Respiratory - COPD
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Optimising COPD Management: The Integrated Care Paradigm
Optimising COPD Management: The Integrated Care Paradigm
Optimising COPD Management: The Integrated Care Paradigm
Dr Dhiviya Ganesan, Respiratory Registrar, Galway University Hospital (GUH)
Dr Dhiviya Ganesan, Respiratory Registrar, Galway University Hospital (GUH)
Dr Sinéad Walsh, Respiratory Care GUH Written by DrWalsh, Dhiviya Ganesan,Integrated Respiratory Galway University Hospital (GUH) and Dr Sinéad Respiratory IntegratedRegistrar, CareConsultant, Consultant, GUH & & Community Community Healthcare Organisation 2 2 Integrated Care Consultant, GUH & Community Healthcare Organisation 2 Dr Sinéad Walsh, Respiratory Healthcare Organisation
Dr Dhiviya Ganesan
Dr Sinéad Walsh
The most common symptom reported by patients is dyspnoea on exertion. Dyspnoea that is persistent, progressive over time and worse with exercise is characteristic of COPD. The modified Medical Research Council (mMRC) scale is a useful dyspnoea scoring system that forms part of the GOLD COPD classification system. Dyspnoea is multi-factorial in COPD. Contributing factors include airway obstruction, parenchymal destruction, dynamic hyper inflation leading to air trapping, and systemic effects including sarcopenia.
function has occurred. Tachypnoea occurs with activity, with increasing respiratory rate in proportion to disease severity. Use of accessory respiratory muscles and paradoxical indrawing of the lower intercostal spaces (Hoover sign) indicates airway hyperinflation and a flattened diaphragm. Other findings on thoracic examination include a barrel chest, hyperresonance on percussion, diffusely decreased breath sounds, and prolonged expiration. Diagnosis
Diagnosis of COPD is based on a triad of causative exposure, symptoms and spirometry. • Abnormal lung growth and Introduction Cough and sputum occur in 30% Spirometry is the most development of COPD patients. Less commonly, reproducible and objective The updated The updated 20242024 GlobalGlobal Initiative Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines patients symptoms of The updated 2024 Global Initiative forsocioeconomic Chronic Obstructive Lungdescribe Disease (GOLD) guidelines measurement of airflow limitation. for Chronic Obstructive Lung • Lower status define (GOLD) Chronic Obstructive Pulmonary Disease (COPD)wheeze, as a fatigue heterogeneous and anorexia. lung condition It measures the volume of air that guidelines defineDisease Chronic Obstructive Pulmonary Disease (COPD) as a heterogeneous lung condition Comorbidities may contribute to (bronchitis, a patient can forcibly exhale from • Asthma symptoms and airway hypercharacterized by chronic respiratory due to abnormalities of the airways define Chronic Obstructive restriction of of activity. include characterized by chronic respiratory symptoms due to abnormalities the These airways (bronchitis, the point of maximal inspiration reactivity Pulmonary Disease (COPD) as bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow heart disease, osteoporosis, (Forced Vital Capacity, FVC) and a heterogeneous lung condition bronchiolitis) and/or alveoli (emphysema) that cause persistent, progressive, airflow malignancy, often musculoskeletal • Recurrent respiratory infections the volume of air that is exhaled characterized by chronic obstruction. In this article, we review the aetiology,disorders, clinical features, diagnosis, and anxiety and depression. during and the first second of this respiratory symptoms due to obstruction. In this article, we review the aetiology, clinical features, diagnosis, Clinicalboth features of COPD management of COPD, including non-pharmacological & pharmacological interventions. manoeuvre (Forced Expiratory abnormalities of the airways The key findings on clinical management of COPD, including both non-pharmacological & pharmacological interventions. (bronchitis, bronchiolitis) and/or The main symptoms of theAssessment We will also describe the roleFigure of three Integrated CareABE in management of COPD, examination ofTool a patient withwith a paradigm 1: GOLD alveoli (emphysema) that cause are dyspnoea, chronic COPD are usually absent until We will also describe the role of COPD Integrated in the management of COPD, with a paradigm shift away from hospital-centred care to Care person-centred care. persistent, often progressive, Figure 1: GOLD ABE Assessment Tool significant impairment of lung cough, and sputum production. shift away from hospital-centred care to person-centred care. airflow obstruction. In this article, we review the aetiology, Causes of COPD clinical features, diagnosis, and management of COPD, including Causes of COPD both non-pharmacological & • Tobacco smoke pharmacological interventions. will also describe the • We Tobacco smoke • Marijuana smoking role of Integrated Care in the of COPD, with a • Indoor (household air pollution from burning solid fuels for cooking or heating) and • management Marijuana smoking paradigm shift away from hospitaloutdoor air pollution (particulate matter) • centred Indoor from burning solid fuels for cooking or heating) and care to(household person-centredair pollution care.• Occupational exposures, including dusts, chemical agents and fumes
Introduction Introduction
outdoor air pollution (particulate matter) • Occupational exposures, including dusts, chemical agents and fumes smoke • Females aresuch moreassusceptible than males to the harmful effects of cigarette smoke, • • Tobacco Genetic factors alpha-1-antitrypsin deficiency • Marijuana smokingwho smoke are 50% more likely to develop COPD than men women • Females are more susceptible than males to the harmful effects of cigarette smoke, • Indoor air pollution • (household Abnormal lung growth and development women smoke from burningwho solid fuels for are 50% more likely to develop COPD than men • Lower socioeconomic status or heating) and growth outdoor and • cooking Abnormal lung development air•pollution (particulate Asthma and matter) airway hyper-reactivity • • Occupational Lower socioeconomic status exposures, • Recurrent respiratory infections including dusts, chemical agents • Asthma and airway hyper-reactivity and fumes • • Genetic Recurrent respiratory infections factors such as alpha-1Causes COPD factors such as alpha-1-antitrypsin deficiency • ofGenetic
antitrypsinfeatures deficiency of COPD Clinical
• Females are more susceptible than males to the harmful effects Clinical features of COPD of cigarette smoke, women who smoke are 50% more likely to develop COPD than men
JANUARY 2024 • HPN | HOSPITALPROFESSIONALNEWS.IE
