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afya
COPD
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> diagnosis on ratio of <0.7, treatment and prognosis on FEV1 % predicted //over 35, smoker//, Sx - //chronic cough, regular sputum, exertional SOB//, wheeze, winter bronchitis NOT - unproductive cough, variable Sx with night wakening - asthma //red flags// - wt loss, effort intolerance, night waking, ankle swelling, fatigue, occupation, chest pain, haemoptysis ''Mx'' - ''//STOP SMOKING//'' annual flu jab, 10yr pneumo jab 1st SABA or SAMA prn - if still Sx - measure FEV1 2nd if FEV1 >50% LABA or LAMA if <50% also ICS (beware inc in non-fatal pneumonia) 3rd all 3 ''Improve survival'' smoking cessation long term oxygen if fit criteria lung volume surgery in selected pts ''Other therapy'' Oral - steroids or theophylline - if all 3 fail or intolerant Muycolytic if helps Sx Oxygen - FEV1<30% Pulmonary rehab Manage exacerbations - oral steroids, antibx, nebs, ?hospital ICS - reduces frequency of exacerbations ''Ix'' Spirometry - post bronchodilator (shows obstructive picture - FEV1/FVC < 0.7) FEV1 - categorises severity (I-IV, >80%, 50-80, 30-50, <30) CXR (hyperinflation, bullae, flat hemidiaphragm, exclude ca), FBC (xclude 2ndary polycythaemia), BMI also consider - disability, frequency of exacerbations, prognosis (SOB, exercize capacity, health status, BMI, PaO2) peak flow - little value as underestimates obstruction
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Respiratory