Chronic obstructive pulmonary disease (COPD) encompasses chronic bronchitis and emphysema, leading to airflow obstruction, chronic cough, and respiratory issues. Its prevalence is significant, with high smoking rates being a major risk factor, and it is the fourth leading cause of death in the USA. Treatment includes smoking cessation, bronchodilators, corticosteroids, oxygen therapy, and potential surgical options.

1. Chronic Obstructive Pulmonary Disease (COPD)
OR
Chronic Obstructive Airway Disease (COAD)
Dr P Mayurathan

2. Chronic Obstructive Pulmonary Disease
(Chronic Obstructive Airway Disease)
• Consists of mainly 2 diseases;
– Chronic Bronchitis
– Emphysema

3. Chronic Bronchitis
• Excessive tracheobronchial mucus production
sufficient to cause cough with expectoration for most
days of at least 3 months of the year for 2 consecutive
years
• CO2 retention can occur
• Blue bloater

4. • Long term inflammation or swelling of the bronchi
• This can result in large amout of mucus production
Chronic Bronchitis

5. Emphysema
• Permanent abnormal distention of air spaces distal to
the terminal bronchiole with destruction of alveolar
septa (containing alveolar capillaries) and attachments
to the bronchial walls
• Pink puffer

6. • It damages the inner walls of
the alveoli and causes them to
eventually rupture
• This creates one larger air
space instead of many small
ones and reduces the surface
area available for gas exchange
Emphysema

7. COPD
• Chronic airflow obstruction due to chronic bronchitis
and/or emphysema
• Degree of obstruction may be less when the patient is
free from respiratory infection and may improve with
bronchodilator drugs
• Significant obstruction is always present

8. Epidemiology of COPD
• Global and South Asian estimated prevalence are 11.7%
and 6-7% respectively
• 30% of smokers develop COPD
• 20% of adult males have COPD
• 15% of COPD patients are severely symptomatic
• 4th leading cause of death in USA and 6th leading cause of
death worldwide

9. Risk factors of COPD
• Smoking
• Nearly all patients with symptomatic COPD are current
or former smokers
• 10-20% of smokers will develop symptomatic COPD
• Occupational Exposures
• Dusts, gases, fumes
• Alpha1-antitrypsin deficiency
• Alpha1-antitrypsin is an important protease inhibitor
that usually prevents elastases from causing lung
destruction

10. Pathophysiology of COPD

11. Pathophysiology of COPD

12. Pathophysiology of COPD
•  elastic recoil pressure  dynamic collapse of airways during
expiration ineffective cough mechanism and pursed lips
breathing (emphysema)
•  compliance (emphysema)
•  airway resistance
• Prolonged forced expiratory time
• Air trapping – RV and FRC elevated
• Hyperinflation –TLC elevated

13. Clinical features of COPD
• Chronic cough and sputum production - clear, white, yellow or
greenish
• Shortness of breath
• Wheezing
• Chest tightness
• Blueness of the lips or fingernail beds (cyanosis)
• Frequent respiratory infections
• Lack of energy
• Features of right heart failure due to cor-pulmonale

14. Medical Research Council (MRC) Dyspnoea Scale
for COPD patients

15. COPD

16. Normal COPD
R

18. GOLD (Global initiative for Chronic Obstructive Lung
Disease) Spirometric Classification of COPD

19. Treatment of COPD
• SMOKING CESSATION!
• Bronchodilators: β2 agonists
• Short acting - Salbutamol
• Long acting - Salmeterol
• Bronchodilators: Anti-cholinergic agents
• Short acting - Ipratropium
• Long acting - Tiotropium
• Methylxanthines (Theophylline)
• Has anti-inflammatory affect, and improves respiratory muscle function, stimulates
the respiratory center, and promotes bronchodilation
• Adverse effects include anxiety, tremors, insomnia, nausea, cardiac arrhythmia, and
seizures
• Inhaled corticosteroids
• Beclomethasone, Fluticasone, Budesonide
• Combination of Inhaled corticosteroid and long-acting -agonist
• Fluticasone + Salmeterol
• Oral Corticosteroids

20. Treatment of COPD
Oxygen Therapy
• 24 – 28% Oxygen via Venturi device
• Target saturation – 88 – 92% if CO2 retention
• Indications of domiciliary oxygen are:
• Resting Pa02 of < 55 mm Hg or Resting Oxygen Saturation < 88%
• Resting Pa02 of 56-59 mmHg or Oxygen Saturation < 89% in the
presence of dependent oedema, pulmonary hypertension,
secondary polycythaemia or nocturnal hypoxia
• Symptom control – 15 hours/day
• Improvement in mortality – more than 19 hours/day

21. Venturi Device

22. Venturi Mask

23. Treatment of COPD
• Pulmonary Rehabilitation
• Proper dietary modification
• Pneumococcal and influenza vaccination
• Chest physiotherapy with postural drainage
• Other physical fitness exercises
• Surgery
• Bullectomy
• Lung volume reduction surgery
• Double lung transplantation/heart-lung transplantation

24. Asthma – COPD Overlap
• When patients have features of both asthma and COPD
• Spirometry is essential for confirming persistent airflow
limitation or variable airflow obstruction
• For patients with features of both asthma and COPD
– Treat as asthma.

25. Nebulization
• A nebulizer is a drug delivery device used to administer
medication in the form of a mist inhaled into the lungs

26. Inhalers
• Mainly 2 types;
– Dry Powder Inhaler (DPI)
– Metered Dose Inhaler (MDI) with or without volumetric
spacer

27. Dry Powder Inhaler (DPI)

28. Metered Dose Inhaler (MDI)

29. Volumetric spacer