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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