundation OTC cold medications. I am no longer coughing a lot and have terrible coughing fits. Then I sound like someone with emphysema. I will cough until I throw up but the doctors don't really have any new treatments for me, after trying out herbal health remedies foundation now am better. Contact: info@herbalhealthremediesfoundation.com or Website:http://herbalhealthremediesfoundation.com

      Delete
    4. Do anyone still doubt natural herbs? I’ve seen the great importance of natural supplements and the wonderful work Dr Edidia has done in my husband life.
      I was looking for chronic obstructive pulmonary disease COPD treatments for my husband who was 72yrs old, my husband has COPD and cancer, his condition was very critical which i was very afraid that will not survive it.
      His white blood count was very low right now and his doctors are planning on starting some chemo or other treatment soon.. I don't believe he will last long if he does this.. His COPD is getting worse even though he hasn't smoked in 30 years. so i decided to come online to see if there will be better alternative, during my research i saw a lady post about doctor Dr Edidia who has power over deadly disease, so i decided to contact him because i really do not care about what my husband was talking in all i want for him is for him to get well for me because he was all i have, my husband took the remedies that he send to us through UPS as he told us and few weeks later my husband stop to notice that symptoms of his disease are begging to leave him so he went back to his Dr and he was told he no longer has those diseases.
      My husband is totally free of COPD and cancer if not for doctor Edidia who help us rid this problem there is a possibility that my husband wouldn't be alive today.
      their contact info (dredidiaherbalhome@gmail.com or whatsapp +2349074505296 visit his website
      http://dredidiaherbalhome.weebly.com/

      Delete
    5. Do anyone still doubt natural herbs? I’ve seen the great importance of natural supplements and the wonderful work Dr Edidia has done in my husband life.
      I was looking for chronic obstructive pulmonary disease COPD treatments for my husband who was 72yrs old, my husband has COPD and cancer, his condition was very critical which i was very afraid that will not survive it.
      His white blood count was very low right now and his doctors are planning on starting some chemo or other treatment soon.. I don't believe he will last long if he does this.. His COPD is getting worse even though he hasn't smoked in 30 years. so i decided to come online to see if there will be better alternative, during my research i saw a lady post about doctor Dr Edidia who has power over deadly disease, so i decided to contact him because i really do not care about what my husband was talking in all i want for him is for him to get well for me because he was all i have, my husband took the remedies that he send to us through UPS as he told us and few weeks later my husband stop to notice that symptoms of his disease are begging to leave him so he went back to his Dr and he was told he no longer has those diseases.
      My husband is totally free of COPD and cancer if not for doctor Edidia who help us rid this problem there is a possibility that my husband wouldn't be alive today.
      their contact info (dredidiaherbalhome@gmail.com or whatsapp +2349074505296 visit his website
      http://dredidiaherbalhome.weebly.com/

      Delete
    6. Do anyone still doubt natural herbs? I’ve seen the great importance of natural supplements and the wonderful work Dr Edidia has done in my husband life.
      I was looking for chronic obstructive pulmonary disease COPD treatments for my husband who was 72yrs old, my husband has COPD and cancer, his condition was very critical which i was very afraid that will not survive it.
      His white blood count was very low right now and his doctors are planning on starting some chemo or other treatment soon.. I don't believe he will last long if he does this.. His COPD is getting worse even though he hasn't smoked in 30 years. so i decided to come online to see if there will be better alternative, during my research i saw a lady post about doctor Dr Edidia who has power over deadly disease, so i decided to contact him because i really do not care about what my husband was talking in all i want for him is for him to get well for me because he was all i have, my husband took the remedies that he send to us through UPS as he told us and few weeks later my husband stop to notice that symptoms of his disease are begging to leave him so he went back to his Dr and he was told he no longer has those diseases.
      My husband is totally free of COPD and cancer if not for doctor Edidia who help us rid this problem there is a possibility that my husband wouldn't be alive today.
      their contact info (dredidiaherbalhome@gmail.com or whatsapp +2349074505296 visit his website
      http://dredidiaherbalhome.weebly.com/

