This document provides an overview of Chronic Obstructive Pulmonary Disease (COPD). It discusses the causes of COPD, including cigarette smoking which accounts for 80-90% of cases. The signs and symptoms of COPD typically include cough, expectoration, and dyspnea. Diagnosis involves tests such as chest X-rays, CT scans, pulmonary function tests, and arterial blood gases. Management focuses on smoking cessation, bronchodilators, oxygen therapy, vaccines, and treating exacerbations. The prognosis is related to the severity of lung function impairment.

1. Chronic Obstructive Pulmonary Disease
COPD
Prof. dr abid naeem

4. CXR

5. CT- Scan

6. History & Physical
 History
 ■ Cigarettes account for 80–90% of COPD
 ■ Only 10–20% of smokers develop COPD
 ■ Synergy between smoking and certain inhaled dusts
 ■ More common in men (corrected for smoking)

7. Signs & Symptoms
 ■ Cough, expectoration (usually scant), dyspnea.
 ■ May start as dyspnea with exertion.
 ■ Chronic bronchitis most common cause of hemoptysis.
 ■ Physical exam often normal.
 ■ Rhonchi, wheezes, crackles variably present.
 ■ Prolonged expiration common; >4 sec = significant obstruction.
 ■ Late: barrel chest, pursed lips, weight loss, tripod posture (leaning
forward supported on arms/elbows).
 ■ Loud P2 suggests pulmonary hypertension.

8. Tests
 ■ PFTs
 ■ All patients should have spirometry
 ■ Quantitative severity of obstruction
 ■ Assess reversibility
 ■ Follow/document progress/prognosis
 ■ Decreased FEV1, FEV1/FVC
 ■ TLC, RV may be increased
 ■ Decreased DLCO in emphysema

9. Imaging
 CXR:
 ■ Not specific for COPD; most useful for complications
 ■ Bronchial wall thickening, “tram-tracks” suggest chronic bronchitis
 ■ Hyperinflation, oligemia, bullae suggest emphysema
 ■ CT can demonstrate emphysema, bronchiectasis

10.  Arterial Blood Gases
 ■ Early: Mild-moderate hypoxemia
 ■ Late: Increased hypoxemia; hypercapnia
 ■ Sputum
 Commonly colonized with Spneumoniae, Hinfluenza, M catarrhalis

11. Differential Diagnosis
 ■ Asthma (distinguished by reversibility)
 ■ Chronic bronchitis (sputum ×3mo×≥2 successive y)
 ■ Emphysema (CT or pathologic diagnosis)
 ■ Cystic fibrosis
 ■ Bronchiectasis (CT diagnosis)
 ■ Alpha1-proteinase inhibitor deficiency (<1% of all COPD)

12. Management
 ■ What to do first
 ■ Assess severity:
 ■ Spirometry should be routine
 ■ Hypoxemia influences survival

13. General Measures
 ■ Eliminate causative factors (smoking, allergens, occupational
exposures)
 ■ Improve airway function (bronchodilators, steroids)
 ■ Prevent or treat infectious exacerbations (vaccines, antibiotics)
 ■ Support end-stage COPD
 ■ Look for co morbid conditions (Pneumothorax, CHF, PE,
Hypophosphatemia, Hypokalemia)

14. Specific Therapy
 ■ Smoking cessation slows loss of lung function
 ■ Oxygen (only treatment proven to prolong life):
 ■ Indications:
 ■ PaO2 <55; SaO2 <88%
 ■ PaO2 56–59 or SaO2 89% + right heart failure or Hct >56%
 ■ Continuous (20–24 h/d) better than 12 h
 ■ Titrate flow to PaO2 60–80
 ■ Patients require increased flow for exercise, sleep

15. Bronchodilators

16.  ■ Bronchodilators:
 ■ Ipratropium or short-acting beta2 or long-acting beta2 or
combination
 ■ Nebulization usually not necessary with proper inhaler technique
and dose
 ■ Theophylline may be useful as additional therapy
 ■ Long-acting anticholinergics and PDE4 inhibitors look promising for
the near future

17.  ■ Inhaled corticosteroids (ICS):
 ■ ICS do not slow progression of disease
 ■ May reduce exacerbations and visits
 ■ Increased risk of osteoporosis, skin thinning
 ■ Oral steroids effective in exacerbation

18.  Treat infectious exacerbations:
 Unclear when antibiotics needed; meta-analysis suggests pos effect
 Treat empirically for S pneumonia, H influenza, M catarrhalis,
 Legionella, Mycoplasma; consider Pseudomonas, AFB

19.  ■ Vaccination:
 ■ Pneumococcal q 5–10 y
 ■ Influenza q 1 y
 ■ Pulmonary rehabilitation improves quality of life, not survival
 ■ Lung volume reduction surgery controversial; benefits may be short
live
 ■ Lung transplant: COPD most common indication; 1-y survival,
 ∼90%; 5-y, ∼50%
 ■ Opiates help relieve dyspnea in some patients

20. Follow-up
 Follow-up
 ■ Routine, periodic spirometry best objective measure to assess status
 ■ Evaluate frequently for co morbid conditions (CHF, poor nutrition)

21. Complications and prognosis
 Complications and prognosis
 Complications
 ■ Exacerbation (S pneumoniae, H influenzae up to 80%)
 ■ Pneumonia
 ■ Hemoptysis

22.  Pneumothorax: suspect with sudden increase in dyspnea
 ■ Respiratory failure
 ■ Cor pulmonale: vasoconstriction due to hypoxemia; LVH may
contribute; thromboemboli also
 ■ Depression, anxiety, inactivity
 ■ Sleep abnormalities (less REM, hypercarbia)
 ■ Malnutrition (50%): may affect respiratory muscles
 ■ Giant bullae: usually in smokers, upper lung zones, may become
infected, esp with Aspergillus
 ■ Lung cancer

23. Prognosis
 Prognosis
 ■ Mild obstruction (FEV1 >50%): Good
 ■ Severe obstruction (FEV1 ≤0.75 L): 1-y mortality, 30%

24. Thanks