1. Chronic obstructive pulmonary disease (COPD) is a slowly progressive disorder characterized by airway obstruction including chronic bronchitis and emphysema. 2. Chronic bronchitis involves excessive mucus production and airway obstruction for at least 3 months per year for 2 years. Emphysema involves the abnormal enlargement of air spaces in the lungs. 3. Cigarette smoking is a leading cause of COPD and its management involves bronchodilators, steroids, antibiotics and smoking cessation.

1. Respiratory systemRespiratory system
Chronic obstructive pulmonaryChronic obstructive pulmonary
disease (COPDdisease (COPD((

2. COPD: is defined as chronic slowlyCOPD: is defined as chronic slowly
progressive disorder characterized byprogressive disorder characterized by
airway obstruction, which does not changeairway obstruction, which does not change
markedly by several months. Which ismarkedly by several months. Which is
includingincluding::
11--Chronic bronchitisChronic bronchitis
22--EmphysemaEmphysema

4. Chronic bronchitisChronic bronchitis
Is a clinical condition characterized byIs a clinical condition characterized by
excessive mucus production resulting inexcessive mucus production resulting in
airways obstruction on most days for atairways obstruction on most days for at
least 3 months of the year during at leastleast 3 months of the year during at least
2 consecutive years.2 consecutive years.
Etiology:Etiology:
-Air pollution-Air pollution -Cigarette smoking-Cigarette smoking
-Coal, gold mining, cement, grain handling-Coal, gold mining, cement, grain handling
and farming.and farming.

6. Clinical manifestations:Clinical manifestations:
-Excessive mucus production-Excessive mucus production
-Bronchospasm, dyspnea and wheezing-Bronchospasm, dyspnea and wheezing
-Hypoxia and hypercapnia (Blue in color)-Hypoxia and hypercapnia (Blue in color)
-Productive cough-Productive cough
-Increase body weight-Increase body weight
Complications:Complications:
Cor-pulmonaleCor-pulmonale

7. Cor pulmonaleCor pulmonale

8. EmphysemaEmphysema
An abnormal permanent enlargement of air spacesAn abnormal permanent enlargement of air spaces
distal to the terminal bronchioles, accompanieddistal to the terminal bronchioles, accompanied
by destruction of their walls.by destruction of their walls.
Etiology:Etiology:
Cigarette smokingCigarette smoking
Clinical manifestations:Clinical manifestations:
-Dyspnea at rest -Tachypnea (flushed-Dyspnea at rest -Tachypnea (flushed
appearance)appearance)
-Patient will be thin-Patient will be thin

10. Investigations:Investigations:
1-Spirometer1-Spirometer
2-Arterial blood gases2-Arterial blood gases
3-Blood test (Polycythemia)3-Blood test (Polycythemia)
4-X-ray to differentiate between two4-X-ray to differentiate between two
diseases.diseases.

11. Emphysema
Bronchitis

12. Treatment:Treatment:
-Stop smoking-Stop smoking
1-Antibiotics1-Antibiotics
2-Bronchodilator2-Bronchodilator
--Salbutamol (200-800ug/d inhalation) orSalbutamol (200-800ug/d inhalation) or
-Ipratropium (80-120 ug/d inhalation)-Ipratropium (80-120 ug/d inhalation)
3-Predinsolone tab. 30mg/d for 2 weeks if there is3-Predinsolone tab. 30mg/d for 2 weeks if there is
improvement 200-500ug twice daily should beimprovement 200-500ug twice daily should be
taken.taken.
4-Mucolytic (Bromhexin 16mg tid oral) or4-Mucolytic (Bromhexin 16mg tid oral) or
expectorant (Guaifenesin 200mg tid oral)expectorant (Guaifenesin 200mg tid oral)
5-Influenza vaccination5-Influenza vaccination

13. Case studiesCase studies
Case 1Case 1::
M.R is a 60-year man, who is heavy smoker for the past 40M.R is a 60-year man, who is heavy smoker for the past 40
years. He has had a chronic cough for the past 6 years,years. He has had a chronic cough for the past 6 years,
often producing grey sputum. He is overweight andoften producing grey sputum. He is overweight and
occasionally becomes breathlessoccasionally becomes breathless..
M.R was admitted to hospital with increasingM.R was admitted to hospital with increasing
breathlessness, wheeze and productive cough. Hisbreathlessness, wheeze and productive cough. His
sputum was thick & green and he had a temperature ofsputum was thick & green and he had a temperature of
39 C39 C°°. His present medication includes. His present medication includes::
--Salbutamol + Ipratropium combined inhaler 2 puffs fourSalbutamol + Ipratropium combined inhaler 2 puffs four
times a daytimes a day..
--Belomethasone inhaler 500ug twice a dayBelomethasone inhaler 500ug twice a day..
--aminophylline slow release tab. 225 mg twice a dayaminophylline slow release tab. 225 mg twice a day..

14. QuestionsQuestions::
11--What is the probable diagnosis for this patientWhat is the probable diagnosis for this patient??
22--What factors lead to this caseWhat factors lead to this case??
33--Does this patient require antibiotics therapy? IfDoes this patient require antibiotics therapy? If
so what would your recommended? Whyso what would your recommended? Why??
44--What other measures could be used to preventWhat other measures could be used to prevent
further exacerbationsfurther exacerbations??
55--Are there any particular precautions necessary ifAre there any particular precautions necessary if
influenza vaccination is administered to thisinfluenza vaccination is administered to this
patientpatient??
66--What is the complication of chronic bronchitisWhat is the complication of chronic bronchitis??

15. Case 2Case 2::
H.C is a 68-year old male who presents toH.C is a 68-year old male who presents to
emergency room (ER) with chief complaints ofemergency room (ER) with chief complaints of
fatigue and shortness of breath that has becomefatigue and shortness of breath that has become
progressively worse over the past two weeks.progressively worse over the past two weeks.
He was seen by his local physician one weekHe was seen by his local physician one week
ago, and treated with ampicillin for a presumedago, and treated with ampicillin for a presumed
upper respiratory infections. Over the past weekupper respiratory infections. Over the past week
dyspnea developed & worsened especially atdyspnea developed & worsened especially at
rest. The past medical history is pertinentrest. The past medical history is pertinent
EmphysemaEmphysema..

16. QuestionsQuestions::
11--What are signs& symptoms of EmphysemaWhat are signs& symptoms of Emphysema??
22--What are its etiology and investigationsWhat are its etiology and investigations??
33--What are the differences between COPDWhat are the differences between COPD
underlying typesunderlying types??
44--What is the strategy in treatment acute COPDWhat is the strategy in treatment acute COPD??
55--What is the role of expectorant & mucolyticWhat is the role of expectorant & mucolytic
agents in COPDagents in COPD??

17. ReferencesReferences
 Walker and Edwards (eds). ClinicalWalker and Edwards (eds). Clinical
Pharmacy and Therapeutics. Third editionPharmacy and Therapeutics. Third edition
(2003).(2003).
 Rang, Dale and Ritter PharmacologyRang, Dale and Ritter Pharmacology
(2009)(2009)
 KatzungKatzung ––Basic and ClinicalBasic and Clinical
Pharmacology (2009)Pharmacology (2009)
 British National Formulary (BNF) (2009)British National Formulary (BNF) (2009)