obstructive restrictive fev1 -vol of air patient able to exhale in the first second of forced...

FEV1-vol of air patient able to exhale in the first second of forced expiration

FVC-total vol of air patient can forcibly exhale in one breath

FEV1/FVC-ratio of FEV1 to FVC as %

FEV1 and FVC expressed as % of predicted normal for a person of same age/sex/height

Post bronchodilator FEV1/FVC <0.7 (base)

FEV1% predicted <80%

Severity of COPD indicated by extent of FEV1 reduction

Asthma may show same abnormality as COPD-use reversibility testing to identify asthma

Obstructive pattern;› FEV1<80%› FVC reduced but less than FEV1› FEV1/FVC <0.7

Restrictive pattern;› FEV1 <80% predicted› FVC <80% predicted› FEV1/FVC normal >0.7

Post bronchodilator spirometry (reversibility not usually necessary)

CXR FBC for anaemia/polycythemia BMI

LABA? LAMA? SABA? SAMA?

?

http://www.nice.org.uk/nicemedia/live/13029/49399/49399.pdf

COPD >35 Risk factor (usually

smoking) Exertional SOB Chronic cough Regular sputum Frequent winter

bronchitis/wheeze No clinical features of

asthma

Asthma; >1 of wheeze; cough;

SOB; chest tightness Triggers-exercise;

viral; emotions; pets Atopic history Fh of atopy/asthma Widespread wheeze Improvement in

symptoms with treatment

Spirometry with reversibility >400ml response to bronchodilator or

after 2 week trial of pred 30mg daily Reversibility testing;

› Salbutamol/ipratropium/terbutaline Or one month trial bronchodilator

response with spirometry

Moderate COPD Why?

Severe COPD Why?

Moderate COPD Why?

Asthma Why?

John Smith

Moderate COPD Why?

1. FEV1 and FEV1/FVC for diagnosis of COPD2. FEV1% of 30-49% is………COPD3. Restrictive pattern spirometry looks like…..4. FEV1 of …….to use inhaled steroids in COPD5. Example of generic name of starting inhaler

for COPD symptoms6. Step 4 of asthma treatment in children <5y7. Inhaled steroid dose for children 5-12y in

step 2 of asthma treatment8. What do you add in step 3 of adult asthma

treatment?

NICE guidelines COPD and asthma BTS guidelines Spirometry in practice Gpnotebook.co.uk