Context and Definition
Context
It is estimated that there are 3 million persons in the UK with COPD [2].
COPD cases comprise over 1 million hospital bed days every year in England [1]. 1 in 8 medical admissions are secondary to COPD [3]. This group of patients will commonly present to the emergency department (ED) when they suffer an exacerbation of their disease.
COPD is believed to be the only major cause of death whose incidence is on the rise in the UK and Britain has one of the highest death rates from this condition in Europe [3].
There are approximately 30 000 deaths / year attributable to COPD [1].
It is therefore vital that the emergency physician has a good knowledge of COPD and its management in order to improve its associated morbidity and mortality. It is also important to recognise which patients may be safely treated in the community to avoid unnecessary admissions.
This session aims to outline the management of COPD relevant to the ED. In particular with reference to the evidence based guidelines published by the National Institute of Clinical Excellence (NICE) in 2010 [4].
Definition
COPD is a respiratory disease characterised by airflow obstruction that is not fully reversible.
Airflow obstruction is defined as a value of < 0.7 when a ratio of the FEV1 (Forced expiratory volume in 1 second) / FVC (Forced vital capacity) is measured.
A diagnosis of COPD should be considered in a patient over the age of 35 who presents with exertional breathlessness, cough, sputum production, wheeze or frequent winter bronchitis in the presence of risk factors [4].
By far the largest risk factor for COPD is smoking, although other risk factors include occupational exposure to fumes or dust, occupational exposure to tobacco smoke or alpha 1 antitrypsin deficiency.
Traditionally within the diagnosis of COPD there were considered to be 2 main subtypes, namely chronic bronchitis and emphysema. COPD is now the preferred term for all with the disease.
An exacerbation of COPD is defined as a worsening of the patients symptoms beyond their normal day-to-day variability. They will often have worse breathlessness, cough, increased sputum production and change in the nature of their sputum. Additional medication will usually be needed in order to treat the exacerbation.
Learning bite
COPD is a respiratory disease characterised by airflow obstruction that is not fully reversible. A diagnosis of COPD should be considered in a patient over the age of 35 who presents with exertional breathlessness, cough, sputum production, wheeze or frequent winter bronchitis in the presence of risk factors [4].