Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation that is slowly progressive. It is also known as Chronic obstructive lung disease. “(COLD)” It refers to Chronic Bronchitis and emphysema, a pair of two commonly coexisting disease of the lungs in which the airways become narrowed.

1. MS.B.SHYLA MERCY. M.Sc.(N),
MEDICAL SURGICAL NURSING
LECTURER
GANGA COLLEGE OF NURSING
COIMBATORE

2. CHRONIC OBSTRUCTIVE PULMONARY DISEASE

3. INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is a
preventable and treatable disease characterized by
persistent airflow limitation that is slowly progressive. It is
also known as Chronic obstructive lung disease. “(COLD)”
It refers to Chronic Bronchitis and emphysema, a pair of
two commonly coexisting disease of the lungs in which
the airways become narrowed.

4. DEFINITION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Chronic obstructive
pulmonary disease is
defined as a preventable
and treatable disease
reversible, that is due to
airway and alveolar
abnormalities caused by
significant exposure to
noxious particles or gases.

5.  Incidence of COPD increases with age
 It is more common in men due to
increased number of smoking
 It affects 210 million people world wide
and 9% of total death
 India estimated >20% annually
INCIDENCE
RISK FACTORS
 Exposure to tobacco smoke
 Passive smoking
 Occupational exposure
 Ambient Air pollution

6. 1.CIGARETTE SMOKING
• In India 57% males and 11% female use tobacco in some form.
A)ACTIVE SMOKING:
• COPD affects about 15% of smokers.
• The Irritating effect of the smoke causes Hyperplasia of cells,
increased production of mucus and abnormal dilation of distal air
space with destruction of alveolar walls.
• It causes oxidative stress,imbalance between proteases and
antiproteases.
ETIOLOGICAL FACTORS

7. B)PASSIVE SMOKING:
• Exposure of non smokers to cigarette smoke also known as “Environmental
Tobacco Smoke”
2. OCCUPATIONAL CHEMICALS AND DUSTS
• Prolonged exposure to dusts, vapors, fumes in workplace have been implicated in
development of airflow obstruction.
3. AIR POLLUTION
• High levels of urban air pollution are harmful to people with existing lung disease.

8. 4. INFECTION
.Bacterial infection e.g.Streptococcus Infections are risk factor for
developing COPD.
5. AGING
• Aging results in loss of elastic recoil of lungs. Number of functional
alveoli decreases and peripheral airways lose supporting tissues
6. GENETICS
ALPHA1- ANTITRYPSIN DEFICIENCY
• It is autosomal recessive disorder affects lungs. In this condition, body
does not make enough protein, α1 – Antitrypsin. It protects the lung tissue
from attack by proteases during inflammatory response.

9. TYPES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
1)CHRONIC BRONCHITIS: (BLUE BLOATERS)
• Chronic bronchitis is defined as the presence of cough and sputum
production for atleast 3months in each 2 consecutive years.
2)EMPHYSEMA: (PINK PUFFERS)
• Emphysema is defined as an abnormal permanent enlargement of the
air spaces distal to the terminal bronchioles, accompanied by
destruction of the walls of alveoli.

11. TYPES OF EMPHYSEMA
A)CENTRIACINAR:
• Dialation of Respiratory Bronchioles
• Most often in smokers, coal mine workers
• Upper lobes – severely involved
B)PANACINAR:
• Whole of Acinus uniformly affected
• Lower lobes- Severely involved
• Association – Alpha 1 Antitrypsin deficiency, cigarette smokers.

