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![Page 1: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/1.jpg)
![Page 2: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/2.jpg)
Pep Cañellas
CAP Balsareny
![Page 3: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/3.jpg)
![Page 4: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/4.jpg)
Moviment
• Variació respecte a una referència.
![Page 5: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/5.jpg)
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¡Y tenia corazon! (Enrique Simonet) 1890 Museo de Malaga
![Page 8: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/8.jpg)
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Símptomes compartits
MPOC i Insuficiència cardíaca
![Page 12: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/12.jpg)
Comorbilitat
Cardiopatia isquèmica
SAHS
HTA
DM2
COR Pulmonale
Poliglobulia
…
![Page 13: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/13.jpg)
Sospita clinica de MPOC: símptomes compatibles, fumador, > 40 anys
ESPIROMETRIA
FORÇADA Patró normal Patró no obstructiu
PATRO
OBSTRUCTIU
PBD -
No MPOC
revalorització
PBD +
MPOC
Revalorització, Registre domiciliari
del PEF, Tractament
(broncodilatadors i antiasmàtics)
Variabilitat negativa,
reversibilitat no total
Estudi de malaltia restrictiva
(DLCO), medició de volúms
estàtics (CPT, CRF, VR)
Variabilitat positiva
reversibilitat total
ASMA
Algoritme diagnòstic de la MPOC
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RADIOLOGIA
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ESPIROMETRIA
Major de 40 anys
Fumador o exfumador amb index igual o superior a 10 paquets-any
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La relació (en %) postbroncodilatació:
FEV1 / FVC
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Dona de 50 anys, fumadora. Consulta per tos
matinal desde fa 3 mesos.
![Page 18: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/18.jpg)
Dona de 50 anys, fumadora. Consulta per tos
matinal desde fa 3 mesos.
OBSTRUCTIU
Patró ventilatori
obstructiu lleuger
![Page 19: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/19.jpg)
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MPOC…
…o NO…
![Page 21: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/21.jpg)
MPOC…
…o NO…
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Home de 69 anys, ex-fumador, consulta per
dispnea d’esforç desde fa mesos.
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Home de 69 anys, ex-fumador, consulta per
dispnea d’esforç desde fa mesos.
No obstructiu
Patró ventilatori
no obstructiu
sever
Restrictiu??
![Page 24: Pep Cañellas - · PDF fileEmfisema Fibrosis Bronquitis Hiperreactivitat bronquial Bronquiectasies •DLCO (Atrapament) •FVC (Dispnea) •FEV1 •PBD + (Sibilants) •TCAR](https://reader031.fdocumento.com/reader031/viewer/2022013113/5a78c6497f8b9a21538d2e1a/html5/thumbnails/24.jpg)
FEV1
Símptomes
Lleu Moderada Greu Molt Greu
Tractament de la MPOC
Abandó del tabac, activitat física, vacunacions
Broncodilatadors sols o en combinació
Associar broncodilatadors i glucocorticoides
inhalats, Rehabilitació
Cirurgia
Oxígen domiciliari
Teofilina
Guia SEPAR-ALAT
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(C)
(D)
(A)
(B)
mMRC 0-1 mMRC ≥ 2
CAT < 10 CAT ≥ 10
Simptomes (mMRC o CAT)
4
3
2
1
≥ 2
1
0
Exac
erb
acio
ns
Gra
ve
tat
lim
ita
ció
flu
xe
ae
ri
GO
LD
GOLD 2011
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Pacient Caracteristiques Classific.
Espiro
Exacerba
cions/any
mMRC CAT
A Baix risc
Pocs simptomes
GOLD 1-2 ≤ 1 0-1 < 10
B Baix risc
Més simptomes
GOLD 1-2 ≤ 1 ≥ 2 ≥ 10
C Alt Risc
Pocs simptomes
GOLD 3-4 ≥ 2 0-1 < 10
D Alt risc
Més simptomes
GOLD 3-4 ≥ 2 ≥ 2 ≥ 10
GOLD 2011
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Escala de dispnea MRC
0. Absència de dispnea excepte al fer exercici intens.
1. Dispnea al caminar ràpid o al pujar una pendent poc
pronunciada
2. Incapacitat mantenir el pas d’altres persones de la
mateixa edat, caminant en pla, o haver d’aturar-se
en pla al propi pas
3.Haver d’aturar-se per descansar al caminar uns100m o
als pocs minuts de caminar en pla al propi pas
4. La dispnea impedeix sortir de casa o apareix amb
activitats com vestir-se o desvestir-se.
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WWW.CATestonline.org
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TOS
Questionari CAT
EXPECTORACIÓ
OPRESSIÓ
DISPNEA
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ACTIVITATS DOMÈSTIQUES
SORTIR DE CASA
DORMIR
ENERGIA
Questionari CAT
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Comorbilitat Caracteristica del pacient
Cardiopatia isquèmica SAHS
Osteoporosi Pèrdua de pes
Càncer de pulmo HTA DM2
Depressió Insuficiència respiratoria
COR Pulmonale Poliglobulia
…
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Diferents cares de la
MPOC
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MPOC (Fenotips: Caracteristica de malaltia)
Emfisema
Fibrosis
Bronquitis
Hiperreactivitat bronquial
Bronquiectasies
…
• DLCO (Atrapament)
• FVC (Dispnea)
• FEV1
• PBD + (Sibilants)
• TCAR (Expectoració)
• … Aguditzador (Infecció bronquial crònica?)
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FENOTIPS
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