COPD is the 6th leading cause of death worldwide characterized by narrowing of airways. The two main types are chronic bronchitis, involving inflammation of the airways, and emphysema, involving enlargement of airspaces in the lungs. Smoking is the primary cause. Diagnosis involves spirometry showing reduced airflow and imaging may be used. Treatment focuses on reducing risk factors, managing stable COPD and exacerbations, and addressing comorbidities through bronchodilators, steroids, oxygen therapy, pulmonary rehabilitation, and occasionally surgery.

1. COPD
Chronic bronchitis
&
Emphysema

2. COPD
 6th
leading cause of death worldwide
 Prevalence- ~5%
 Chronic progressive lung disease
 Characterized by narrowing of airways
 Partially reversible, unlike asthma
 Commonly associated with smoking
 Cause SOB & cough with expectoration
 Diagnosis requires PFT

3. Types
 Chronic bronchitis
 Cough with sputum production on most days for 3 months of a year, for
2 consecutive years
 Hyperplasia & hypertrophy of goblet cells & mucous glands, with
inflammation of the airways
 Progression causes metaplasia & fibrosis
 Advanced disease causes cyanosis & fluid retention- blue bloater
 Emphysema
 Permanent enlargement of air-spaces distal to terminal bronchioles,
leading to reduced surface area for exchange of gases
 Elasticity of lungs is reduced
 Patient makes effort to breathe giving looks of pink puffer

4. Causes
 Smoking- cumulative exposure
 Occupational exposure
 Air pollution
 Genetic- α-1 anti-trypsin deficiency
 Repeated lung infection
 ?autoimmunity
 Acute exacerbation- infection, pollutants, PE

5. Clinical features
 Symptoms
 Chronic cough with
expectoration
 Shortness of breath
 Wheezing
 Chest tightness
 h/o smoking
 Signs
 Tachypnea
 Active accessory
muscles
 Barrel-shaped chest
 Prolonged expiration
 Rhonchi

6. Diagnosis
 Spirometry- FEV1 correlates with M&M
 Mild- FEV1 >80% predicted
 Moderate- 50-79%
 Severe- 30-49%
 Very severe- <30% or s/s of respiratory failure
 CxR
 CT scan of lungs
 ABG

7. Management
 Assess & monitor
 Reduce risk factors- smoking, pollution, dust
 Manage stable COPD
 Prevent & treat acute exacerbations
Pneumococcal & annual Influenza vaccination
 Manage comorbidity
 Pulmonary rehabilitation
 Only measures to reduce mortality-
smoking cessation & supplemental oxygen

8. Drug treatment
For symptomatic relief
No effect on rate of decline
of lung function

9. Treatment
 Bronchodilators- relax smooth-muscle around
airways, providing an improved quality of life
 Given as inhalers
 Anticholinergics- Tiotropium, Ipratropium
 Beta-agonists- Salmeterol/Formoterol, Salbutamol
 Oral Theophylline
 Steroids- inhaled or oral, to treat & prevent
acute exacerbations in those with moderate
or severe COPD

10. Treatment- severity
 Mild- short-acting bronchodilator SOS
 Moderate- regular long-acting
bronchodilators
 Severe- +inhaled steroids, oral steroids
for acute exacerbations
 Very severe- +LTOT, ± regular oral
steroids

11. Long-term oxygen therapy
 For moderate or severe COPD
 Need based on ABG, on 2 occasions, at least
3 weeks apart, in patient with stable COPD,
on optimum medical treatment
 Indications-
 PaO2 <55 mm Hg or SaO2 <88% on RA
 PaO2 55-59 mm Hg with dependent edema/Hct >56%/PHT
 Nocturnal hypoxemia
 Duration- >15 hours a day, longer is better

12. Surgery
 Bullectomy, for bulla encompassing >30% of
a hemithorax
 Lung volume reduction surgery- only for
upper lobe emphysema
 Lung transplantation-
 FEV1 <25% predicted
 Resting RA PaCO2 >55 mm Hg
 Elevated PaCO2 with need for LTOT
 Elevated pulmonary artery pressure with progressive
deterioration

13. Management of exacerbation
 Acute sustained worsening of
symptoms
 Check CxR, ABG, CBC, sputum culture
 Treatment-
 Short-acting inhaled bronchodilators
 Prednisolone, 30 mg OD X 7-14 days
 Supplemental oxygen to keep SaO2 >90%
 Empiric antibiotics, if sputum purulent x 7 days
 IV Theophylline, as adjunct to bronchodilators
 Non-invasive or invasive ventilation

14. Prognosis
 COPD is a progressive disease
 Poor prognostic markers are-
 Severe airflow obstruction
 Poor exercise capacity
 Severe SOB
 Significantly over/underweight
 Respiratory failure or cor pulmonale
 Continued smoking
 Frequent acute exacerbations