Download Chronic Obstructive Pulmonary Disease in Primary Care. Class by David Bellamy PDF

By David Bellamy

COPD (the spectrum of illnesses together with persistent bronchitis, emphysema, long-standing irreversible bronchial asthma and small airlines ailment) is likely one of the commonest and demanding respiration problems obvious in basic care. This up-to-date 3rd version exhibits how you can deal with COPD in fundamental care - effectively and with invaluable results on your sufferers.

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Example text

Clinical signs In mild and moderate disease, clinical signs are mostly absent. It is not until the disease is severe that clinical signs become apparent. Early COPD is detectable only by measuring lung function with a spirometer. ) More can be gained by inspecting the chest than by examining it with a stetho- Presentation and history 33 scope. Removing the patient’s shirt and taking a good look can be most informative. Although a definitive diagnosis does not depend on the examination alone, it is still an essential part of the assessment and can be used to support the history and the diagnostic tests.

This could be enhanced with a flow/volume trace, which is the most sensitive simple test for detecting early changes. In a recent study from the Netherlands, airflow obstruction was found in 27% of smokers with a cough. Stopping patients smoking at this stage – admittedly not an easy task – would largely prevent COPD in most of them as well as reducing their risk of lung cancer and cardiovascular disease. There is some encouraging evidence from Poland that patients who are found to have airflow obstruction on general screening are more likely to stop smoking.

An alternative to having a spirometer in the practice may be open access spirometry at the local respiratory unit. Spirometry What does it mean? In simple terms, spirometry measures two parameters – airflow from fully inflated lungs and the total volume of air that can be exhaled from maximum inhalation to maximum exhalation, using maximum force to blow all the air out as hard and as fast as possible. In a healthy individual this forced expiratory manoeuvre can normally be completed in three to four seconds, but with increasing airflow obstruction it takes longer to push all the air out of the lungs.

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