2. Introduction
COPD, or chronic obstructive pulmonary disease- is a group of lung diseases that make it difficult to breathe.
Types
1. Chronic Bronchitis
2. Emphysema
Epidemiology
➢ It is more common in men than women and is most commonly diagnosed in people over the age of 40.
➢ third leading cause of death globally.
➢ It is estimated to affect over 300 million people worldwide.
Etiology
COPD is caused by damage to the lungs that makes it harder to breathe.
Risk Factors
➢ Smoking
➢ Exposure to air pollution, dust, and other irritants can also contribute
The two often coexist. Pure emphysema or pure chronic bronchitis is rare
3. Symptoms and signs of COPD
● chronic Productive cough (With sputum production)
● shortness of breath, and
● Wheezing
Note: These symptoms may be worse during physical activity or exposure to irritants such as smoke or pollution.
Signs
➢ Barrel Chest
➢ Clubbing of Fingers
➢ Hyper inflated lungs on X-ray
➢ Air Trapping on X-ray
4. Pathophysiology
COPD is characterized by chronic inflammation and damage to the lungs, which results in narrowed airways and reduced lung function. This damage is what
results to the above presenting symptoms.
By Type
➢ Chronic bronchitis
Excess mucus production narrows the airways.
Inflammation and scarring in airways, enlargement in mucous glands, and smooth muscle hyperplasia lead to obstruction.
➢ Emphysema
Destruction of alveolar walls is due to relative excess in protease (elastase) activity, or relative deficiency of antiprotease (α1-antitrypsin)
activity in the lung. Elastase is released from PMNs and macrophages and digests human lung.
This is inhibited by α1-antitrypsin.
Tobacco smoke increases the number of activated PMNs and macrophages, inhibits α1-antitrypsin, and increases oxidative stress on the
lung by free radical production
6. Treatment | Management
Management
➢ Life changes
○ avoiding triggers
➢ regular exercise
➢ medications
○ Smoking cessation (Most important intervention)
○ Bronchodilators
○ Corticosteroids or antibiotics
○ oxygen therapy or pulmonary rehabilitation.
➢ Surgery
7. Treatment Guideline
The GOLD guidelines classify patients into four different categories: GOLD 1 (mild), GOLD 2 (moderate), GOLD 3 (severe), or GOLD 4
(very severe) based on their level of airflow limitation. This is assessed by evaluating a post bronchodilator FEV1/FVC. Refer to TABLE 1
for more information regarding FEV1 values and GOLD classification.
8. Symptom burden and risk of exacerbation are also further classified into GOLD groups A through D, which is used to
guide therapy. Classification is patient-specific, and each patient’s treatment regimen should be tailored specifically to
their needs. Refer to FIGURE 1 for the GOLD group classification algorithm.
9. Maintenance Treatment of COPD
GOLD classifications are used to determine initial treatment options for patients with COPD. FIGURE 2 shows the initial
pharmacologic treatment for each GOLD group classification. Refer to TABLE 1 and FIGURE 2 for classifications. Importantly, all
patients with COPD should be prescribed a rescue short-acting bronchodilator for immediate symptom relief.
10. In terms of managing patient follow-up, the guidelines recommend modifying therapy based on two treatable targets: dyspnea or
exacerbations. If a patient presents with both dyspnea and exacerbations, the guidelines recommend following the exacerbation
treatment pathway as shown in FIGURE 3.
11. Complication
1. Acute exacerbations
➢ most common causes are infection,
➢ noncompliance with therapy
➢ cardiac disease
2. Secondary polycythemia
➢ compensatory response to chronic hypoxemia
➢ (Hct >55% in men or >47% in women)
3. Pulmonary HTN and cor pulmonale
➢ may occur in patients with severe, long standing COPD who have chronic hypoxemia
Note: COPD patients are at a high risk of developing Lung Cancer
13. Reference
➢ Step-up to Medicine 4ED (Steven S. Agabegi, Elizabeth D. Agabegi)
➢ Standard Treatment Guidelines for Zambia
➢ www.uspharmacist.com
➢ www.heart.org
➢ https://en.wikipedia.org
➢ https://www.sciencedirect.com
