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chronic obstructive pulmonary disease

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  • The trachea begins immediately below the larynx (voice box) and runs down the center of the front part of the neck and ends behind the upper part of the sternum.
  •  FEV1 is the maximal amount of air you can forcefully exhale in one second. It is then converted to a percentage of normal. For example, your FEV1 may be 80% of predicted based on your height, weight, and race. FEV1 is a marker for the degree of obstruction with your asthma:FEV1 greater 80% of predicted= normal
    FEV1 60% to 79% of predicted = Mild obstruction
    FEV1 40% to 59% of predicted = Moderate obstruction
    FEV1 less than 40% of predicted = Severe obstruction
  • Other Tests
    A chest x ray or chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms.
    An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need oxygen therapy.
  • COPD

    1. 1. Assignment 1 Shortness of Breath during Exert i on Present by : Heba althuwaini Tutor : dr.shahina Group no: 5
    2. 2. Learning Objectives • What is breathlessness ? • Shortness of breath during exercise • What do the result of the physical examination pointed to? • What do the abbreviation of the result of the pulmonary function test stand for? • What do the changes in static and dynamic lung volume indicate? • What would explain the change in sao2? • How can the man’s shortness of breath be explained? • Which condition is the most probable cause? • Why is expiration extended?
    3. 3. Stopped 6 years ago Case summary
    4. 4. Case Signs & Symptoms Looks pale, feels as his temperature is raised. Productive cough with green sputum. Shortness of breath due to effort. Trouble breathing while sitting still.
    5. 5. breathlessness • Is unpleasant sensation of uncomfortable, rapid or difficult breathing. • The medical term is dyspnoea. • It may come on suddenly (acute) or gradually over a period of time (chronic). • Dyspnea at rest indicate cardiac , pulmonary disease or other illnesses
    6. 6. impulse s from the if you motor are causing cortex So the increase in not Shortness of breath ventilation to lungs will increase the normall during exercise flow of stimulat are air oxygenrich into the y lungs e RC getting offand to blow extra physica carbon larger, dioxide lly muscle active s which are feeling breathless respon sible for
    7. 7. Productive Cough • Coughing : is the body's way of removing foreign material or mucus from the lungs and upper airway passages or of reacting to an irritated airway. • Productive cough: Is a cough that produces phlegm or mucus (sputum) • Green sputum is indicative of a long-standing, possibly chronic, infection.
    8. 8. The physical examination What the result pointed to ?!
    9. 9. Rate of blood pressure • Normal blood pressure = 120/80 mmHg • 132/78 mmHg = prehypertension Heart rate • Normal resting heart rate for adult = 60-100 per minute • 94 per min = Normal
    10. 10. Broad chest • broad chest describes a rounded, bulging, almost barrel-like appearance of the chest. • It indicates a reduced pulmonary elastic recoil ( increase the compliance) = sign of obstructive lung disease • occurs as a result of long-term overinflation of the lungs. •Because the lungs are overinflated with air, the rib cage stays partially expanded, giving the characteristic appearance of a barrel chest .
    11. 11. Position of Trachea Normal position of trachea indicate there is no tracheal Deviation
    12. 12. Auscultation Wheezing Extended expiration Reduced breath sound
    13. 13. Wheezing • Wheezing is defined as a high-pitched whistling sound that occurs with breathing. • Wheezing can occur both with breathing in (inspiratory wheezing) and with breathing out (expiratory wheezing. • Wheezing indicates difficulty breathing, often caused by constricted airway (excess mucus or inflammation).
    14. 14. Extended expiration • Extended expiration is a longer exhaling due to the increased Airway resistance. • It indicates an airway obstruction.
    15. 15. Reduced breath sound entire lung arae • This might be due to a reduction in the generation of sounds due to poor transmission of sounds due to destruction of parenchyma.
    16. 16. increase in the rate of respiration 32 min1 •A normal average resting respiratory rates by age are: • Adults: 12-20 breaths per minute •An increase in the rate of respiration )hyperventilation( is called tachypnea in the medical term. •Tachypnea is common in people who have emphysema, either because they are not getting enough oxygen or they are trying to "blow off" excess carbon dioxide . •Tachypnea is commonly associated with dypsnea
    17. 17. Oxygen saturation • Oxygen saturation is a term referring to the concentration of oxygen in the blood. • Normal arterial oxygen saturation = 95-100%. Sao2= 91 %
    18. 18. Investigation test What the result pointed to ?!
