1. step 11
1.1. Review and evaluate
1.2. Group members
1.3. Chairman
1.4. Scribe
1.5. Tutor
1.6. Material
1.7. 10 minutes
2. Step 9
2.1. Review session 2
2.2. visualize the data and theory
2.2.1. chronic smokers
2.2.1.1. more irritation and more mucus secretions and mucus gland hyperatrophy
2.2.1.1.1. lead to COPD
2.2.1.1.2. viral infections due to the increase amount of mucus secretions
2.3. learning objective from last session
2.3.1. moraxella catarrhalis
2.3.1.1. why patient is not fibril, and CBC is normal?
2.3.1.1.1. because it is a normal flora of the body
2.3.1.2. gram negative, dipplococci,
2.3.1.3. affecets COPD
2.3.1.4. irritates the airways caused the exacerbation
2.3.1.5. peak colonization after two years
2.3.1.6. second bacterial most common of exacerbating of COPD
2.3.1.7. us annually 2- 4 patient of COPD comes with this infection
2.3.1.8. the immune reaction is age dependent
2.3.1.8.1. causes otitis in children
2.3.1.9. high risk in immune compromised
2.3.2. types respiratory failure
2.3.2.1. type 1
2.3.2.1.1. hypoxia
2.3.2.2. type 2
2.3.2.2.1. hypoxia and hypercapnia
2.3.2.2.2. decreased oxygen and increased carbon dioxied
2.3.2.2.3. more risky
2.3.2.2.4. reduction in the ventalation rate
2.3.2.2.5. cyanosis
2.3.2.2.6. decrease the muscle conractility
2.3.2.2.7. caused by COPD , asthma , flial chest and kyphscoliosis
2.4. 20 minutes
3. Step 10
3.1. Management (for the individual)
3.1.1. short term
3.1.1.1. oxygen therapy
3.1.1.1.1. 24% oxygen
3.1.1.1.2. mechanical ventilation in case of acidosis NPPV
3.1.1.1.3. reduce the mortality 50 %
3.1.1.1.4. the goal is to reach 88-90 %
3.1.1.2. for the infection(antibiotics)
3.1.1.2.1. start with broadspectrum antibiotics
3.1.1.2.2. agumantin
3.1.1.2.3. H.influenza
3.1.1.2.4. doxacyclin
3.1.1.2.5. exacerbation increase by pollution or weather and antibiotics could be helpfull
3.1.1.2.6. second line is better like azthromycun
3.1.1.3. bronchodialators
3.1.1.3.1. sabutamol
3.1.1.3.2. ipotropuim
3.1.1.3.3. for symptoms improvment
3.1.1.3.4. side effect like termers
3.1.1.3.5. combination therapy is recommended
3.1.1.4. systemic corticosteroids
3.1.1.4.1. predinisolone
3.1.1.4.2. can take IV drug
3.1.2. medim
3.1.2.1. heparin to prevent thromboembolism
3.1.2.2. pulmonary rehabilitaion
3.1.2.2.1. education
3.1.2.2.2. excercise, walk
3.1.2.2.3. breathing excercising
3.1.2.2.4. nutrition
3.1.2.2.5. high carbon diet increase CO2
3.1.2.2.6. respiratory muscle improvement
3.1.3. long
3.1.3.1. goals
3.1.3.1.1. prevent exacerbation
3.1.3.1.2. improve lung function
3.1.3.2. theyphyllines
3.1.3.2.1. fourth line mangement
3.1.3.3. STOP SMOKING
3.1.3.3.1. use a councler
3.1.3.3.2. nicotin patch
3.1.3.4. vaccinations
3.1.3.4.1. pneumococcal
3.1.3.4.2. influenza
3.1.3.5. surgery
3.1.3.5.1. bullaeectomy
3.1.3.5.2. lung transplantation
3.1.3.5.3. LVRS
3.1.3.6. diuretics
3.1.3.7. continuation of bronchodialators
3.1.3.7.1. inhaled corticosteroid
3.1.3.7.2. short acting b 2 agonst when needed
3.1.3.8. prevent infection
3.1.3.8.1. hygiene
3.1.3.8.2. stay a way at high season
3.1.3.9. antibiotics
3.1.3.9.1. like azethromycine
3.1.3.10. antimucolytics agents
3.2. Prevention (for the population)
3.2.1. education about smoking
3.2.1.1. possible effects of smoking
3.2.1.2. either from the beggning or those smoker to stop
3.2.1.3. go to councel and the use of pharmacological therpay
3.2.2. occupational dust and work with chemical
3.2.2.1. should be educated
3.2.3. educate COPD patient about heart problem
3.2.4. campaign about smoking
3.2.5. educate COPD about exacerbation factors
3.2.6. educate about high altitude and different oxygenation in COPD
3.2.6.1. like traveling by plane or to mountain cities
3.2.7. free screening
3.2.8. changing in bad habits
3.2.9. nutrition and its effect on COPD
3.2.10. osteoprosis