1. Respiratory
COPD/Asthma

2. Spirometry Examples

3. Spirometry Examples
Obstructive
Restrictive

5. Spirometry
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

6. Spirometry-COPD 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

7. Spirometry Obstructive pattern; Restrictive 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

8. Initial Diagnostic Evaluation
Post bronchodilator spirometry (reversibility not usually necessary)
CXR
FBC for anaemia/polycythemia
BMI

9. COPD

10. LABA? LAMA? SABA? SAMA? ?

11. COPD Stepwise Treatment

12. COPD Vs Asthma 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

13. Asthma 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

14. Adult Asthma Treatment

15. Children 5-12y Treatment

16. <5y Asthma Treatment

17. Spirometry Answers

18. William Gibson
Moderate COPD
Why?

19. Andrew Pell
Severe COPD
Why?

20. Eric Rowland
Moderate COPD
Why?

21. Nathan Nelder
Asthma
Why?

22. John Smith
Moderate COPD
Why?

23. Quiz Time! FEV1 and FEV1/FVC for diagnosis of COPD
FEV1% of 30-49% is………COPD
Restrictive pattern spirometry looks like…..
FEV1 of …….to use inhaled steroids in COPD
Example of generic name of starting inhaler for COPD symptoms
Step 4 of asthma treatment in children <5y
Inhaled steroid dose for children 5-12y in step 2 of asthma treatment
What do you add in step 3 of adult asthma treatment?

24. Things to look at further…
NICE guidelines COPD and asthma
BTS guidelines
Spirometry in practice
Gpnotebook.co.uk