This document provides an overview of chronic obstructive pulmonary disease (COPD) including its definition, types, symptoms, diagnosis and management based on both modern and Ayurvedic perspectives. It defines COPD and notes that it is the second most common lung disorder in India after tuberculosis. The types of COPD are described as chronic bronchitis and emphysema, with details on different types of emphysema. Clinical features, investigations, diagnosis and modern medical management approaches are summarized. Ayurvedic views on pathogenesis, clinical features of respiratory tract involvement, and treatment approaches focusing on shodhana and shamana therapies are also presented.

1. Presented by – Anchal jaiswal
MD 1st year
Rognidan evam vikriti vigyan

2. INTRODUCTION
 Definition –The global initiative for chronic obstructive lung
disease (COLD) define COPD as a disease characterized by
progressive development of chronic airflow limitation that is
not fully reversible and is used to describe a number of
conditions , which include CHRONIC BRONCHITIS
,EMPHYSEMA and SMALL AIRWAY DISEASE.
 In India COPD is the second most common lung disorder after
pulmonary tuberculosis.
 The disease is frequently encountered in the middle aged
patient and is rare below the 35 years.

3. CONTINUED …
 In Ayurveda respiratory diseases occur due to involvement of
pranavaha srotas where cough, breathing difficulties ,
disturbed respiratory pattern respiratory pattern occurs .
 Though it is impossible to correlate COPD with any single
condition of pranavaha sroto dushti, but advanced condition of
doshika kasa and tamaka svasa may result in COPD.

4. COPD INCLUDES-
 Chronic Bronchitis
 Emphysema

5. EMPHYSEMA
 Abnormal and permanent enlargement of airspaces distal
to terminal bronchioles that is accompanied by the
destruction of airspace walls, without obvious fibrosis.

6. TYPES OF EMPHYSEMA
 Centriacinar (centilobular ) emphysema
 Dilatation involve the central or proximal part of acini
 Common and severe in upper lobes, especially in apical
segment

7.  Panacinar (panlobular ) emphysema
 All the air spaces beyond terminal bronchiole are more or less
uniformly dilated
 More common lower lobes ,and is usually most severe at bases
 Associated with alpha 1- antitrypsin deficiency

8.  Distal acinar (paraseptal) emphysema
 Dilatation affects the distal air spaces at periphery of the lobule
 It is found near the pleura . Dilated space of more than 1 cm in
size are known as bullae which may be rupture cause
spontaneous pneumothorax

9.  Irregular (scar or cicatricial) emphysema
 Acinus is irregularly involved and may be asymptomatic
 Most common form of emphysema
 Occurs near the scar and is commonly found around healed
inflammatory process lie tuberculous scars.

10. CHRONIC BRONCHITIS
 Defined as chronic productive cough for three month in each of
successive years in a patient in which other cause of chronic
cough have been excluded.

11. AETIO-PATHOGENESIS
 Faulty diet and life style patterns form the basis of
pathogenesis of any disease as per Ayurveda .
 Etiological factors of COPD mentioned in classical and modern
literature includes diet articles, food habits and lifestyle errors.

12. DIET Excessive intake of kidney beans, black gram
oil, sesame oil, white flour preparations,
tubers,curd, unboiled milk, aquatic and
marshy meat or any dietic articles difficult to
digest causing indigestion
DIETIC
HABITS
Irregular and untimely eating of food
(vishamashana)
LIFE STYLE Exposures to dust, fume, smoke wind residing
in cold place and using cold water, reduced
physical exertion or over exertion , day time
sleep, irregular or reversed sleep pattern
OTHERS Injury to vital parts

15. SAMPRAPTI
Nidansevan
kapha and ama increases in amashya
This vitiated kapha moves upwarads and reaches the
respiratory system
producing obstruction in the respiratory tract(pranvahastrotas)
normal movements of prana vayu are hampered and moves upward
producing the disese shwasa

16. PRANVAHA SROTODUSHTI LAKSHAN
 Atisristam-atibaddhama (too long or too restrictred respiration)
 Kupita (disturbed pattern of respiration)
 Alpa-alpam (shallow or frequent respiration)
 Shashbdam sashulam (respiration associated with sound and
pain)

17. SYMPTOMS OF COPD
 The characteristic symptoms of COPD are chronic and
progressive dyspnea , cough, sputum production that can be
variable from day to day.
 Dyspnea –progressive, persistant and characteristically worse
with exercise
 Chronic cough-May be intermittent and may be unproductive
 Chronic sputum production – COPD patients commonly
cough up sputum.

