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By – Dr. Unique Sharma – 2nd year M.D.
Guide - Dr. Muralidhar P. Pujar , Professor
Dept. of Panchakarma
3/24/2018 1
• Introduction
• Aetio – Pathogenesis
• Pathogenesis
• Risk factors
• Symptoms
• Physical signs
• Clinical Manifestation
• Diaganosis
• Lab. Investigations
• Management
3/24/2018 2
• Definition – The global initiative for Chronic obstructive lung
disease(COLD) defines COPD as a disease characterized by
progressive development of chronic airflow limitation that is
not fully reversible and is used to describe a number of
conditions, which include Chronic bronchitis, emphysema and
small airway disease
• In India, COPD is the second most common lung disorder after
pulmonary tuberculosis.
• The disease is frequently encountered in the middle aged
patients and is rare below the 35 years.
• COPD affects male more frequently because of smoking and is
a leading cause of chronic morbidity and mortality among
patients over 55 year.
3/24/2018 3
• It is equally prevalent in rural and urban areas.
• In Ayurveda respiratory diseases occur due to involvement of
Pranavaha Srotas where cough, breathing difficulties, disturbed
respiratory pattern occurs.
• Though it is impossible to correlate COPD with any single
condition of Pranavaha Sroto Dushti, but advanced condition
of Doshika Kasa and Tamaka Shvasa may result into COPD.
3/24/2018 4
1) Chronic Bronchitis
2) Emphysema
3/24/2018 5
• Defined as chronic productive cough for three months in each
of two successive years in a patient in which other cause of
chronic cough have been excluded.
3/24/2018 6
• Abnormal and permanent enlargement of the airspaces distal to
the terminal bronchioles that is accompanied by the destruction
of the airspace walls, without obvious fibrosis.
3/24/2018 7
3/24/2018 8
• Faulty diet and life style patterns form the basis of
pathogenesis of any disease as per Ayurveda.
• Etiological factor of COPD mentioned in classical and modern
literature include diet articles, food habits and life style errors.
3/24/2018 9
Diet Excessive intake of kidney beans, black
gram oil, sesam oil, white flour prepations,
tubers, curd, unboiled milk, aquatic and
marshy meat or any dietic articles difficult
to digest causing indigetion
Dietic Habits Irregular and untimely eating of food
(Vishamashana).
Life Style Exposure to dust, fume, smoke, wind,
residing in cold place and using cold
water, reduced physical exertion or over
exertion, day time sleep, irregular or
reversed sleep pattern
Other Injury to vital parts
3/24/2018 10
Smoki
ng
Air
Wall
inflam
mation
Hypert
rophy
of
mucus
secreti
ng
glands
Increas
e in
numbe
r of
goblet
cells in
bronch
i
decrease
number
of
ciliated
cells
increase
d
mucous
transport
become
less
Airway
obstruc
tion
and
loss of
pulmo
nary
elastici
ty
COPD
3/24/2018 11
Nidana sevana
Vitiated prana and
udana situated in
pranavaha srotas
enforces kapha
Resulting in
obstruction of
channels of the
pranavaha
3/24/2018 12
3/24/2018 13
• The characteristic symptoms of COPD are chronic and
progressive dyspnea, cough, and sputum production that can be
variable from day to day.
• Dyspnea :- Progressive , persistent and characteristically worse
with exercise
• Chronic cough :- May be intermittent and may be unproductive
• Chronic sputum production :- COPD patients commonly cough
up sputum
3/24/2018 14
• Wheezing
• Chest tightness
• Weight loss
• Respiratory infections
3/24/2018 15
3/24/2018 16
• INSPECTION
 Barrel – shaped chest
 Accessory respiratory muscle participate
 Prolonged expiration during quite breathing
 Expiration through pursed lips
 Paradoxical retraction of the lower interspaces during
inspiration ( i.e. hoovers’s sign )
 Tripod position
3/24/2018 17
3/24/2018 18
3/24/2018 19
• Palpation :-
 Decreased fermitus vocalis
• Percussion :-
 Hyperresonant
 Depressed diaphragm
 Dimination of the area of absolute cardiac dulness
• Auscultation :-
 Prolonged expiration
 Reduced breath sounds
 The presence of wheezing during quite breathing
 Crackle can be heard if infection exists
3/24/2018 20
3/24/2018 21
• The presence of a post-bronchodilator FEV1/FVC < 0.70
confirms the presence of persistent airflow limitation and thus
of COPD.
