COPD- A RESPIRATORY DISORDER

1. PREPARED BY – Sushmita Karna
BDS
B.P. Koirala Institute of Health Sciences(BPKIHS)

2. INTRODUCTION:-
 Definition:-
Preventable or curable, treatable disease characterized
by persistent airflow limitation that is usually
progressive and is associated with enhanced chronic
inflammatory response in the airway.
 Exacerbation and co – morbidities contribute to overall
severity in patients , commonly associated co-morbid
conditions include cardiovascular disease,
cerebrovascular disease , the metabolic syndrome
,osteoporosis , depression and lung cancer.

3. Introduction contd….
 Note: In medicine, co-morbidities means the presence
or occurrence of additional condition in the presence
of primary condition
 Prevalence of COPD is directly prevalence of risk
factor such as tobacco smoking, coal dust exposure,
age of the patient
 Cigarette smoking, is the most common and
significant factor causing COPD.

4. Contd….
 Two major COPD condition that are more common
are:
 Chronic bronchitis: condition with history of cough
and sputum for more than 2 years, provides no other
cause of cough and sputum is noted.
 Emphysema: irreversible destruction and enlargement
of airway distal to terminal bronchiole


5. Pathophysiology
 COPD has pulmonary and systemic components.
 Airflow limitation combined with premature closure
of airway , that leads to gas trapping and
hyperinflation, adversely affecting pulmonary and
chest wall compliance. Pulmonary hyperinflation
leads to flattened diaphragmatic muscles and leads to
increased horizontal alignment of intercostal muscle
placing respiratory at disadvantage i.e the work of
breathing is increased

6. Etiological factors(risk factor) of
COPD
Environmental:
1.Tobacco smoke: major cause of COPD.
2. Indoor air pollution : cooking, biomass fuel and other air
pollutants
3. Occupational : coal dust, silica, cadmium, husk
4. Low birth weight may reduce maximally attained lung function
in young adult life.
5.Lung growth: childhood infection, maternal smoking may affect
lung growth adversely and problem may arise in young adult life
6. Infection : may induce inflammation and damage associated
with decline in FEV1
7. Lower socio-economic status
8. Cannabis smoking

7. Etiological factors contd…
 Genetic factors: alpha –antitrypsin deficiency, other
COPD susceptibility genes are likely to be indentified
 Airway hypersensitivity

8. Clinical features of COPD
 COPD can be suspected in patient above 40 years , who has
symptoms of chronic bronchitis or/ and breathlessness
 Important symptoms are cough , sputum production and
exertional dyspnea, sputum is thick and mucoid, scanty .
May be streaking of sputum with blood.
 Chest sound reveals vesicular breath sound with prolonged
expiration, wheezing and crackles may be heard in the
lower zones.
 Patient with predominant emphysema show barrel shaped
chest, loss of cardiac , liver dullness and diminished
vascular breath sound

9. Clinical features contd…
 The use of accessory respiratory muscle , breathing with
pursed lips and lack of cyanosis characterises emphysema
(PINK PUFFERS)
CLINICAL SIGNS OF COPD:
General:-
1. Cyanosis
2. Signs of rt. Heart failure
Pedal emphysema, raised JVP, hepatomegaly , ascitis,
3. Signs of CO2 retension :
Flapping tremor, bounding pulse obtundation , pursed lips
wasting and weight loss

10. Repiratory clinical symptoms for
COPD
 Use of accessory muscle of respiration
 In-drawing of intercoastal muscle during respiration,
also called Hoover’s sign.
 Increased AP diameter of chest
 Loss of cardiac dullness and liver dullness
 Prolonged expiratory phase
 Generalised wheeze
 Crackles at the base

11. Investigation
 Pulmonary function test : airway obstruction without
significant reversal is the hallmark of COPD diagnosis
 FEV1<80% and FEV1/VC <70% indicates COPD, lung
volume increases due to air trapping
 Chest x-ray : bullae formation, hyper-translucent lung
fields, flattened diaphragm prominent pulmonary arterial
shadow , x-ray is also helpful in ruling out other condition
 Serum alpha 1 antitrypsin level should be measured in the
young patient with history of COPD
 Arterial blood gas analysis reveals hypoxemia and
hypercarbia i.e. low PO2 and high PCO2 repectively

12. Complications
 1. pneumothorax due to rupture of bullae
 2.repiratory failure (type II) and
 Cor pulmonale

13. Treatment
 Two phases of treatment of COPD
1. Chronic stable phase
2. Acute excerbation
 Chronic phase:
 Smoking cessation : bupropion or nicotine replace
therapy are employed
 Oxygen therapy : long term of oxygen therapy at home is
required in patient with PO2 <55mmHg or 50-60mmHg
. Patient with is partial pressure of oxygen may have
Hypotension, heart failure, polycythemia, where oxygen
concerntration is low atleasr for 15 hours a day .

14. Treatment of chronic contd
DRUGS:
 Bronchiodilators:
 Given for sympathetic relief. Anti cholinergic agent are used in
the form of inhaler, beta – agonists like sulbutamol are also used
, oral theophylline is used to increase exercise tolerance and
help in improving quality of life in COPD patients.
 Corticosteroids : inhaled corticosteroids has shown to decrease
acute exacerbation, however oral dose of corticosteroids
contraindicated.
 Antibiotics can also be used as there are many exacerbation
caused by micro-organism. Mainly the infection is by
S.pneumoniae
 Pulmonary rehabilitation and exercise improves dyspnea


15. Treatment of chronic phage
contd….
 Lung volume reduction in patient with emphysema
 Surgerical ressection required in patient with large
bullae
 Severe COPD may need lung transplant

16. Acute Exacerbation treatment
 Acute exacerbation of COPD is characterised by presence of cough,
breathelessness , production of high volume of purulent sputum and
sometimes heartfailure.
 Cyanosis
 Acute exacerbation can be differentiated from others based on the
onset of dyspnea.
Mostly requires hospitalization . The steps of treatment of A.E. of
COPD includes .
1. Oxygen therapy
2. Antibiotic to treat infection
3. Bronchiodilators
4. Oral corticosteroid in low amount
5. Diuretics in case of increase of jugular venous pressure( JVP) and
edema
6. Mechanical ventricular support is given

17. Differential diagnosis of COPD
 Pneumonia
 Pneumothorax
 Left ventricular failure
 Pulmonary embolism
 Acute airway obstruction

18. References
1. Davidson’s Principle and Practice of Medicine,23rd
edition
2. Essential of Medicine for Dental Students, Anil Kr.
Tripathi, 2nd edition