1. Presented by – Anchal jaiswal
MD 1st year
Rognidan evam vikriti vigyan
2. INTRODUCTION
Definition –The global initiative for chronic obstructive lung
disease (COLD) define 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
patient and is rare below the 35 years.
3. CONTINUED …
In Ayurveda respiratory diseases occur due to involvement of
pranavaha srotas where cough, breathing difficulties ,
disturbed respiratory pattern 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 svasa may result in COPD.
5. EMPHYSEMA
Abnormal and permanent enlargement of airspaces distal
to terminal bronchioles that is accompanied by the
destruction of airspace walls, without obvious fibrosis.
6. TYPES OF EMPHYSEMA
Centriacinar (centilobular ) emphysema
Dilatation involve the central or proximal part of acini
Common and severe in upper lobes, especially in apical
segment
7. Panacinar (panlobular ) emphysema
All the air spaces beyond terminal bronchiole are more or less
uniformly dilated
More common lower lobes ,and is usually most severe at bases
Associated with alpha 1- antitrypsin deficiency
8. Distal acinar (paraseptal) emphysema
Dilatation affects the distal air spaces at periphery of the lobule
It is found near the pleura . Dilated space of more than 1 cm in
size are known as bullae which may be rupture cause
spontaneous pneumothorax
9. Irregular (scar or cicatricial) emphysema
Acinus is irregularly involved and may be asymptomatic
Most common form of emphysema
Occurs near the scar and is commonly found around healed
inflammatory process lie tuberculous scars.
10. CHRONIC BRONCHITIS
Defined as chronic productive cough for three month in each of
successive years in a patient in which other cause of chronic
cough have been excluded.
11. AETIO-PATHOGENESIS
Faulty diet and life style patterns form the basis of
pathogenesis of any disease as per Ayurveda .
Etiological factors of COPD mentioned in classical and modern
literature includes diet articles, food habits and lifestyle errors.
12. DIET Excessive intake of kidney beans, black gram
oil, sesame oil, white flour preparations,
tubers,curd, unboiled milk, aquatic and
marshy meat or any dietic articles difficult to
digest causing indigestion
DIETIC
HABITS
Irregular and untimely eating of food
(vishamashana)
LIFE STYLE Exposures 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
OTHERS Injury to vital parts
13.
14.
15. SAMPRAPTI
Nidansevan
kapha and ama increases in amashya
This vitiated kapha moves upwarads and reaches the
respiratory system
producing obstruction in the respiratory tract(pranvahastrotas)
normal movements of prana vayu are hampered and moves upward
producing the disese shwasa
16. PRANVAHA SROTODUSHTI LAKSHAN
Atisristam-atibaddhama (too long or too restrictred respiration)
Kupita (disturbed pattern of respiration)
Alpa-alpam (shallow or frequent respiration)
Shashbdam sashulam (respiration associated with sound and
pain)
17. SYMPTOMS OF COPD
The characteristic symptoms of COPD are chronic and
progressive dyspnea , cough, sputum production that can be
variable from day to day.
Dyspnea –progressive, persistant and characteristically worse
with exercise
Chronic cough-May be intermittent and may be unproductive
Chronic sputum production – COPD patients commonly
cough up sputum.
19. CLINICAL PRESENTATION
CLINICAL
FEATURES
EMPHYSEMA CHRONIC
BRONCHITIS
Dyspnea Severe Mild to moderate
Cough With exertion, develops
after dyspnea starts
Frequent, develops before
dyspnea starts
Sputum-amount ,nature Scanty, mucoid Copious , purulent
Frequency of
mucopurulent relapses
Less More
cyanosis Absent Present
Pulmonary hypertension Late and mild Early and severe
RV failure & respiratory
failure
Late and often terminal Repeated episodes
Mechanism of airway
obstruction
Loss of elastic recoil Decreased airway lumen
due to mucus &
inflammation
20.
21. PHYSICAL SIGNS
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’ sign)
Tripod position
22. CLINICAL MANIFESTATION
Palpation
Decreased fremitus vocalis
Percussion
Hyper resonant
Depressed diaphragm
Dimination of the area of absolute cardiac dullness.
Auscultation
Prolonged expiration
Reduced breath sounds
Presence of wheezing during quiet breathing, crackle can be
heard if infection exist.
24. INVESTIGATIONS
Emphysema Chronic bronchitis
Hematocrit (PCV) Normal Increased
pao2 Normal to low ‘pink puffer’ Low ‘blue bloater’
paco2 Normal to decreased (<40) High (>40)
FEV1 Decreased Decreased
Diffusing capacity Reduced Normal
Chest x-ray Features of hyperinflation,
bullae and tubular
Increased bronchovascular
markings and cardiomegaly
Elastic recoil Decreased Normal
Airway resistance Normal to slightly increased Increased
Cor pulmonale Late , mild Early , marked
26. LABORTORY EXAMINATION
BLOOD
Hemoglobin level and PCV may be elevated due to persistent
hypoxemia.
SPUTUM EXAMINATION
Streptococcus pneumonia
Hemophillus inflenza
HIGH RESOLUTION CT SCANS
Greater sensitivity and specificity for emphysema
For evalution of bullous disease
27. DIAGNOSIS OF COPD
Symptoms
Shortness of breath
Chronic cough
sputum
Exposure to risk factor
Tobacoo
Occupation
Indoor/outdoor pollution
Spirometry : required to establish diagnosis
28. MANGEMENT
Prevention of further progress of disease
Preservation and enhancement of pulmonary functional
capacity
Avoidance of exacerbations in order to improve the quality of
life
29. BROCHODILATORS
Three major classes of bronchodilators
Beta 2- agonists :
Short acting : salbutamol& terbutaline
Long acting : salmeterol & formoterol
Anticholinergic agents :
Ipatropium , tiotropium
Theophylline
30. GLUCOCORTICOIDS
Regular treatment with inhaled glucocorticoid is appropriate
for symptomatic patients with an FEV1<50% and repeated
exacerbations
Chronic treatment with systemic glucocorticoid should be
avoided because of an unfavorable benefit to risk ratio
31. OTHER TREATMENTS
Pulmonary rehabilitation
Nutrition
Surgery :
Bullectomy
Lung volume reduction surgery
Lung transplantation