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Copd
This document provides an overview of Chronic Obstructive Pulmonary Disease (COPD). It defines COPD as a preventable and treatable lung disease characterized by limited airflow. The two main conditions that make up COPD are chronic bronchitis and emphysema. Chronic bronchitis involves long-term inflammation of the bronchial tubes, while emphysema involves breakdown of lung tissue. Cigarette smoking is the primary cause of COPD. Symptoms include shortness of breath, cough, and sputum production. Diagnosis involves patient history, exams, pulmonary function tests, chest x-rays, and blood tests. Management focuses on smoking cessation, medications like bronchodilators, oxygen therapy, pulmonary rehabilitation
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Copd
- 1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE preparedby, Likhila abraham
- 2. DEFINITION OF COPD Chronicobstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by air flow limitation that is not fully reversible. (ask.com) Air flow limitation is usually progressive and is associated with an abnormal inflammatory response of lungs to noxious particles or gases,primarily caused by cigarette smoking.
- 4. COPD is alung disease defined poor air flow as a result of break down of lung tissue or dysfunction of small air ways .primary symptom include shortness of breath ,cough ,and sputum production( medical dictionary)
- 5. Etiology 1.Cigerette smoking 2.Infections 3.Heriditory 4.Occupational dusts andchemicals 5.Air pollution 6.aging
- 6. classification of COPD definitionInclude chronic bronchitis ,emphysema with airflow limitation. The
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- 8. Chronic Bronchitis Chronic bronchitisis defined clinically as the presence of a cough productive of sputum not attributable to other causes on most days for at least 3 months over 2 consecutive years. Chronic inflammation of the bronchii
- 10. Chronic Bronchitis Chronic nonspecificinflammation Symptoms of cough and sputum production with or without gasping Recurrent attacks Chronic proceeding
- 11. Classification of ChronicBronchitis Simple type of Chronic Bronchitis (without gasping) Cough Sputum expectoration Chronic Bronchitis with gasping Cough Sputum expectoration Gasping
- 12. Stages of ChronicBronchitis Stages Time Courses Exacerbation In a week Chronic lag phase One month or longer stable Lasts for two months
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- 17. Weight loss and anorexia Insomnia Airhunger Cyanosis
- 18. Diagnosis of chronic bronchitis History Cough & Sputum expectoration & Gasping Three months /per year or longer Continuously longer than two years Exclude other lung and heart disease If shorter than three months /per year then definite objective evidences are demanded (such as X-Ray and lung function et al.)to diagnose.
- 19. 1.Physical examination ( .Diminishedbreath sounds) 2.Pulmonary function test 3.Chest x ray 4.Blood test 5.CT
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- 21. Definition of Emphysema Pulmonary emphysema (a pathological term) is characterized by abnormal,permanent enlargement of air spaces distal to the terminal bronchioles ,accompanied by destruction of their walls and hyperdistension leading to reduction in lung elastics recoil and airway obstruction.
- 22. Classification of Emphysema ObstructiveEmphysema senile Emphysema emphysema(Physiological) without Interstitial Emphysema Obstruction Compensating Emphysema Scarred Emphysema
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- 24. Chest pain Non productivecough Fatigue malaise Weight loss
- 25. •Lung parenchyma (respiratorybronchioles and alveoli) Alveolar wall destruction, apoptosis of epithelial and endothelial cells. • Centrilobular emphysema: dilatation and destruction of respiratory bronchioles; most commonly seen in smokers • Panacinar emphysema: destruction of alveolar sacs as well as respiratory bronchioles; most commonly seen in alpha-1 antitrypsin deficiency
- 26. Normal distal lungacinus
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- 29. spirometric classification ofCOPD FEV1/FVC mild <70% moderate <70% severe disease <70% Very severe < 70% FEV1%pred ≥80% 50~80% 30~50% ≤ 30%or<50% following with respiratory failure & right heart failure
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- 31. •Pulmonary vasculature Thickening ofintima, endothelial cell dysfunction, smooth muscle pulmonary hypertension.
- 32. Clinical Manifestations ofcopd Symptoms: Gradually progressive dyspnea is the most common presenting character. Dyspnea that is: Progressive (worsens over time) Usually worse with exercise Persistent (present every day) Described by the patient as an “increased effort to breathe,”“heaviness,” “air hunger,” or “gasping.”