3/24/2018 22
3/24/2018 23
3/24/2018 24
3/24/2018 25
3/24/2018 26
• Marked over inflation is noted with flattened and low
diaphragm
• Intercostal space becomes widen
• A horizontal pattern of ribs
• A thin heart shadow
• Decreased markings of lung peripheral vessels
3/24/2018 27
3/24/2018 28
3/24/2018 29
• Blood Examination :-
 In excerbation or acute infection in airway, leucoctes may be
detected
• Sputum Examination :-
 Streptococcus pneumonia
 Haemophilus influenzae
 Moraxella catarrhalis
 Klebsiella pneumonia
3/24/2018 30
1) Nidanaparivarjana (Avoiding etiological factors)
2) Shodhana (Biopurifactory methods)
3) Shamana (Pacification treatment)
3/24/2018 31
• Find out the causative factor for COPD in individual, such
as to stop smoking, taking appropriate precaution in
certain type of occupational environment, avoiding close
contact with people suffering from respiratory infection,
exposure to excessive heat, cold and high altitudes,
exposure to environmental irritants and day sleep
3/24/2018 32
• Exercising regularly, taking fresh, warm diet which is low in
saturated fat but rich in fruits, vegetables, and whole grain
foods and maintaining a normal weight, to be in well ventilated
hygienic environment.
• Nasya of two drops of Anutaila / Shadbindu Taila in each
nostrils daily may prevent coming in contact with irritant or
pollutant with the nasal mucosa.
• Waking up early in the morning at regular time and taking glass
of warm water early morning empty stomach and avoiding
Irregular and untimely eating of food may help to prevent
complication of COPD
3/24/2018 33
• Use of Katu, Lavana, Ushna, Snigdha, Laghu, Ahara,
vegetables including of gourd, bottle gourd, Spinach, Methi,
garlic, ginger, Karvellaka, Patola, Shigru and pulses like
Mudaga daal, Kulatha should be encouraged in the patients of
COPD.
• Excessive use of tomato, cauli flower, potatoes, preparation of
rice flour, sweets, curd, whole milk, black gram, coconut oil,
fermented and sour food articles and cold drinks, refrigerated
food articles etc. shall be avoided in the daily diet.
3/24/2018 34
• Timely and seasonal Shodhana (biopurification)should be
performed in accordance with the patients strength like strong
patients may undergo Vamana, Virechana, and Niruha basti as
well as Nasya therapy in a appropriate seasons. These type of
therapies alleviate Kapha and may dry up excess mucous
secretions in the Pranavaha Srotasa(respiratory system).
3/24/2018 35
• Single drugs: Ardraka, Ela, Haridra, Trikatu, Pippali,
Ashvagandha, Agnimantha, Ajmoda, Ajaji, Guduchi, Ativisha,
Aragvadha, Karanjabija, Daruharidra, Lashuna,Rasona, Hingu.
• Preparations: Kaphketurasa, Gojihvadi Kvatha, Dashmula
Kvatha, Chitraka Haritaki Avleha, Choshath Prahari Pippali,
Tamra Bhasma, Mahalakshmi Vilas Rasa, Loknath Rasa,
Vyoshadi Churna, Sarpi Guda, Shringyadi Churna, Haritakyadi
Modaka, Pippalyadi Gutika, Sitopaladi Churna, Talishadi
Churna, Vyaghri Haritaki Avaleha.
• Rasayana: Pippali Rasayana, Chyavanaprasha, Agtsya Haritaki
, Vyaghri Haritaki, Haridra Khanda, Ashwagandha, Guduchi
etc. can be used as Rasayana.
3/24/2018 36
• Pranayama :- Kapalabhati
• Yoga :- Bhujangasana, Savasana, Shalabhasana,
Paschimotasana are useful Asana for Pranavaha Srotas
as it accelerates the blood circulation of the lungs and
thus increase the vital capacity of lung.
