2. Chronic Obstructive
Pulmonary Disease (COPD)
is a preventable treatable slowly progressive respiratory
disease of airflow obstruction involving the airways,
pulmonary parenchyma, or both.
COPD may include diseases that cause airflow obstruction
(e.g., emphysema, chronic bronchitis) or any combination
of these disorder. Other diseases such as cystic fibrosis
(CF), bronchiectasis, and asthma are classified as chronic
pulmonary disorders.
While COPD and lower respiratory diseases are the fourth
leading cause of death of people of all ages in the US,
they are the third leading cause of death for people ages
65 and over.
3. Pathophysiology
People with COPD commonly become symptomatic during the middle
adult years, and the incidence of the disease increases with age.
In COPD, the airflow limitation is both progressive and associated with
the lungs’ abnormal inflammatory response to noxious particles or gases.
The inflammatory response occurs throughout the proximal and peripheral
airways, lung parenchyma, and pulmonary vasculature
Because of the chronic inflammation and the body’s attempts to repair it,
changes and narrowing occur in the airways.
In the proximal airways, changes include increased number of goblet cells
and enlarged submucosal glands, both of which lead to hypersecretion of
mucus
In the peripheral airways, inflammation causes thickening of the airway
wall, peribronchial fibrosis, exudate in the airway, and overall airway
narrowing.
4. Pathophysiology
Overtime, this ongoing injury-and-repair process causes scar tissue
formation and narrowing of the airway lumen.
Finally, the chronic inflammatory process affects the pulmonary
vasculature and causes thickening of the lining of the vessel and
hypertrophy of smooth muscle, which may lead to pulmonary
hypertension.
Processes related to imbalances of substances in the lung may also
contribute to airflow limitation.
5.
6. Chronic Bronchitis
COPD
a disease of airways, is
defined as the
presence of cough and
sputum production for
at least 3 months in
each of 2 consecutive
years
Constant irritation
causes the mucus -
secreting and goblet
cells to increase in
number
Bronchial walls also
become thickened,
further narrowing the
bronchial lumen.
8. Emphysema
COPD
is a pathologic term that
describes an abnormal
distention of the
airspaces beyond the
terminal bronchioles
and destruction of the
walls of the alveoli
9. Two main types of Emphysema, based on the changes taking place in the lung:
(Both types may occur in the same patient)
Take place mainly in the
center of the secondary
lobule, preserving the
peripheral portions of the
acinus
This leads to central
cyanosis and respiratory
failure
The patient also develops
peripheral edema
Centrilobular
There is a destruction of the
respiratory bronchiole, alveolar
duct, and alveolus
All airspaces within the lobule
are essentially enlarged, but
there is little inflammatory
disease
A hyperinflated chest, marked
by dyspnea on exertion, and
weight loss typically occurs
Panlobular
11. Management of Patient with Chronic Pulmonary Disease
Risk Factors
Environmental exposures and host factors:
Exposure to tobacco smoke accounts for an estimated 80 - 90 %
of cases of chronic obstructive pulmonary disease
Secondhand smoke
Increased age
Occupational exposure - dust, chemicals
Indoor and outdoor air pollution
Genetic abnormalities, including a deficiency of Alpha1-
antitrypsin, an enzyme inhibitor that normally counteracts the
destruction of lung tissue by certain other enzymes
Other environmental risk factors for COPD:
Other types of tobacco (e.g., pipes, cigars) and marijuana
Prolonged and intense exposure to occupational dust and chemicals
Indoor and outdoor air pollution
12. Management of Patient with Chronic Pulmonary Disease
It is generally a progressive disease characterized by
three primary symptoms: Chronic Cough
Sputum Production
Dyspnea
1.
2.
3.