13. C)PARASEPTAL (DISTALACINAR)
• Localized along pleura – peripheral part of the acinus
• Predisposes to spontaneous pneumothorax.
• Least common.
D)IRREGULAR – MIXED EMPHYSEMA
• Combination of types,
• Most common around scar tissue

15. PATHOPHYSIOLOGY OF COPD

18. CLINICAL MANIFESTATIONS
1. Smoker’s cough
(prominent cough and production of sputum)
2. Chest tightness
3. Dyspnea on Exertion
4. Flattened Diaphragm
5. Fatigue
6. Weight loss
7. Anorexia
8. Wheezing

20. 9. Polycythemia
10. Cyanosis
11. Barrel chest
(Anteroposterior diameter of chest increased from chronic air trapping)
12.Tripod position
(Patient sit upright with arms supported on a fixed surface)
13.Pursed lip breathing
14.Presence of cyanosis and edema(“BLUE BLOATERS”)
15.Present with cough with little or no sputum, wheeze, exertional dyspnea
(“PINK PUFFERS”)

21. DIAGNOSTIC EVALUATION
1. HISTORY COLLECTION
2. PHYSICAL EXAMINATION
3. CHEST X - RAY
Hyperinflated lungs with flattend diaphragm, Retrosternal Airspace,
may seen bullae with emphysema
4. ARTERIAL BLOOD GAS ANALYSIS
Low PaO2 , Elevated PaCO2, Low-normal PH, Increased HCO3 levels.
5. SPIROMETRY TEST
Spirometry is the common of Pulmonary function test, used to evaluate
airflow obstruction which is determined by ratio of Forced Expiratory
Volume/Forced vital capacity in one second.

24. 6. SERUM α1 – ANTITRYPSIN LEVEL:
Normal 100 – 300 mg/dl ,<80 mg/dl – Risk for lung Disease
7. COPD ASSESMENT TEST ( CAT)
It is a questionnaire for people with COPD. To measure the impact of
COPD in person life.
8. MODIFIED MEDICAL RESEARCH COUNCIL DYSPNEA SCALE:
(MMRC)
Measure the patient’s level of Dyspnea.
9. BODE INDEX:
 It is a way to place COPD into stage
 B – Body Mass (BMI)
 O - Airflow obstruction (FEV1)
 D – Dyspnea ( Degree)
 E – Exercise Capacity (6min Walk test)

26. MANAGEMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
I.SMOKING CESSATION:
• Nicotine replacement products. Nicotine gum, Transdermal patch.
II.PHARMACOLOGICAL MANAGEMENT:
A.BRONCHODILATORS
• The choice of Bronchodilator depends on
• Mild COPD – Short Acting
• Moderate – Long Acting

27. 1)β2 – Adrenergic Agonists:
• Inhaled short Acting ( 4 – 6Hrs)
• Albuterol (Nebulizer, MDI)
• Long Acting (Inhaled) – (1/2 – 12 Hrs)
• Salmeterol (MDI/ DPI) BD 25, 50µg
2)Methylxanthines:
• IV Agent : Aminophylline 5 – 6 mg/kg
• In 100ml NS over 30mts
• Oral: Theophylline 100 – 600 mg oral

29. 3)Anticholinergics:
Short Acting: Ipratropium bromide
(6 to 8 Hrs) Neubulizer, MDI
Long Acting: Tiotropium ( DPI)
B. COTICOSTERIODS
• Inhaled : Budesonide 100/200/400 mg DPI/BD
250/500 mg nebulizer
• Oral : hydrocortisone 100 mg IV TDS
Prednisone - 10-60 mg OD
C.PHOSPHODIESTERASE INHIBITOR
• Roflumilast - Oral 200/500 mg OD (1/2 -24 hr)

30. D.INHALATION AEROSOL
• Combivent Respimat
(Ipratropium and albuterol)
E.OXYGEN THERAPY
F.VACCCINATION
Influenza vaccine annually
Polyvalent Pneumococcal vaccine (patient more than 65 yrs. old)

31. III. NON – PHARMACOLOGICAL MANAGEMENT
1)BREATHING RETAINING EXERCISES:
A)PURSED LIP BREATHING
• Inhale slowly and deeply through nose.
• Exhale slowly through pursed lips
• Relax facial muscles without puffing your cheeks while you exhale, do it for
three times.
B)DIAPHRAGMATIC BREATHING
• Using diaphragm instead of accessory muscles
• Achieve maximum inhalation
• Slow the respiratory rate.