    19. 19. pulmonary function test Full name abbreviation • forced vital capacity FVC  Decreased FVC and FEV 1 • Forced expiratory volume in one second FEV1 FEV1/FVC  Increased TCL, FRC and RV. • The ratio of forced expiratory volume in one second to forced vital capacity • Total lung capacity TLC • functional residual capacity FRC • residual volume RV • the result show:
    20. 20. What do changes in static & dynamic lung volumes indicate ?!
    21. 21. Functional Vital Capacity (IC). Inspiratory Capacity (FVC). The of air Maximum volume maximum volume Reserve Inspiratory of air that can be inspired from that can be forcefully Volume (IRV). end expiratory position. IC expelledMaximum lungs of from = TV+IRVthe amountLung Total following a maximal that can be additional air Capacity (TLC). The inspiration. VC = the end of a inspired from volume of air contained Tidal Volume (TV). IRV+TV+ERV=TLC-RV normal inspiration. lungs at the end in the The Expiratory Reserve amount of gas of a maximal Volume (ERV). inspired or expired inspiration. TLC = The maximum with each breath. RV+IRV+TV+ERV volume of additional Functional Residual Residual air that can be Capacity (FRC). The Volume (RV). expired from the volume of air remaining The volume of air end of a normal in the lung at the end of remaining in the expiration. a normal expiration. lung after a FRC = RV+ERV maximal expiration.
    22. 22. Static & Dynamic lung volumes Static lung volumes : • Lung volumes that are not affected by the rate of air movement in and out of the lungs Dynamic lung volumes : • Lung volumes that depend upon the rate at which air flows out of the lungs ( expressed in ml/min) • In healthy lungs, dynamic and static volume are about equal • “a consistent change in the level of compliance often indicates the presence of a disease state.”
    23. 23. •Static lung volumes All volumes and capacities except FVC and related volumes and capacities. Indicates over expansion and failing to recoil like in obstructive lung diseases indicates collapse in the lung and failing to expand like in restrictive lung diseases
    24. 24. • Dynamic lung volumes •FVC , FEV 1 - FEV1/FVC Restrictive Lung Obstructive Lung Disease Disease FVC or Normal FEV1 or Normal FEV1/FVC
    25. 25. Final diagnosis
    26. 26. COPD • Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow and make breathing difficult.
    27. 27. In the patient with COPD, there will be obstruction of the airways makes it especially difficult to expire, Thus, causing entrapment of air in the alveoli and overstretching them. This causes marked destruction of as much as 50 to 80% Explain the of the alveolar wall. change in the sao2 Therefore, the marked loss of alveolar greatly decrease the diffusing capacity of the lung, which reduces the ability of the lung to oxygenate the blood and remove carbon dioxide from the blood.
    28. 28. Etiology The most common irritant that causes COPD is cigarette smoke. Breathing in secondhand smoke Air pollution Chemical fumes or dust
    29. 29. Clinical assessment • Productive cough • Shortness of breath, especially with physical activity • Prolonged period of exhalation ( extended expiration) • broad chest
    30. 30. Diagnosis Lung Function Tests: • Spirometry The machine measures how much air you breathe out. Spirometry is a painless study of air volume and flow rate within the lungs.  Other Tests • A chest x ray or chest CT scan. • Pulse oximetry • Measuring and monitoring a patient's O2 saturation.
    31. 31. Treatmen t
    32. 32. Non-medication treatment •Quit Smoking and Avoid Lung Irritants Quitting smoking is the most important step you can take to treat COPD.
    33. 33. Medications treatment •Bronchodilators Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier. •Oxygen Therapy If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better •Inhaled steroids Corticosteroid drugs inhaled as aerosol sprays may help relieve shortness of breath.
    34. 34. Summary
    35. 35. References id=0&sid=0&ContentTypeId=34&ContentID=21274-1 Guyton and Hall Textbook of Medical Physiology
    36. 36. Thank you