      Delete
    7. Do anyone still doubt natural herbs? I’ve seen the great importance of natural supplements and the wonderful work Dr Edidia has done in my husband life.
      I was looking for chronic obstructive pulmonary disease COPD treatments for my husband who was 72yrs old, my husband has COPD and cancer, his condition was very critical which i was very afraid that will not survive it.
      His white blood count was very low right now and his doctors are planning on starting some chemo or other treatment soon.. I don't believe he will last long if he does this.. His COPD is getting worse even though he hasn't smoked in 30 years. so i decided to come online to see if there will be better alternative, during my research i saw a lady post about doctor Dr Edidia who has power over deadly disease, so i decided to contact him because i really do not care about what my husband was talking in all i want for him is for him to get well for me because he was all i have, my husband took the remedies that he send to us through UPS as he told us and few weeks later my husband stop to notice that symptoms of his disease are begging to leave him so he went back to his Dr and he was told he no longer has those diseases.
      My husband is totally free of COPD and cancer if not for doctor Edidia who help us rid this problem there is a possibility that my husband wouldn't be alive today.
      their contact info (dredidiaherbalhome@gmail.com or whatsapp +2349074505296 visit his website
      http://dredidiaherbalhome.weebly.com/ or
      https://dr-edidia-herbal-home.business.site/

      Delete
  2. I was diagnosed with COPD 5 years ago and was taking Spiriva and Advair plus nose sprays to slow down progression. My symptoms have always been shortness of breath, and dizziness. I am a 54 year old female. the Spiriva wasn’t really working and I could not tolerate them for long due to severe side effects, so this year our family doctor started me on Natural Herbal Gardens COPD Herbal mixture, We ordered their COPD herbal treatment after reading alot of positive reviews, i am happy to report with the help of Natural Herbal Garden natural herbs I have been able to reverse my symptoms using herbs, my symptoms totally declined over a 9 weeks use of the Natural Herbal Gardens COPD natural herbal formula. My COPD is totally reversed! Their official web page is www . naturalherbalgardens . com After the herbal treatment I also finally was able to give up smoking after 20 years. I ‘m thankful to nature

    ReplyDelete
  3. Eleven months ago I was diagnosed with chronic obstructive pulmonary disease (COPD). I have had asthma all my life. I have just been to the doctors and seen a senior nurse who has told me I no longer have this lung conditions because Total Cure Herbal Foundation has given me a good health while using their prescription. My breathing is totally great and I don't feel I need the COPD inhaler anymore,i actually found the herbal foundation on guessbook i managed to give a try on the their herbs which totally save me from this chronic disease..Id like for you to give a try also by contacting them on
    https://totalcureherbalfou5.wixsite.com/herbal/contact Totalcureherbalfoundation@gmail.com.

    ReplyDelete
  4. I was diagnosed with emphysema in 2008, I have to be on oxygen 16 hours minimum. I have 27% lung function. I have lost count of the times that I have been hospitalized. I worked full time, but found it was getting too much for me, so i decided to find a better solution to get rid of the disease totally,during my research i came across https://totalcureherbalfou5.wixsite.com/herbal/contact Totalcureherbalfoundation@gmail.com which i purchase the products from them, the tremendous cure has successful stop this disease from progression and gradually alleviate all symptoms which including chest pressure, shorts of breath.this herbal formula really saved my life after several years of pains but now im fully cured.

    ReplyDelete
  5. My twin sister was diagnosed with COPD few years ago. She was on a trial for some months. It turned out that the drug she was given was not a placebo, but the real thing and it was working. Then they pulled the plug on it saying it was not viable! So. they got her on another trial, that trial also was cancelled after a while. 2017 I ordered COPD herbal remedy from Best Health Herbal Centre online and they shipped it to me. She only used the COPD herbal remedy for 5 weeks, all her symptoms disappeared, she stopped wearing oxygen and my family doctor confirmed her, COPD free now. Is almost 5 months now, no more COPD. Please fellow oxygen user's or COPD patients, don't hesitate to purchase this incredible product via email : chiefdrlucky@gmail.com .Whats App or call +2349065398067

    ReplyDelete
  6. I have been sick with bronchitis and a sinus infection for about 6 to 7 weeks now. I have been to the doctors twice and the emergency room. I have been put on three different antibiotics, prednisone, an albuterol inhaler, and I take herbal health remedies foundation OTC cold medications. I am no longer coughing a lot and have terrible coughing fits. Then I sound like someone with emphysema. I will cough until I throw up but the doctors don't really have any new treatments for me, after trying out herbal health remedies foundation now am better. Contact: info@herbalhealthremediesfoundation.com or Website:http://herbalhealthremediesfoundation.com

    ReplyDelete
  7. I have been diagnosed with COPD (chronic obstructive pulmonary disease) and my doctor has given me Seebri Breezhaler, it's an inhalation powder 44 micrograms. I take it once a day in the morning. It's a great help to breathing, it's a new medicine on test, 10 out of 10 from me! But still yet i was told it has no cure for it. I was fed up to nearly take my life until my son saw a post of a lady who testify that there's a cure for copd and she was diagnosed with this disease for 8 years before she came arrow a website of an Africa clinic. Which provide natural herbal herbs to cure copd and she purchase it through online. My son purchase their copd herbal remedy on my behalf and give it to me to use with the instructions given on how to apply it, when i applied it as instructed i was totally cured of this deadly disease within 12 weeks of usage. I advise whosoever reading my testimony should visit www.solutionhealthherbalclinic.com and seek for your solution, You also can email at solutionsherbalclinic@gmail.com.