3/24/2018 37
• COPD being a chronic progressive disease with irreversible
changes needs early diagnosis and proper management. An
extra care of diet, diet-pattern modifications and life style
modifications with judicious use of Rasayana can play major
role in the prevention or progresion of COPD.
3/24/2018 38
3/24/2018 39

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Chronic Obstructive Pulmonary Disorder

  • 1. By – Dr. Unique Sharma – 2nd year M.D. Guide - Dr. Muralidhar P. Pujar , Professor Dept. of Panchakarma 3/24/2018 1
  • 2. • Introduction • Aetio – Pathogenesis • Pathogenesis • Risk factors • Symptoms • Physical signs • Clinical Manifestation • Diaganosis • Lab. Investigations • Management 3/24/2018 2
  • 3. • Definition – The global initiative for Chronic obstructive lung disease(COLD) defines COPD as a disease characterized by progressive development of chronic airflow limitation that is not fully reversible and is used to describe a number of conditions, which include Chronic bronchitis, emphysema and small airway disease • In India, COPD is the second most common lung disorder after pulmonary tuberculosis. • The disease is frequently encountered in the middle aged patients and is rare below the 35 years. • COPD affects male more frequently because of smoking and is a leading cause of chronic morbidity and mortality among patients over 55 year. 3/24/2018 3
  • 4. • It is equally prevalent in rural and urban areas. • In Ayurveda respiratory diseases occur due to involvement of Pranavaha Srotas where cough, breathing difficulties, disturbed respiratory pattern occurs. • Though it is impossible to correlate COPD with any single condition of Pranavaha Sroto Dushti, but advanced condition of Doshika Kasa and Tamaka Shvasa may result into COPD. 3/24/2018 4
  • 5. 1) Chronic Bronchitis 2) Emphysema 3/24/2018 5
  • 6. • Defined as chronic productive cough for three months in each of two successive years in a patient in which other cause of chronic cough have been excluded. 3/24/2018 6
  • 7. • Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles that is accompanied by the destruction of the airspace walls, without obvious fibrosis. 3/24/2018 7
  • 9. • Faulty diet and life style patterns form the basis of pathogenesis of any disease as per Ayurveda. • Etiological factor of COPD mentioned in classical and modern literature include diet articles, food habits and life style errors. 3/24/2018 9
  • 10. Diet Excessive intake of kidney beans, black gram oil, sesam oil, white flour prepations, tubers, curd, unboiled milk, aquatic and marshy meat or any dietic articles difficult to digest causing indigetion Dietic Habits Irregular and untimely eating of food (Vishamashana). Life Style Exposure to dust, fume, smoke, wind, residing in cold place and using cold water, reduced physical exertion or over exertion, day time sleep, irregular or reversed sleep pattern Other Injury to vital parts 3/24/2018 10
  • 11. Smoki ng Air Wall inflam mation Hypert rophy of mucus secreti ng glands Increas e in numbe r of goblet cells in bronch i decrease number of ciliated cells increase d mucous transport become less Airway obstruc tion and loss of pulmo nary elastici ty COPD 3/24/2018 11
  • 12. Nidana sevana Vitiated prana and udana situated in pranavaha srotas enforces kapha Resulting in obstruction of channels of the pranavaha 3/24/2018 12
  • 14. • The characteristic symptoms of COPD are chronic and progressive dyspnea, cough, and sputum production that can be variable from day to day. • Dyspnea :- Progressive , persistent and characteristically worse with exercise • Chronic cough :- May be intermittent and may be unproductive • Chronic sputum production :- COPD patients commonly cough up sputum 3/24/2018 14
  • 15. • Wheezing • Chest tightness • Weight loss • Respiratory infections 3/24/2018 15
  • 17. • INSPECTION  Barrel – shaped chest  Accessory respiratory muscle participate  Prolonged expiration during quite breathing  Expiration through pursed lips  Paradoxical retraction of the lower interspaces during inspiration ( i.e. hoovers’s sign )  Tripod position 3/24/2018 17