33. 2) CHEST PHYSIOTHERAPY:
• It is primarily used for patient with excessive bronchial secretions
who have difficulty clearing them by using method of percussion and
vibration.
• Postural drainage
• Use of positioning technique to drain secretions
• Percussion – position with the hands cuplike position with the
fingers and thumb closed.
• Vibration – tensing the hand and arm muscles repeatedly an pressing
with flat of hand on affected area while a patient slowly exhales a
deep breathe.

34. 3) AIRWAY CLEARANCE
DEVICES:
Flutter has mouthpiece, high density
steel ball, and one that holds ball.
When patient exhale through flutter
the steel ball move, which cause
oscillations in airway and loosen
secretions., moves mucus up through
airway to mouth, where mucus can
be expectorated.

35. IV.DIETARY MANAGEMENT:
• Fluid intake at least 3 litre per day. a diet high in calorie and protein ,
moderate in carbohydrate.
V. SURGICAL MANAGEMENT:
a) LUNG VOLUME REDUCTION SURGERY:
• Through bronchoscope, removing diseased lung tissue , so remaining
healthy lung tissue can perform better.
b) BULLECTOMY:
• Bullae resected through thoracoscopy (large bullae larger than 1 cm)
c) LOBECTOMY AND LUNG TRANSPLANTATION
• For severe COPD

37. VI. NURSING MANAGEMENT OF COPD
 Administer oxygen as needed.
 Vital signs
 Auscultate lung sounds
 Provide fowlers position.
 Assess skin color and temperature.
 Assess respiratory condition
 Encourage slow and deep breathing exercises.
 Regulate fluid intake
 Educate about use of oxygen at home.

38. VII.SELF MANAGEMENT OF COPD
Exercise regularly
Vaccination
 Stay away from infections
Quit smoking
Balanced diet and hydration
Plenty of sleep and regular medication.

39. COMPLICATIONS OF COPD
 Cor Pulmonale
 Atelectasis
 Pneumothorax
 Pneumonia
 COPD exacerbations.

40. NURSING DIAGNOSIS
1. Impaired gas exchange related to alveolar hypoventilation.
2. Ineffective airway clearance related to excessive secretions.
3. Activity intolerance related to fatigue.
4. Self-care deficit related to fatigue secondary to increased work of
breathing.
5. Ineffective coping related to reduced socialization.

41. PULMONARY REHABILITATION
1.It shown to improve exercise tolerance, reduce dyspnoea and
increase quality of life.
2.It includes breathing and retraining exercise programs.
3.Self-management education
4.Through a multidisciplinary team, patient enrolled in 6-12 week
program include psychosocial support , nutritional improvement and
education.

42. CONCLUSION
• COPD is a disease that results in airway obstruction and a
decreased ability to exhale air and carbon dioxide out of the lungs.
• Chronic bronchitis and emphysema are two forms of COPD and
usually occur together.
• There is no cure for COPD
• Primary symptoms of COPD are dyspnea and chronic cough
• Treatments are aimed at increasing bronchodilation, decreasing
bronchial constriction, and maintaining appropriate oxygen and
carbon dioxide levels within the body.

43. BIBLIOGRAPHY
1. Brunner and Suddarth’s, “Text Book of Medical Surgical
Nursing”,10thedition, Lippincott Williams and Wilkins.
2. Lewis’s “Medical Surgical Nursing” Volume I, Second South
Asia edition, Elsevier publications.
3. Phipps’, “Medical Surgical Nursing” Health and Illness
perspectives, Elsevier publications.
4. Gerard J.Tortora, “Principles of Anatomy and Physiology”,
12th edition, CBS publications.
5. Linton, “Introduction to Medical Surgical Nursing”, Elsevier
publications.