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COPD 
Abdul Waris Khan 
Soepel: 2 
Det: Internal medicine
SOEPEL 
• Subjective: A 55 years old male smoker presented to 
ER with shortness of breath and productive cough. 
• H/O pr...
• Objective: physical examination 
• Pulse: 77 
• RR: 20 
• BP: 125/90 
• Evaluation: DD: COPD, Asthma 
• Plan: Spirometry...
Learning goals: COPD
Definition 
• Chronic obstructive pulmonary disease (COPD) is a preventable and 
treatable disease state characterized by ...
• Chronic bronchitis is defined clinically as chronic productive cough for 3 
months for most of the days in 2 successive ...
Tobacco smoke is the most important risk factor for COPD worldwide.
Pathophysiology 
Tobacco smoking is the main risk factor for COPD. 
This causes an inflammatory response in the lungs, whi...
•The major antiproteinases involved in the pathogenesis of COPD include: 
Alpha-1-antitrypsin 
Secretory leukoproteinase...
Bronchitis
Emphysema
What abnormalities arise? 
Mucous hyper secretion 
Ciliary dysfunction 
Airflow limitation 
Hyperinflation 
Gas excha...
Symptoms. 
 Cough 
 Sputum 
 Dyspnea
Investigations 
CBC, ESR, CRP 
Sputum culture 
ABGs 
Chest X ray 
ECG
Flow-Volume Loops
Obstructive vs. Restrictive 
• Obstructive Disorders 
– Characterized by a limitation of 
expiratory airflow so that airwa...
• Obstructive Disorders 
– FVC normal or↓ 
– FEV1 ↓ 
– FEF25-75% ↓ 
– FEV1/FVC ↓ 
– TLC normal or ↑ 
• Restrictive Disorde...
References 
• Kumar and Clark's clinical medicine 7th edition 
• Davidson principals and practice of medicine 21st edition
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
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Chronic Obstructive Pulmonary Disease (COPD)

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COPD, Chronic bronchitis, Emphysema

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Chronic Obstructive Pulmonary Disease (COPD)

  1. 1. COPD Abdul Waris Khan Soepel: 2 Det: Internal medicine
  2. 2. SOEPEL • Subjective: A 55 years old male smoker presented to ER with shortness of breath and productive cough. • H/O presenting illness: The symptoms have been there for 3 years and now worsened. He is a chain smoker more than pack a day for the past 20 years. He is known to be hypertensive. No other past medical or family history.
  3. 3. • Objective: physical examination • Pulse: 77 • RR: 20 • BP: 125/90 • Evaluation: DD: COPD, Asthma • Plan: Spirometry, sputum culture • Elaboration: Bronchodilators, corticosteroids, antibiotics
  4. 4. Learning goals: COPD
  5. 5. Definition • Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. • The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.
  6. 6. • Chronic bronchitis is defined clinically as chronic productive cough for 3 months for most of the days in 2 successive years. • Emphysema is defined as the presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
  7. 7. Tobacco smoke is the most important risk factor for COPD worldwide.
  8. 8. Pathophysiology Tobacco smoking is the main risk factor for COPD. This causes an inflammatory response in the lungs, which is exaggerated in some smokers, and leads to the characteristic pathological lesions of COPD. In addition to inflammation, an imbalance of proteinases and antiproteinases in the lungs occur.
  9. 9. •The major antiproteinases involved in the pathogenesis of COPD include: Alpha-1-antitrypsin Secretory leukoproteinase inhibitor Tissue inhibitors of MMPs.
  10. 10. Bronchitis
  11. 11. Emphysema
  12. 12. What abnormalities arise? Mucous hyper secretion Ciliary dysfunction Airflow limitation Hyperinflation Gas exchange abnormalities
  13. 13. Symptoms.  Cough  Sputum  Dyspnea
  14. 14. Investigations CBC, ESR, CRP Sputum culture ABGs Chest X ray ECG
  15. 15. Flow-Volume Loops
  16. 16. Obstructive vs. Restrictive • Obstructive Disorders – Characterized by a limitation of expiratory airflow so that airways cannot empty as rapidly compared to normal (such as through narrowed airways from bronchospasm, inflammation, etc.) Examples: – Asthma – Emphysema/Bronchitis – Cystic Fibrosis • Restrictive Disorders – Characterized by reduced lung volumes/decreased lung compliance Examples: – Interstitial Fibrosis – Scoliosis – Obesity – Lung Resection – Neuromuscular diseases – Cystic Fibrosis
  17. 17. • Obstructive Disorders – FVC normal or↓ – FEV1 ↓ – FEF25-75% ↓ – FEV1/FVC ↓ – TLC normal or ↑ • Restrictive Disorders – FVC ↓ – FEV1 ↓ – FEF 25-75% normal to ↓ – FEV1/FVC normal to ↑ – TLC ↓
  18. 18. References • Kumar and Clark's clinical medicine 7th edition • Davidson principals and practice of medicine 21st edition

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