Copd 2010

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pathophysiology

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Copd 2010

  1. 1. Chronic Obstructive Pulmonary Disease
  2. 2. Chronic Obstructive Pulmonary Disease <ul><li>A disease state characterised by airway obstruction that is not fully reversible </li></ul><ul><li>Includes chronic bronchitis and emphysema </li></ul><ul><li>Major contributor to the overall burden of disease & second only to stroke in NZ </li></ul><ul><li>3 rd cause of death for males & 4 th for females in NZ </li></ul><ul><li>50% die within 10yrs of diagnosis </li></ul><ul><li>Symptomatic during middle adult years </li></ul><ul><li>Incidence increases with age </li></ul>
  3. 3. Pathophysiology <ul><li>Includes </li></ul><ul><li>inflammation & fibrosis of bronchial wall </li></ul><ul><li>hypertrophy of submucosal glands </li></ul><ul><li>hypersecretion of mucous </li></ul><ul><li>loss of elastic lung fibres & alveolar tissue leading to airway collapse </li></ul><ul><li>All of the above result in obstruction of airflow </li></ul><ul><li>destruction of alveolar tissue decreases surface area for gas exchange </li></ul>
  4. 4. Chronic Bronchitis <ul><li>A disease of the airways </li></ul><ul><li>Presence of cough & sputum production for at least 3 months in each of 2 consecutive years </li></ul><ul><li>Smoke or other pollutants irritate airways, resulting in hypersecretion of mucous & inflammation </li></ul><ul><li>Constant irritation causes: </li></ul><ul><li>mucous-secreting glands & goblet cells to increase in number </li></ul><ul><li>reduction of ciliary function </li></ul><ul><li>Production of more mucous </li></ul>
  5. 5. Clinical Manifestations of Chronic Bronchitis <ul><li>Earliest symptoms: </li></ul><ul><li>Frequent productive cough during winter </li></ul><ul><li>Frequent respiratory infections </li></ul><ul><li>Bronchospasm can occur at end of paroxysms of coughing </li></ul><ul><li>Cough usually exacerbated by respiratory irritants or cold air </li></ul><ul><li>Dyspnoea on exertion </li></ul><ul><li>History of smoking is almost always present </li></ul><ul><li>Normal weight </li></ul><ul><li>Hypoxaemia and hypercapnia (Result from hypoventilation and  airway resistance in addition to problems with alveolar gas exchange) </li></ul>
  6. 6. Emphysema <ul><li>Carbon dioxide elimination is impaired resulting in hypercapnoea (excess CO2 in the blood) </li></ul><ul><li>As alveolar walls break down, pulmonary capillary bed is reduced </li></ul>
  7. 7. Structural Changes in Emphysema <ul><li>Hyperinflation of alveoli </li></ul><ul><li>Destruction of alveolar walls </li></ul><ul><li>Destruction of alveolar capillary walls </li></ul><ul><li>Narrowed, tortuous, small airways </li></ul><ul><li>Loss of lung elasticity </li></ul>
  8. 8. Clinical Manifestations of Emphysema <ul><li>Dyspnoea- initially on exertion & then on rest </li></ul><ul><li>Minimal coughing </li></ul><ul><li>No sputum or small amts of mucoid sputum </li></ul><ul><li>Barrel chest – alveoli over distended, air trapped </li></ul><ul><li>Pursed – lip breathing (expiration through pursed lips). Increases the resistance to the outflow of air & helps to prevent airway collapse by increasing airway pressure </li></ul><ul><li>‘ Chest breather’ – relying on intercostal & accessory muscles (ribs become fixed in inspiratory position) </li></ul><ul><li>Hypoxaemia (during exercise) & hypercapnoea later in disease </li></ul><ul><li>Underweight </li></ul>
