Let's discuss chronic obstructive pulmonary disease.
We have a lot of information to get through.
We’ll start with the definition,
spend a lot of time on diagnosis and treatment too.
So, from the Global Initiative for Chronic Obstructive Lung Disease
or the GOLD management guidelines,
which are really the gold standard
for the diagnosis and management of COPD,
how they define COPD?
So, first of all, there is airflow
limitation and it’s not reversible.
So, that's why spirometry is so critical for
these patients to demonstrate that.
It's usually progressive unfortunately.
It’s associated with an abnormal pulmonary
inflammatory response to noxious stimuli and,
very importantly, is defined by an FEV1
over FVC ratio of less than 0.7.
So, that’s the simple diagnosis of COPD for you.
In terms of where it occurs and how
frequently it occurs in the United States,
still very common, but decreasing in prevalence thankfully.
6% of US adults have COPD.
It’s, of course,
very much related to the rates
of smoking in a given area.
You can see that in the eastern
and southern United States,
rates of COPD are higher because
rates of smoking are higher essentially there.
So, let’s look at a case just to talk about some
of the diagnosis and potential treatments for COPD.
This is Robert.
He's a 70-year-old male.
He complains of regular dyspnea
that limits his walking to two blocks.
Nice use of a functional assessment in there.
And it affects his activities, daily living.
So, we know he has at least moderate disease.
He has mild shortness of breath at rest.
He is using albuterol four times daily,
which is a lot.
Frequent cough, usually with mild phlegm.
His past medical history includes
hypertension and hyperlipidemia.
Now, I see that he is getting albuterol MDI,
but he’s also taking amlodipine.
I assume that's for hypertension.
Carvedilol is an interesting one because
that's frequently used for heart failure
as well as an aspirin a day.
Now, he is a former smoker
who quit smoking five years ago,
but he had been using for 40 pack years.
So, long time.
He rarely consumes alcohol.
And here’s his vital signs.
So, his blood pressure is high.
His respiratory rate is normal,
but his saturation on room air for oxygen is fairly low.
You’d find on his exam he has
a diffuse wheeze, but no rhonchi.
And his peak flow is also depressed, 350.
Peak is a decent measurement
that approximates FEV1.