COPD COPD COPD COPD COPDExacerbation.pptx

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1. COPD Exacerbation

2. Outline Definition & causes Differential diagnosis Classification of severity Indications for hospitalizations Management of severe exacerbations Indications for MICU admission, NIV & IMV Discharge criteria and recommendations for follow up

3. Definition A n exacerbation of COPD is a sustained worsening of the patient's condition, from the stable state and beyond normal day-to-day variations that is acute in onset and may warrant additional treatment in a patient with underlying COPD . Exacerbations are infrequent in early COPD and are largely a feature of moderate-to-severe disease.

4. COPD exacerbation Negatively affects a patient’s quality of life Accelerates the rate of decline of lung function Associated with significant mortality, particularly in those requiring hospitalizations

5. Main Causes of COPD Exacerbations Bacterial   and viral infections pollution events  cold weather  interruption of regular treatment

6. © 2020 Global Initiative for Chronic Obstructive Lung Disease

7. Classification of severity of COPD exacerbations Mild: treated with antibiotics but no systemic corticosteroid. Absence of respiratory failure. Moderate: treated with parenteral corticosteroids with or without an antibiotic. Absence of respiratory failure. Severe: Type 1 respiratory failure with hypoxaemia but no carbon dioxide retention or acidosis. Very severe & Life-threatening: Type 2 respiratory failure, decompensated with acidosis and carbon dioxide retention. © 2019 Global Initiative for Chronic Obstructive Lung Disease

8. Potential indications for hospitalization assessment*

9. Management of severe but not life threatening exacerbations*

10. What are the indications to add antibiotics Three cardinal symptoms-increase in dyspnea, sputum volume and sputum purulence Signs of pneumonia Mechanical ventilation

11. Key points for the management of exacerbations

12. Indications for medical intensive care unit admission*

13. Indications for Noninvasive mechanical ventilation (NIV)

14. Indications for Invasive mechanical ventilation

15. Discharge criteria

16. Recommendations for follow up

17. Case study 4 A 45 year old woman from rural area has noticed a mild, occasionally productive cough for the past 3-4 months. The cough is worse whenever she spends the day at her home while cooking where is exposed to the smoke of the wood fire. She finally decides to visit you at the health center. Her husband and she never smoked cigarette. The cough has been present for almost a year. She has no fever or chills. She does admit to more shortness of breath when she walks for long distance over the past six months. Physical examination was normal findings . Discussion points 1- What further questions do you want to ask ? 2- What differential diagnoses do you consider? 3-At this point, what further investigations do you think would be appropriate ? 4-What would be the best option to improve her symptoms and slow progression ?

18. Answers 1- What further questions do you want to ask ? -characteristic of cough intermittent or persistent? -cough with phlegm or productive? -nigh sweating, fever or weight loss? 2- What differential diagnoses do you consider? Tuberculosis Bronchial asthma Bronchiectasis Lung cancer COPD 3-At this point, what further investigations do you think would be appropriate? Chest x ray, Sputum AFB, ESR, CBC Lung function studies: flow meter and spirometer and response to salbutamol 4-What would be the best option to improve her symptoms and slow progression? Reduce exposure to Smoking (outdoor cooking) Behavioral change communication Nutrition and regular treatment of chest infection etc… Bronchodilator treatment Exercise to improve exercise tolerance and quality of life Home oxygen treatment and morphine depending on the advance of disease

19. We would like to thank Dr. Tewodros Haile, Dr Hanan Yusuf, Dr Amsalu Bekele and Dr Rahel Argaw for preparing this powerpoint