COPD DESCRIPTION AND EXPLAINATION

1. CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
MOORTHI ABINAYA

2. DEFINITION
• Chronic obstructive pulmonary disease (COPD) is a syndrome characterized by
chronic airflow obstruction. COPD includes emphysema (lung parenchymal
destruction), chronic bronchitis (chronic cough and phlegm production), and
small airway disease (fibrosis and destruction of small airways) in varying
combinations in different pts.
• The presence of airflow obstruction is determined by a reduced ratio of the
forced expiratory volume in 1 s (FEV1 ) to the forced vital capacity (FVC).
• Among individuals with a reduced FEV1 /FVC ratio, the severity of airflow
obstruction is determined by the level of reduction in FEV1 ≥80% is stage I, 50–
80% is stage II, 30–50% is stage III, and

3. TREATMENT
OUTPATIENT MANAGEMENT
• Smoking Cessation
Elimination of tobacco smoking has been convincingly shown to reduce decline in
pulmonary function and to prolong survival in pts with COPD; complete smoking
cessation is essential for all COPD pts. Although lung function does not typically
improve substantially after smoking cessation, the rate of decline in FEV1 often
reverts to that of nonsmokers. Pharmacologic treatment to assist with smoking
cessation is often beneficial. Use of nicotine replacement therapy

4. • Nonpharmacologic Treatment
Pulmonary rehabilitation improves dyspnea and functional status and reduces
hospitalizations. Annual influenza vaccinations are strongly recommended; in
addition, pneumococcal and pertussis vaccinations are recommended.
• Bronchodilators
Pts with mild symptoms and infrequent exacerbations can usually be managed with
an inhaled short-acting anticholinergic such as ipratropium or a short-acting β
agonist such as albuterol. Combination therapy with long-acting β agonists and/or
long-acting anticholinergics should be added in pts with significant respiratory
symptoms and/or frequent exacerbations. The narrow toxictherapeutic ratio of
theophylline compounds limits their use, and monitoring of serum levels is
required.

5. • Corticosteroids
Chronic systemic corticosteroid treatment is not recommended in COPD pts due to
the risk of multiple complications, including osteoporosis, weight gain, cataracts,
and glucose intolerance. Although inhaled steroids have not been proven to reduce
the rate of decline of FEV1 in COPD, inhaled steroid medications (typically given in
combination with a long-acting β agonist and/or long-acting anticholinergic) likely
reduce the frequency of COPD exacerbations. Inhaled steroids have been associated
with an increased risk of pneumonia.
• PDE4 Inhibitors
Roflumilast reduces exacerbation frequency in severe COPD pts with chronic
bronchitis and a prior history of exacerbations; however, side effects including
nausea often limit its use.

6. • Antibiotics
Chronic treatment with azithromycin has been demonstrated to reduce
exacerbation frequency and should be considered in COPD pts with frequent
exacerbations.
• Surgical Options for Severe COPD
Two main types of surgical options are available for end-stage COPD. Lung volume
reduction surgery can reduce mortality and improve lung function in selected pts
with upper lobe–predominant emphysema and low exercise capacity (after
pulmonary rehabilitation). Individuals who meet the criteria for the highrisk group
(FEV1

7. MANAGEMENT OF COPD EXACERBATIONS
• COPD exacerbations are a major cause of morbidity and mortality. Critical decisions in
management include whether hospitalization is required. Although there are no definitive
guidelines to determine which COPD pts require hospitalization for an exacerbation, the
development of respiratory acidosis, worsening hypoxemia, severe underlying COPD,
pneumonia, or social situations without adequate home support for the treatment required
should prompt consideration of hospitalization
• Antibiotics
Because bacterial infections often trigger COPD exacerbations, antibiotic therapy should be
strongly considered, especially with increased sputum volume or change in sputum color. Common
pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
Antibiotic choice should depend on the local antibiotic sensitivity patterns and the severity of
disease.

8. • Glucocorticoids
Systemic steroids hasten resolution of symptoms and reduce relapses. Dosing is not
well worked out, but 30–40 mg of prednisolone daily (or IV equivalent) is standard,
with a total course of 5−10 days in outpatients. Hyperglycemia is the most
commonly reported complication.
• Oxygen
Hypoxemia often worsens during COPD exacerbations. Supplemental O2 should be
administered to maintain SaO2 ≥90%. Very high O2 delivery can worsen
hypercarbia, primarily due to increasing ventilation-perfusion mismatch. However,
providing adequate O2 to obtain saturation of ∼90% is the key goal. Therefore,
supplemental O2 delivery should be focused on providing adequate oxygenation
without providing unnecessarily high O2 saturations. Pts may require use of
supplemental O2 after hospital discharge until the exacerbation completely
resolves.

9. • Ventilatory Support
• Numerous studies suggest that noninvasive mask ventilation (noninvasive
ventilation [NIV]) can improve outcomes in acute COPD exacerbations with
respiratory failure (PaCO2 >45 mmHg). Contraindications to NIV include
cardiovascular instability, impaired mental status, inability to cooperate, copious
secretions, craniofacial abnormalities or facial trauma, extreme obesity, or
significant burns. Progressive hypercarbia, refractory hypoxemia, or alterations in
mental status that compromise ability to comply with NIV therapy, hemodynamic
instability, and respiratory arrest may necessitate endotracheal intubation for
mechanical ventilation. Sufficient expiratory time during mechanical ventilatory
support is required to avoid the development of auto-PEEP.

10. THANK YOU