Weight Loss
Patients with COPD who have a primary emphysematous
component, chronic hyperinflation leads to the “barrel
chest” thorax configuration Retraction of the
superclavicular fossae occurs on inspiration, causing the
shoulders to heave upward
Metabolic disturbances and depression
Clinical manifestations
13. Management of Patient with Chronic Pulmonary Disease
assessment and diagnostic findings
Health History
Physical Assessment
Spirometry
Arterial Blood Gas
Chest X-ray
CT chest scan
Screening for alpha1-
antitrypsin
Pulmonary function test
( four grades depending on the severity)
14. Management of Patient with Chronic Pulmonary Disease
Respiratory insufficiency and failure and major life-threatening
complications of COPD
Acute Respiratory insufficiency and failure may necessitate
ventilatory support until other acute complications, such as
infection, can be treated
Other complications”: Pneumonia, Chronic Atelectasis,
Pneumothorax, and Pulmonary Arterial Hypertension
complications
15. Medical Management | RISK REDUCTION
Smoking cessation
is the single most
cost - effective
intervention to
reduce the risk of
developing COPD
and to stop its
progression
Medical management
Smoking cessation
can begin in a
variety of health
core settings
Risk Reduction
16. Medical Management | OXYGEN THERAPY
is the administration
of oxygen at a
concentration
greater than that
found in the
environmental
atmosphere
Oxygen Therapy
To provide
adequate transport
of oxygen in the
blood while
decreasing the
work of breathing
and reducing stress
on the mycocardium
17. Oxygen Therapy
A change in the patient’s
respiratory rate or pattern
may be one of the earliest
indicators of the need for
oxygen therapy
These changes may result
from hypoxemia or hypoxia
The need for oxygen is
assessed by arterial blood
gas analysis, pulse oximetry,
and clinical evaluation
indications complications
In terms of oxyhemoglobin
dissociation curve, arterial
hemoglobin at these levels
is 80% to 98% saturated
with oxygen
Oxygen toxicity may occur
when too high
concentration of oxygen is
given for an extended
period
Medical Management | OXYGEN THERAPY
18. Oxygen Therapy
Oxygen is dispensed from a
cylinder or a piped-in system
The use of oxygen concentrators
is another means of providing
varying amounts of oxygen,
especially in the home setting.
These devices are relatively
portable, easy to operate, and
cost - effectivebut require more
maintenance
Methodsof
oxygen
administration
Gerontologic
considerations
As the respiratory
muscles weaken and the
large bronchi and alveoli
become enlarged, the
available surface of the
lungs decreases,
resulting in reduced
ventilation and
respiratory gas
exchanged
Medical Management | OXYGEN THERAPY
19. Medical Management | OXYGEN THERAPY
Low-flowsystems
Different oxygen devices
Cannula
(nasal and reservoir)
(oropharyngeal) catheter
Nasal Mask, simple
20. Medical Management | OXYGEN THERAPY
Low-flowsystems
Different oxygen devices
Mask, partial
breathing
Mask, nonbreathing
21. Medical Management | OXYGEN THERAPY
high-flowsystems
Different oxygen devices
Mask, Venturi
Transtracheal oxygen
catheter
Mask, aerosol
22. Medical Management | OXYGEN THERAPY
high-flowsystems
Different oxygen devices
Trancheostomy collar
T - piece Face Tent
23. Medication regimens used to
manage COPD are based on
disease severity:
pharmacologic therapy
For Grade I (mild)
COPD, a short
acting
bronchodilator
may be prescribed
For Grade II or II
(moderate to severe)
COPD, a short acting
bronchodilator and
regular treatment with
one or more long-
acting bronchodilators
may be used
For Grade III or IV (severe
or very severe) COPD,
medication therapy includes
regular treatment with long-
acting bronchodilators
and/or inhaled
corticosteroids(ICSs) for
repeated exacerbations
Management of Patient with Chronic Pulmonary Disease
24. pharmacologic therapy
Bronchodilators
Long-acting bronchodilators
are more convenient for
patients to use
are typically used for
maintenance treatment for
long-term symptom
control
Short-acting bronchodilators
are usually used for acute
management of
symptomattic flairs
Pressurized metered-dose
inhalers (pMDIs)
contained aerosolized
powder of medications
Dry-powder inhalers (DPIs)
rely solely on the patient’s
inspiration for medication
deliveryy
Small-volume nebulizer (SVN)
handled with apparatus
that is easier to use than a
pMDI or a DPI but lacks the
convenience of these
inhalers as it requires a
power source in order to
operate
Management of Patient with Chronic Pulmonary Disease
26. Management of Patient with Chronic Pulmonary Disease
surgical management
BULLECTOMY
is a surgical option for select
patients with bullous
emphysema
it may help to reduce
dyspnea and improve lung
function
27. Management of Patient with Chronic Pulmonary Disease
surgical management
lungvolume
reductionsurgery
treatment options for patients with
advanced or end-stage COPD with a
primary emphysematous component
are limited, although lung volume
reduction surgery is a palliative
surgical option
28. Management of Patient with Chronic Pulmonary Disease
surgical management
LUNGTRANSPLANTATION
is a viable option for definitive
surgical treatment of severe
COPD in select patients
29. Management of Patient with Chronic Pulmonary Disease
surgical management
PULMONaryrehabilitaTION
one of the most cost-effective
treatment strategies, is a holistic
intervention aimed at improving
physical and psychological health of
patients with COPD
