COPD

• 1.2 million people are living with diagnosed COPD 
• 80,000 people in England diagnosed with COPD per year

BLF, 2018

• COPD is the 2nd most common cause of emergency admission 
• COPD is the fifth most common cause of mortality in the UK, and causes nearly 30,000 deaths in England

BLF (2018)

• Smocking 
• Fumes and dust at work 
• Air pollution 
• Genetics

• In 2016 - 78,000 deaths attributed to smoking = 16% of all deaths across the UK
• 35% more likely to see their GP than non-smockers 

[ONS, 2019; PHE, 2019]

Occupational exposure is linked to COPD 

• Agriculture 
• Construction 
• Mining 
• Pottery/ceramic worker 

Responsibility = minimise risks (employer)

Tor and Johnsson, (2018) ; Health and Safety Executive, (2018)

• Long Term Exposure: 28k-36k premature deaths 
• Short term: exacerbation and irritation of respiratory conditions 
• Long Term: stroke, lung cancer, respiratory disorders (COPD)  

• 1% genetic disorder 
• Alpha-1-antitrypsin (AAt) deficiency

Silverman, (2020)

• Symptoms 
• Spirometry 
• Additional Investigations 
• Differentiating between COPD and Asthma 
• Prognosis and severity Assessment 
• Refer 
• Managment 

NICE, 2020

• Breathlessness on exertion 
• Persistent cough 
• Frequent sputum production 
• Frequent winter 'brionchitis' 
• Wheeze 

• Weight loss 
• Reduced exercise tolerance 
• Ankle swelling 
• Chest pain 
• Haemoptysis 
• Waking at night with breathlessness

• Spirometry 
• Chest radiograph 
• Full blood count 
• BMI calculated 

[NICE, 2020]

Assessment: [NICE, 2020]

• FEV1 
• Smokign status 
• Chronic hypoxia 
• Low BMI 
• Severity and frequency of exacerbations 
• Fraility 
• TLCO 
• Exercise Capacity 
• Symptom burden (CAT score)
• Multi-morbidity (6-minute walk test)
• Breathlessness(MRC scale)

• Refer people for specialist advice, 
• Alpha-1 antitrypsin deficiency specialist centre 
• Refer people to dietetic advice if they have abnormal BMI 
• Refer for assessment by social services if they have disability caused by COPD. 

• Support patients in understanding their diagnosis and how to effectively self-manage
• Encourage smoking cessation '
• Encourage patients to provide pneumococcal and an annual influenza vaccination 
• Provide psychological support/medications for patients experiencing depression/anxiety 
• Establish a managment plan to identify and intervene early 
• Chest physiotherapy 
• Inhaled therapy 
• Pulmonary rehabilitation

• A diagnosis of COPD should be made accurately and early. If the diagnosis is incorrect, any subsequent treatment will be of no value.
• There should be better coding and recording of COPD consultations, prescribing and referrals. 

• Fisk, M. et al. (2019) 
  • Primary care audit of Welsh COPD-Coded patient data
  • 48,105 patients 
    • poor documentation of spirometry = affects the accuracy of diagnosis
    • Abscence of coded FEV1/FVC ratio suggests that the test has nor been taken 

• Wat, D. and Sibley, S. (2017)
  • Consultant-led Knowsley Community Respiratory Service was invided for a clinical review 
    • 20.8% had a spirometry inconsisent with diagnosis of COPD 
      • 723 = normal result 
      • 18 restricted results 
      • 445 following review had asthma 

Melzer et al. (2017) 

• Cross-sectional study patients using at least one metered dose inhaler
• 688 participants 
  • 65.5% had poor technique for at least one device 
    • Black people 
    • female 
    • current smokers 
    • limited education

Stepherd and Bowell, (2019)

• 35% of hospitalised patients are malnourished with COPD 
• Eating is effected by COPD 
• 25-40% of patients living with malnutrition 
• 15% of patients with stable COPD suffer from sarcopenia 

