1. COPD
IS A-Systemic
disease
(Dr/Sami EL-Dahdouh (MD
Lecturer of Pulmonary & Critical care
, Faculty of Medicine
Menofia University

2. Definition of COPD
COPD is a preventable and treatable disease with
some significant extrapulmonary effects
(comorbidites - Gold 2011) that may contribute
to the severity in individual patients.
Its pulmonary component is characterized by
airflow limitation that is not fully reversible.
The airflow limitation is usually progressive and
associated with an abnormal inflammatory
response of the lung to noxious particles or
gases.

3. Release of
mediators & oxidative
cytokines e.g. stress.
IL6, TNF
.alpha
PATHOGENSIS
increase
hypoxemia
acute
and its
phase
effect on
proteins
.tissues

4. Manifestations
 Wt loss and muscle wasting.
 Endocrinal manifestations.
 Effect on other systems as heart,
GIT, Neuro- psychiatry, sleep
disorders, kidney.

6. Wt loss & Muscle
Weakness
 Is due to
1-imbalance between increase catabolism
(TNF alpha, IL1&6( and decrease anabolic
hormones( GH, Insulin & Testerone(.
2-Decrease caloric intake due to dyspnea,
anorexia and GIT disturbances.
 Wt loss & muscle weakness lead to impaired
excises intolerance & poor outcome of the
patients .
 This is demonstrated by BODE index.

7. The BODE Index
 Predicts survival based on
 Body mass index (< 21 is associated with
greater mortality)
 FEV1 (airflow obstruction)
 Degree of dyspnea (MRC grade)
 Capacity for exercise (6-minute walk
distance)
Can Fam Physician 2008;54:706-11

9. The BODE Index Score
Points Used To Calculate
Can Fam Physician 2008;54:706-11

10. Medical Research Council
dyspnoea scale
Grade Degree of breathlessness related to activities
 0 Not troubled by breathlessness except on
strenuous exercise
 1 Short of breath when hurrying or walking up a
slight hill
 2 Walks slower than contemporaries on level
ground because of breathlessness, or has to stop for
breath when walking at own pace
 3 Stops for breath after walking about 100m or
after a few minutes on level ground
 4 Too breathless to leave the house, or
breathless when dressing or undressing

11.  If score more than 7 associated with
30% mortality in 2 years.
 If score 5-6 associated with 15%
mortality in 2 years.
 If less than 5 associated with less
than 10% mortality in 2 years.

12. Endocrinal manifestations
1- Hypogonadism & impotence due to
hypoxemia, steroid used, increase s. leptin &
decrease s. testerone.
2- Salt &water retention is due to
 increase renin –angiotensin system.
 vasopressin.
 increase ADH.
 Hypercapnia ++CAE salt and water
retention.

13. 3- Osteoporosis is due to:
 mal nutrition,
 Steroid use,
 Hypoxemia increase renal exertion of
ca+2 and
 Acidosis decrease absorption of ca +2.

14. Other system affections
CVS:
cor pulomnale, lt sided dystolic dysfunction,
IHD.
GIT:
-Reflux oesphgitis due to hypoxemia.
Hypercapnia, hyperinflation, also coughing
lead to increase in intra abdominal
pressure.
- Peptic ulcer effect of hypoxia and
hypercapnia and effect of drugs.

15. Sleep disturbances is due to
 Hypoxemia,
 Nocturnal bronchospasm,
 Drugs as theophylline,
 Anxiety , depression &
 Sleep apnea syndromes may be
associated with COPD (overlap syndrome),
or complication of sever air flow obstruction.

16.  Neuro- psychiatric disorders in
the form of
1. depression
2. psychosis
3. anxiety
4. panic disorders.

17. Predictors of COPD Mortality
• High BODE index
• Multiple severe exacerbations
• CVD
• Decreased FEV1
• Dyspnea
• Hyperinflation (IC/TLC = 25%)
• Pulmonary hypertension
• Impaired Exercise Performance
• Depression
• Low BMI

18. Treatment
 O2 therapy.
 Antioxidants.
 Anti mediators:
as TNF alpha antagonist.

19.  Nutritional problems
- high fat diet ( increase caloric intake)
- decrease CHO intake.
- give anabolic hormone.
- give appetizer e.g. megastrol.
 Rehabilitation. All COPD patients
benefit from exercise training programs,
improving with respect to both exercise
tolerance and symptoms of dyspnea and
fatigue.

20. Rehabilitation
Rehabilitation