By David Bellamy

COPD (the spectrum of ailments together with power bronchitis, emphysema, long-standing irreversible bronchial asthma and small airlines affliction) is among the most typical and demanding breathing problems noticeable in fundamental care. This up-to-date 3rd version indicates the way to deal with COPD in fundamental care - effectively and with helpful results on your sufferers.

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Example text

When airflow through the airways is obstructed, less air can be exhaled in the first second and the FEV1/FVC ratio falls. Levels below 70% indicate airflow obstruction. 1. 1). The FEV1 is very reproducible and varies by less than 120ml between blows if the test is carried out correctly. The FVC can show more variation, as it will depend on how hard the subject tries to blow the last remaining air out of the lungs. 3 Severe obstruction Another extra manoeuvre, in addition to the forced expiratory manoeuvre discussed above, is the relaxed or slow vital capacity (VC), in which the patient blows out at their own pace after maximal inhalation.

5 Histology showing the loss of the ‘guy ropes’, resulting in airway collapse reduces the capacity to exchange oxygen and carbon dioxide in the lungs. In the early stages of the disease the body is able to compensate for this loss by increasing the respiratory drive. As the disease progresses, however, the ability to compensate successfully diminishes and the blood gases become persistently abnormal, with serious consequences. When the respiratory drive is responsive, abnormalities of blood gases will result in an increase in both respiratory drive and respiratory rate.

The genetics of COPD is being investigated intensively. Chronic asthma Asthma is defined as: ‘a chronic inflammatory condition of the airways . . in susceptible individuals inflammatory symptoms are usually associated with widespread, but variable, airflow obstruction and an increase in airway response to a variety of stimuli. ’ Long-standing asthma may result in permanent damage to the airways and subsequent loss of that reversibility. Long-standing bronchial hyper-reactivity can cause hypertrophy of the bronchial smooth muscle, just as skeletal muscles will hypertrophy if exercised regularly.

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