Holst et al. (2019)

• 79 participants living in the community
  • 14% had BMI <20 kg/m²
  • The majority of participants were overweight/obese 
    • Stll have insufficient energy and protein intake 
  • 51% had insufficient intake of protein and 41% energy intake
  • 35% reported some eating difficulties 

Verberne et al. (2017)

• 4938 patients with mild to moderate COPD
  • Mean BMI was 27.5 kg/m²
  • More likely to develop diabetes, oesteorathris and hypertension

Negewo wt al. (2016)

• 28 obese patients living with COPD (Mean BMI was 36.1)
  • 12 week diet and resistence training
  • Comordities included hypertension (53.6%), depression (32.1%), diabetes (14.3%)
  • RESULT: patients had raised biochemical markers, weight loss improved cardio-metabolic markers and depression scores 

NICE (2018); GOLD Strategy 

• Calculate BMI for people with COPD
  • Normal range for BMI is: 20-25 kg/m2
  • refer people for diatetic advice if BMI is high or low 
  • Low BMI = nutritional supplements 

NICE (2018)/GOLD Strategy 

• Pulmonary Rehabilitation = multidisciplinary and multicomponent programme/intervention of care for people with chronic respiratory impairment 

• Offer to all people 
  • EXCEPT for people who are unable to walk, who have unstable angina or who have had a recent myocardial infarction.

• Effective and improve adherence = held at times that are suitable for people, easy access 
• Should include physical training, disease education, psychological and behavioural intervention. 
• State the benefits of attending the programme

• Yohannes, et al. (2017)
  • 165 COPD patients completed an 8-week community based PR programm
  • Measures Dyspnoea, QoL and Anxiety
  • All scales of assessment at 8 weeks showed an improvement 
  • QoL at 2 years was mantained

• Salcedo, et al. (2018)
  • 21 randomized controlled trails 
  • WBE training is effective for improving pulmonary function in adults with chronic lung disease. 

• McCarron, et al. (2019)
  • 281 patients were invited to attend PR in 2016 
  • Questionnaires sent to those who did not attend (n=20) and those that dropped out (n=13)
  • Age, sex, low perceived benefits and smoking status was a contributing factors. 

GOLD Strategy (2020)

• Obstructive sleep apnoea (OAS)
  • sleep disorder hallmarked by repeated episodes of upper airway closure
  • Overlap syndrome (OVS) = COPD + OAS

Adler, et al. (2020)

• 46,786 patients had moderate-to-severe OAS
• Lower proportion OVS compained of snoring, morning headaches and excessive daytime sleepiness compared to OAS alone

Azkona, et al. (2019)

• 2654 patients were included.
• The mean FEV1% was 50.6%
• Respiratory symptoms + poor lung function + exacerbations + depression = contributes to poorer quality of sleep

Shah, et al. (2020) 

• 480 participants
• Time to trigger an exacerbations was shorter for those with poor quality 

• McCarron, et al. (2019)
  • 281 patients were invited to attend PR in 2016 
  • Questionnaires sent to those who did not attend (n=20) and those that dropped out (n=13)
  • Age, sex, low perceived benefits and smoking status was a contributing factors. 

Verberne et al. (2017)

• 4938 patients with mild to moderate COPD
  • Mean BMI was 27.5 kg/m²
  • More likely to develop diabetes, oesteorathris and hypertension

Negewo wt al. (2016)

• 28 obese patients living with COPD (Mean BMI was 36.1)
  • 12 week diet and resistence training
  • Comordities included hypertension (53.6%), depression (32.1%), diabetes (14.3%)
  • RESULT: patients had raised biochemical markers, weight loss improved cardio-metabolic markers and depression scores 

NICE (2018); GOLD Strategy 

• Calculate BMI for people with COPD
  • Normal range for BMI is: 20-25 kg/m2
  • refer people for diatetic advice if BMI is high or low 
  • Low BMI = nutritional supplements