  9. 10. Risk Factors for COPD <ul><li>Exposure to tobacco smoke (80%) </li></ul><ul><li>Passive smoking </li></ul><ul><li>Occupational exposure </li></ul><ul><li>Air pollution </li></ul><ul><li>Genetic abnormalities </li></ul>
  10. 11. Cigarette Smoking <ul><li>Nicotine acts as a stimulant to the sympathetic nervous system resulting in: </li></ul><ul><li>Increased HR </li></ul><ul><li>Increased peripheral vasoconstriction </li></ul><ul><li>Increased BP & cardiac workload </li></ul>
  11. 12. Cigarette Smoking <ul><li>Decreased ciliary activity </li></ul><ul><li>Possible loss of ciliated cells </li></ul><ul><li>Cellular hyperplasia </li></ul><ul><li>Production of mucous </li></ul><ul><li>Reduction of airway diameter </li></ul><ul><li>Increased difficulty in clearing secretions </li></ul>
  12. 13. Clinical Manifestations of COPD <ul><li>Cough, sputum production & dyspnoea on exertion </li></ul><ul><li>Symptoms worsen over time </li></ul><ul><li>Chronic cough & sputum production often precede development of airflow limitation by many years </li></ul><ul><li>Dyspnoea may be severe & interferes with ADLs </li></ul><ul><li>Weight loss – dyspnoea interferes with eating & work of breathing is energy depleting </li></ul><ul><li>Use of accessory muscles for breathing </li></ul>
  13. 15. Pathologies of COPD <ul><li>Emphysema </li></ul><ul><li>Hyperinflation of alveoli </li></ul><ul><li>Destruction of alveolar walls </li></ul><ul><li>Destruction of alveolar capillary walls </li></ul><ul><li>Narrow, small , tortuous airways </li></ul><ul><li>Loss of lung elasticity </li></ul><ul><li>Chronic Bronchitis </li></ul><ul><li>Inflammation </li></ul><ul><li>↑ in mucous-secreting glands & goblet cells </li></ul><ul><li>↓ ciliary function </li></ul><ul><li>-> more mucous </li></ul><ul><li>Bronchial walls thicken & narrow </li></ul><ul><li>Mucous can plug airway </li></ul><ul><li>Alveoli damaged ->altered function of macrophages -> more susceptible to resp infections </li></ul>
  14. 16. Comparison of Emphysema & Chronic Bronchitis <ul><li>Emphysema </li></ul><ul><li>Onset 30-40yrs </li></ul><ul><li>Thin </li></ul><ul><li>Marked weight loss </li></ul><ul><li>Generally healthy, insidious dyspnoea, smoking </li></ul><ul><li>Scanty mucoid sputum </li></ul><ul><li>Negligible cough </li></ul><ul><li>Chronic Bronchitis </li></ul><ul><li>Onset 20-30yrs </li></ul><ul><li>Tendency towards obesity </li></ul><ul><li>No weight loss </li></ul><ul><li>Recurrent URTI, smoking </li></ul><ul><li>Dyspnoea variable & late </li></ul><ul><li>Copious mucopurulent sputum </li></ul><ul><li>Considerable cough </li></ul>
  15. 17. COPD <ul><li>Emphysema </li></ul><ul><li>Dyspnoea- initially on exertion & then on rest </li></ul><ul><li>Minimal coughing </li></ul><ul><li>No sputum or small amts of mucoid sputum </li></ul><ul><li>Barrel chest – alveoli over distended, air trapped </li></ul><ul><li>Pursed – lip breathing </li></ul><ul><li>‘ Chest breather’ – relying on intercostal & accessory muscles </li></ul><ul><li>Hypoxaemia (during exercise) & hypercapnoea later in disease </li></ul><ul><li>Underweight </li></ul><ul><li>Chronic Bronchitis </li></ul><ul><li>Frequent productive cough </li></ul><ul><li>Frequent respiratory infections </li></ul><ul><li>Bronchospasm at end of coughing </li></ul><ul><li>Dyspnoea on exertion </li></ul>

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