18. OTHER CLINICAL FEATURES
 Wheezing
 Chest tightness
 Weight loss
 Respiratory infections

19. CLINICAL PRESENTATION
CLINICAL
FEATURES
EMPHYSEMA CHRONIC
BRONCHITIS
Dyspnea Severe Mild to moderate
Cough With exertion, develops
after dyspnea starts
Frequent, develops before
dyspnea starts
Sputum-amount ,nature Scanty, mucoid Copious , purulent
Frequency of
mucopurulent relapses
Less More
cyanosis Absent Present
Pulmonary hypertension Late and mild Early and severe
RV failure & respiratory
failure
Late and often terminal Repeated episodes
Mechanism of airway
obstruction
Loss of elastic recoil Decreased airway lumen
due to mucus &
inflammation

21. PHYSICAL SIGNS
 Inspection
 Barrel shaped chest
 Accessory respiratory muscle participate
 Prolonged expiration during quite breathing
 Expiration through pursed lips
 Paradoxical retraction of the lower interspaces during
inspiration (i.e; hoovers’ sign)
 Tripod position

22. CLINICAL MANIFESTATION
 Palpation
 Decreased fremitus vocalis
 Percussion
 Hyper resonant
 Depressed diaphragm
 Dimination of the area of absolute cardiac dullness.
 Auscultation
 Prolonged expiration
 Reduced breath sounds
 Presence of wheezing during quiet breathing, crackle can be
heard if infection exist.

23. Tripod sign

24. INVESTIGATIONS
Emphysema Chronic bronchitis
Hematocrit (PCV) Normal Increased
pao2 Normal to low ‘pink puffer’ Low ‘blue bloater’
paco2 Normal to decreased (<40) High (>40)
FEV1 Decreased Decreased
Diffusing capacity Reduced Normal
Chest x-ray Features of hyperinflation,
bullae and tubular
Increased bronchovascular
markings and cardiomegaly
Elastic recoil Decreased Normal
Airway resistance Normal to slightly increased Increased
Cor pulmonale Late , mild Early , marked

25. CHEST X-RAY

26. LABORTORY EXAMINATION
 BLOOD
 Hemoglobin level and PCV may be elevated due to persistent
hypoxemia.
 SPUTUM EXAMINATION
 Streptococcus pneumonia
 Hemophillus inflenza
 HIGH RESOLUTION CT SCANS
 Greater sensitivity and specificity for emphysema
 For evalution of bullous disease

27. DIAGNOSIS OF COPD
Symptoms
Shortness of breath
Chronic cough
sputum
Exposure to risk factor
Tobacoo
Occupation
Indoor/outdoor pollution
Spirometry : required to establish diagnosis

28. MANGEMENT
 Prevention of further progress of disease
 Preservation and enhancement of pulmonary functional
capacity
 Avoidance of exacerbations in order to improve the quality of
life

29. BROCHODILATORS
 Three major classes of bronchodilators
 Beta 2- agonists :
 Short acting : salbutamol& terbutaline
 Long acting : salmeterol & formoterol
 Anticholinergic agents :
 Ipatropium , tiotropium
 Theophylline

30. GLUCOCORTICOIDS
 Regular treatment with inhaled glucocorticoid is appropriate
for symptomatic patients with an FEV1<50% and repeated
exacerbations
 Chronic treatment with systemic glucocorticoid should be
avoided because of an unfavorable benefit to risk ratio

31. OTHER TREATMENTS
 Pulmonary rehabilitation
 Nutrition
 Surgery :
 Bullectomy
 Lung volume reduction surgery
 Lung transplantation

32. MANGEMENT IN AYURVEDA
 Nidan parivarjan
 Shodhan chikitsa
 Shmana chikitsa

33. SWASA CHIKITSA SUTRA
 �हक्काश्वासा�दर्तं िस्नग्धैरादौ स्वेदैर ुप| आक्तं
लवणतैलेन नाडीप्रस्तरसङ्क||७१||
 तैरस्य ग्र�थतः श्लेष्मा स्रोतःस्व�भ| खा�न
मादर्वमायािन्त ततो वातानुलोमत||७२||
 यथाऽ�द्र कुञ्जेष्वका�शुतप्तं �वष्यन्दते| श्लेष्मा तप्
िस्थरो देहे स्वेदै�वर्ष्यन्दते||७३||

34.  Shodhana chikitsa
 Snehna, swedna
 Vamana
 Virechna
 Anuvasana basti
 Nasya
 Dumpana
 Shamana chikitsa
 Bhargi nagar yoga

35.  Rasa aushadhi / bhasma /pishti
 Swasakuthara rasa ,kapha ketu rasa, maha lakshmi vilas rasa ,
abhraka basma ,shankha basma, mukta pishti
 Vati
 Vijay vati ,lavangadi vati , marichyadi vati
 Churana
 Shringadi churna ,kushmanada churna , muktidya churna
 Kwatha/ Asva-arista
 Dhasmoola kwatha ,bharangi kwatha ,shrish kwatha
kanaavsava somasva
 Ghrita /Taila
 Manahashiladi ghrita,dhasmoolaadi ghrita, chandanadi ghrita

36.  Avleha/ paka
 Haridra khanda ,chitraka haritki
 Rasyana
 Chwyana prash rasayan
 Single drugs
 Arka, dhatura moola, pippli, haridra, vasa, pushkarmoola,
shati, bharan

37. Thankyou