COPD

• COPD: smoking, pollution and alph 1 antitrypsin deficiency (under 40ys, basal emphysema). Usually clinical diagnosis, PFT with no or limited <15% reversibility
• In moderate to sever COPD Prednisolone trial should be done: 30 mg daily should be given for 2 weeks, with measurements of lung function before and after the treatment period. If FEV1 increase > 15%, prednisolone should be discontinued and replaced by inhaled corticosteroids.

Long-term continuous domiciliary oxygen therapy will benefit patients who have:

A Pao2 of < 7.3 kPa (55 mmHg) when breathing air. Measurements should be taken on two occasions at least 3 weeks apart after appropriate bronchodilator therapy or

A Pao2 7.3–8 kPa with secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema or evidence of pulmonary hypertension.and

 Carboxyhaemoglobin of less than 3% (i.e. patients who have stopped smoking).

LTOT for 15h/day decrease Pulmonary pressure, 19h/day improve survival

• COPD Surgery, Some patients with large emphysematous bullae can benefit from bullectomy, selected patients with severe COPD (FEV1 < 1 L) may benefit from lung volume reduction surgery.

• Obstructive sleep apnea syndrome: The Epworth Sleepiness Scale then confirmed by oximetry and polysomnographic studies> The diagnosis of sleep apnoea/hypopnoea is confirmed if there are more than 10–15 apnoeas or hypopnoeas in any 1 hour of sleep. Management consists of correction of treatable factors, if necessary, nasal continuous positive airway pressure (CPAP) delivered by a nasal mask during sleep