- 33. •Chronic Cough May beintermittent and may be unproductive. •Chronic sputum production: Recurrent respiratory infection Recurrent attacks leading to cor pulmonal heart disease Unexpected Decreased weigh loss food appetite
- 34. Physical Signs: Earlier period:Minimal/Nonspecificsigns Advanced Stage: *Inspection: Barrel-shaped chest , accessory respiratory muscle participate , prolonged expiration during quiet breathing. *Palpation: Weakened fremitus vocalis
- 35. Clinical Manifestation *Percussion : Hyperresonant depresseddiaphragm, dimination of the area of absolute cardiac dullness. *Auscultation: Prolonged expiration ； reduced breath sounds; The presence of wheezing during quiet breathing Crackle can be heard if infection exist. The heart sounds are best heard over the xiphoid area.
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- 38. Chest x-ray Chronic bronchitis Chest Radiograph(X-Ray) Nonapparent abnormality Or thickened and increased of the lung markings are noted.
- 39. Chest X-Ray --emphysema Chest findings are also varible. Marked over inflation is noted with flattend and low diaphragm Intercostal space becomes widen A horizontal pattern of ribs A long thin heart shadow Decreased markings of lung peripheral vessels
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- 41. CT(Computed tomography) : greater sensitivityand specificity for emphysema , especially for the diagnosis of bronchiectasis and evaluation of bullous disease
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- 43. Labortory Examination Blood examination Inexcerbation or acute infection in airway, leucocytosis may be detected. Sputum examination streptococcus pneumonia Haemophilus influenzae Moraxella catarrhalis klebsiella pneumonia
- 44. Blood gas analysis: Arterial bloodgas analysis may reveal hypoxemia,particularly advanced disease. In patients with severe hypoxemia ,CO2 retention,it shows low arterial PO2 and high arterial PCO2.
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- 46. management Aim Based on theprinciples of prevention of further progress of disease preservation and enhancement of pulmonary functional capacity avoidance of exacerbations in order to improve the quality of life.
- 47. TREATMENT Stop smoking Avoidenvironment pollution Breathing retraining Chest physiotherapy
- 48. Flutter mucous clearancedevice
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- 51. Drug Therapy 1.Bronchodilators Bronchodilators arecentral to the symptomatic management of COPD. improve emptying of the lungs,reduce dynamic hyperinflation and improve exercise performance .
- 52. Drug Therapy Bronchodilators Three majorclasses of bronchodilators: β2 - agonists: Short acting: salbutamol & terbutaline Long acting :Salmeterol & formoterol Anticholinergic agents: Ipratropium,tiotropium Theophylline (a weak bronchodilator, which may have some antiinflammatory properties)
- 53. Drug Therapy 2.Glucocorticoids Regulartreatment with inhaled glucocorticoids is appropriate for symptomatic patients with anFEV1<50%pred and repeated exacerbations. Chronic treatment with systemic glucocorticoids should be avoided because of an unfavorable benefit-torisk ratio.
- 54. 3. COMBINATION THERAPY Combinationtherapy of long acting ß2-agonists and inhaled corticosteroids show a significant additional effect on pulmonary function and a reduction in symptoms. Mainly in patients with an FEV1<50%pred
- 55. Drug Therapy 4.Others: Antioxidantagents Immunoreggulators Alpha-1 antitrypsin augmentation Mucolytic(mucokinetic,mucoregulator) agents Antitussives
- 56. Oxygen Therapy Oxygen -- >15h /d Long-term oxygen therapy (LTOT) improves survival,exercise,sleep and cognitive performance in patients with respiratory failure. The therapeutic goal is to maintain SaO2 ≥ 90% and PaO2 ≥ 60mmHg at sea level and rest .
- 57. Long-term Oxygen therapy LTOT Indication: Forpatients with a PaO2 ≤ 55 mmHg or SaO2≤88% , with or without hypercapnia For patients with a PaO2 of 55~70 （ 60 ） mmHg or SaO2≤89% as well as pulmonary hypertension / heart failure / polycythemia (hematocrit >55%)
- 58. Pulmonary rehabilitation Nutrition Surgery: Bullectomy Lung volume reductionsurgery Lung transplantation
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- 60. Complications Cor pulmonale Exacerbations ofcopd Respiratory failure Peptic ulcer and GERD Depression
- 62. Clinical features Dyspnea Crackles S3 gallops Ecgchanges Hepatomegaly ,splenomegaly ,ascitis
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- 64. Nursing management 1.Ineffective airwayclearance 2.Imapaired gas exchange 3.Imbalnced nutrition 4.Insomnia 5.Deficient knowledge 6.anxiety
Editor's Notes
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