    ReplyDelete
  8. I have been diagnosed with COPD (chronic obstructive pulmonary disease) and my doctor has given me Seebri Breezhaler, it's an inhalation powder 44 micrograms. I take it once a day in the morning. It's a great help to breathing, it's a new medicine on test, 10 out of 10 from me! But still yet i was told it has no cure for it. I was fed up to nearly take my life until my son saw a post of a lady who testify that there's a cure for copd and she was diagnosed with this disease for 8 years before she came arrow a website of an Africa clinic. Which provide natural herbal herbs to cure copd and she purchase it through online. My son purchase their copd herbal remedy on my behalf and give it to me to use with the instructions given on how to apply it, when i applied it as instructed i was totally cured of this deadly disease within 12 weeks of usage. I advise whosoever reading my testimony should visit www.solutionhealthherbalclinic.com and seek for your solution, You also can email at solutionsherbalclinic@gmail.com.

    ReplyDelete
  9. Do anyone still doubt natural herbs? I’ve seen the great importance of natural supplements and the wonderful work Dr Edidia has done in my husband life.
    I was looking for chronic obstructive pulmonary disease COPD treatments for my husband who was 72yrs old, my husband has COPD and cancer, his condition was very critical which i was very afraid that will not survive it.
    His white blood count was very low right now and his doctors are planning on starting some chemo or other treatment soon.. I don't believe he will last long if he does this.. His COPD is getting worse even though he hasn't smoked in 30 years. so i decided to come online to see if there will be better alternative, during my research i saw a lady post about doctor Dr Edidia who has power over deadly disease, so i decided to contact him because i really do not care about what my husband was talking in all i want for him is for him to get well for me because he was all i have, my husband took the remedies that he send to us through UPS as he told us and few weeks later my husband stop to notice that symptoms of his disease are begging to leave him so he went back to his Dr and he was told he no longer has those diseases.
    My husband is totally free of COPD and cancer if not for doctor Edidia who help us rid this problem there is a possibility that my husband wouldn't be alive today.
    their contact info (dredidiaherbalhome@gmail.com or whatsapp +2349074505296 visit his website
    http://dredidiaherbalhome.weebly.com/

    ReplyDelete


  10. TESTIMONY ON HOW I BECAME INSTANT MILLIONAIRE WITH THE HELP OF ILLUMINATI Hello viewers, i want to use this opportunity to thank DR ODUCKAYAMUD who finally helped me to become a full member of the Great Illuminati Brotherhood and now i am living my life in happiness. I was once indigent and lived my life in extreme poverty, the standard of living became so poor and low that I even thought of killing myself, I was deeply strangled up by poverty and I had no body to help me, to eat was a problem to me and my family. Until I met with a great generous man by name DR ODUCKAYAMUD who told me there would be no need for me to die and he introduced me into the world of riches and fame. He told me to get my membership form which i did, and he told me to get ready for my initiation day and that all new members will be given a certain reward of $100,000 USD cash on my initiation day, i was so happy. so i was initiated to the Illuminati world and few days later i was awarded a contract worth of millions of Dollars, in my business i am doing very well right now, I used just 200 dollar to get this beg amount of money and I did exactly what i was ask to do and today the story has change, i have up to $800,000000 USD in my bank account, I am a living testimony, my dream and all the wealth, fame, success and riches, i have ever desired is been made a reality. All the same thanks DR ODUCKAYAMUD who made my dreams a reality by helping me become a member of the great illuminate.YOU CAN COUNTACT HIM ON oduckayamud49@gmail.com or oduckayamud49@yahoo.com and also be a happy man like me because we are not getting any younger.his a life changer YOU CAN ALL REACH HIM ON WhatsApp number (+2347059232579)

    ReplyDelete
  11. I am not sure of the cause of COPD emphysema in my case. I smoked pack a day for 12 or 13 years, but quit 40 years ago. I have been an outdoor person all my adult life. Coughing started last summer producing thick mucus, greenish tint to clear. I tried prednisone and antibiotics, but no change. X-rays are negative, heart lungs and blood and serum chemistries all are normal. I have lung calcification from childhood bout with histoplasmosis. I am 75 years old and retired.My current doctor directed me to totalcureherbsfoundation com which I purchase the COPD herbal remedies from them ,they are located in Johannesburg, the herbal treatment has effectively reduce all my symptoms totally, am waiting to complete the 15 weeks usage because they guaranteed me total cure.

    ReplyDelete