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Chronic obstructive pulmonary disease

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Chronic obstructive pulmonary disease

  1. 1. COPD Chronic bronchitis & Emphysema
  2. 2. COPD  6th leading cause of death worldwide  Prevalence- ~5%  Chronic progressive lung disease  Characterized by narrowing of airways  Partially reversible, unlike asthma  Commonly associated with smoking  Cause SOB & cough with expectoration  Diagnosis requires PFT
  3. 3. Types  Chronic bronchitis  Cough with sputum production on most days for 3 months of a year, for 2 consecutive years  Hyperplasia & hypertrophy of goblet cells & mucous glands, with inflammation of the airways  Progression causes metaplasia & fibrosis  Advanced disease causes cyanosis & fluid retention- blue bloater  Emphysema  Permanent enlargement of air-spaces distal to terminal bronchioles, leading to reduced surface area for exchange of gases  Elasticity of lungs is reduced  Patient makes effort to breathe giving looks of pink puffer
  4. 4. Causes  Smoking- cumulative exposure  Occupational exposure  Air pollution  Genetic- α-1 anti-trypsin deficiency  Repeated lung infection  ?autoimmunity  Acute exacerbation- infection, pollutants, PE
  5. 5. Clinical features  Symptoms  Chronic cough with expectoration  Shortness of breath  Wheezing  Chest tightness  h/o smoking  Signs  Tachypnea  Active accessory muscles  Barrel-shaped chest  Prolonged expiration  Rhonchi
  6. 6. Diagnosis  Spirometry- FEV1 correlates with M&M  Mild- FEV1 >80% predicted  Moderate- 50-79%  Severe- 30-49%  Very severe- <30% or s/s of respiratory failure  CxR  CT scan of lungs  ABG
  7. 7. Management  Assess & monitor  Reduce risk factors- smoking, pollution, dust  Manage stable COPD  Prevent & treat acute exacerbations Pneumococcal & annual Influenza vaccination  Manage comorbidity  Pulmonary rehabilitation  Only measures to reduce mortality- smoking cessation & supplemental oxygen
  8. 8. Drug treatment For symptomatic relief No effect on rate of decline of lung function
  9. 9. Treatment  Bronchodilators- relax smooth-muscle around airways, providing an improved quality of life  Given as inhalers  Anticholinergics- Tiotropium, Ipratropium  Beta-agonists- Salmeterol/Formoterol, Salbutamol  Oral Theophylline  Steroids- inhaled or oral, to treat & prevent acute exacerbations in those with moderate or severe COPD
  10. 10. Treatment- severity  Mild- short-acting bronchodilator SOS  Moderate- regular long-acting bronchodilators  Severe- +inhaled steroids, oral steroids for acute exacerbations  Very severe- +LTOT, ± regular oral steroids
  11. 11. Long-term oxygen therapy  For moderate or severe COPD  Need based on ABG, on 2 occasions, at least 3 weeks apart, in patient with stable COPD, on optimum medical treatment  Indications-  PaO2 <55 mm Hg or SaO2 <88% on RA  PaO2 55-59 mm Hg with dependent edema/Hct >56%/PHT  Nocturnal hypoxemia  Duration- >15 hours a day, longer is better
  12. 12. Surgery  Bullectomy, for bulla encompassing >30% of a hemithorax  Lung volume reduction surgery- only for upper lobe emphysema  Lung transplantation-  FEV1 <25% predicted  Resting RA PaCO2 >55 mm Hg  Elevated PaCO2 with need for LTOT  Elevated pulmonary artery pressure with progressive deterioration
  13. 13. Management of exacerbation  Acute sustained worsening of symptoms  Check CxR, ABG, CBC, sputum culture  Treatment-  Short-acting inhaled bronchodilators  Prednisolone, 30 mg OD X 7-14 days  Supplemental oxygen to keep SaO2 >90%  Empiric antibiotics, if sputum purulent x 7 days  IV Theophylline, as adjunct to bronchodilators  Non-invasive or invasive ventilation
  14. 14. Prognosis  COPD is a progressive disease  Poor prognostic markers are-  Severe airflow obstruction  Poor exercise capacity  Severe SOB  Significantly over/underweight  Respiratory failure or cor pulmonale  Continued smoking  Frequent acute exacerbations

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