Obstructive sleep apnoea



Chronic Obstructive Pulmonary Disease (COPD)

General

Disease of chronic airflow limitation due to (mainly) smoking, with gradual and intermittent step-wise deterioration in lung function (acute exacerbations) that may not fully recover. Reduced elastic recoil, and dynamic airways closure produce gas trapping and increased operating lung volumes, leading to breathlessness and reduced exercise capacity.

Differentials (may co-exist):

• Airflow limitation: asthma, bronchiectasis, consider a1-antitrypsin deficiency in young

• Acute hypoxia: inf exac (viral/bacterial/environmental), PE, pneumothorax

History

• Consider diagnosis in patients >35yrs who have a risk factor (generally smoking > 20 pack-year history) and who present with: exertional breathlessness, chronic cough, regular sputum production, frequent winter ‘bronchitis,’ or wheeze.

• Current smoking history – and attempts to stop (include cannabis/ and e-cigs)

• Weight loss, haemoptysis (? underlying lung ca), ankle swelling (? nocturnal hypoxaemia or cor pulmonale)

• Previous vaccinations (influenza, pneumococcus)

• Frequency of exacerbations (and recent use of steroids and antibiotics), hospitalisations, HDU/ICU visits

• Use symptom scores to quantify, and to track progress over time.

o mMRC dyspnoea score:

|Score |Description |

|0 |Not troubled by breathlessness except on strenuous exercise |

|1 |Short of breath when hurrying or walking up a slight hill |

|2 |Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when |

| |walking at own pace |

|3 |Stops for breath after about 100m or after a few minutes on the level |

|4 |Too breathless to leave the house, or breathless when dressing or undressing |

o CAT - COPD assessment tool:

| | |

|FEV1 % predicted |2004 NICE guidelines |2010 NICE guidelines |

|≥ 80% | |1 = Mild |

|50-79% |Mild |2 = Moderate |

|30-49% |Moderate |3 = Severe |

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