  • 20. • Palpation :-  Decreased fermitus vocalis • Percussion :-  Hyperresonant  Depressed diaphragm  Dimination of the area of absolute cardiac dulness • Auscultation :-  Prolonged expiration  Reduced breath sounds  The presence of wheezing during quite breathing  Crackle can be heard if infection exists 3/24/2018 20
  • 22. • The presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD. 3/24/2018 22
  • 27. • Marked over inflation is noted with flattened and low diaphragm • Intercostal space becomes widen • A horizontal pattern of ribs • A thin heart shadow • Decreased markings of lung peripheral vessels 3/24/2018 27
  • 30. • Blood Examination :-  In excerbation or acute infection in airway, leucoctes may be detected • Sputum Examination :-  Streptococcus pneumonia  Haemophilus influenzae  Moraxella catarrhalis  Klebsiella pneumonia 3/24/2018 30
  • 31. 1) Nidanaparivarjana (Avoiding etiological factors) 2) Shodhana (Biopurifactory methods) 3) Shamana (Pacification treatment) 3/24/2018 31
  • 32. • Find out the causative factor for COPD in individual, such as to stop smoking, taking appropriate precaution in certain type of occupational environment, avoiding close contact with people suffering from respiratory infection, exposure to excessive heat, cold and high altitudes, exposure to environmental irritants and day sleep 3/24/2018 32
  • 33. • Exercising regularly, taking fresh, warm diet which is low in saturated fat but rich in fruits, vegetables, and whole grain foods and maintaining a normal weight, to be in well ventilated hygienic environment. • Nasya of two drops of Anutaila / Shadbindu Taila in each nostrils daily may prevent coming in contact with irritant or pollutant with the nasal mucosa. • Waking up early in the morning at regular time and taking glass of warm water early morning empty stomach and avoiding Irregular and untimely eating of food may help to prevent complication of COPD 3/24/2018 33
  • 34. • Use of Katu, Lavana, Ushna, Snigdha, Laghu, Ahara, vegetables including of gourd, bottle gourd, Spinach, Methi, garlic, ginger, Karvellaka, Patola, Shigru and pulses like Mudaga daal, Kulatha should be encouraged in the patients of COPD. • Excessive use of tomato, cauli flower, potatoes, preparation of rice flour, sweets, curd, whole milk, black gram, coconut oil, fermented and sour food articles and cold drinks, refrigerated food articles etc. shall be avoided in the daily diet. 3/24/2018 34
  • 35. • Timely and seasonal Shodhana (biopurification)should be performed in accordance with the patients strength like strong patients may undergo Vamana, Virechana, and Niruha basti as well as Nasya therapy in a appropriate seasons. These type of therapies alleviate Kapha and may dry up excess mucous secretions in the Pranavaha Srotasa(respiratory system). 3/24/2018 35
  • 36. • Single drugs: Ardraka, Ela, Haridra, Trikatu, Pippali, Ashvagandha, Agnimantha, Ajmoda, Ajaji, Guduchi, Ativisha, Aragvadha, Karanjabija, Daruharidra, Lashuna,Rasona, Hingu. • Preparations: Kaphketurasa, Gojihvadi Kvatha, Dashmula Kvatha, Chitraka Haritaki Avleha, Choshath Prahari Pippali, Tamra Bhasma, Mahalakshmi Vilas Rasa, Loknath Rasa, Vyoshadi Churna, Sarpi Guda, Shringyadi Churna, Haritakyadi Modaka, Pippalyadi Gutika, Sitopaladi Churna, Talishadi Churna, Vyaghri Haritaki Avaleha. • Rasayana: Pippali Rasayana, Chyavanaprasha, Agtsya Haritaki , Vyaghri Haritaki, Haridra Khanda, Ashwagandha, Guduchi etc. can be used as Rasayana. 3/24/2018 36
  • 37. • Pranayama :- Kapalabhati • Yoga :- Bhujangasana, Savasana, Shalabhasana, Paschimotasana are useful Asana for Pranavaha Srotas as it accelerates the blood circulation of the lungs and thus increase the vital capacity of lung. 3/24/2018 37
  • 38. • COPD being a chronic progressive disease with irreversible changes needs early diagnosis and proper management. An extra care of diet, diet-pattern modifications and life style modifications with judicious use of Rasayana can play major role in the prevention or progresion of COPD. 3/24/2018 38