Obstructive lung diseases are characterized by airway obstruction. Chronic obstructive pulmonary disease (COPD) refers specifically to chronic bronchitis and emphysema, where the airways become narrowed over time due to inflammation and mucus, limiting airflow. The main symptoms of COPD are cough, sputum production, and shortness of breath. A diagnosis of COPD requires respiratory testing showing airflow limitation. While there is no cure, symptoms can be treated through smoking cessation, bronchodilators, pulmonary rehabilitation, oxygen supplementation, and managing exacerbations.

1. By,
Mr. Aby Thankachan, M.Sc (N) , PGDSH
Nurse Educator
Karpaga Vinayaga College of Nursing,Pudukkottai

2.  Obstructive lung disease is a category of respiratory
disease characterized by airway obstruction. Many
obstructive diseases of the lung result from narrowing of
the smaller bronchi and larger bronchioles, often because
of excessive contraction of the smooth muscle itself. It is
generally characterized by inflamed and easily collapsible
airways, obstruction to airflow, problems exhaling and
frequent medical clinic visits and hospitalizations.
 Types of obstructive lung disease include; asthma,
bronchiectasis, bronchitis and chronic obstructive
pulmonary disease (COPD). Although COPD shares
similar characteristics with all other obstructive lung
diseases, such as the signs of coughing and wheezing,
they are distinct conditions in terms of disease onset,
frequency of symptoms and reversibility of airway
obstruction.Cystic fibrosis is also sometimes included in
obstructive pulmonary disease.

3.  COPD is also known as chronic obstructive
lung disease (COLD), chronic obstructive
airway disease (COAD), chronic airflow
limitation (CAL) and chronic obstructive
respiratory disease (CORD)
 Chronic obstructive pulmonary disease (COPD)
refers to chronic bronchitis and emphysema, a
pair of two commonly co-existing diseases of
the lungs in which the airways become
narrowed. This leads to a limitation of the
flow of
 air to and from the lungs causing
 shortness of breath.

5.  In COPD, less air flows in and out of the
airways because of one or more of the
following:
 The airways and air sacs lose their
elastic quality.
 The walls between many of the air sacs
are destroyed.
 The walls of the airways become thick
and inflamed.
 The airways make more mucus than
usual, which tends to clog them.

8. Gross pathology of lung showing centrilobular emphysema
characteristic of smoking. Closeup of fixed, cut surface shows
multiple cavities lined by heavy black carbon deposits.

9.  It is the 4th leading cause of mortality and
12th leading cause of disability in the
united states.
 In 2020 COPD is the 3rd leading cause of
death.

10. As of 2015 COPD affected about 174.5 million
(2.4%) of the global population.
It typically occurs in people over the age of
40. Males and females are affected equally
commonly. In 2015 it resulted in 3.2 million
deaths, up from 2.4 million deaths in 1990.
More than 90% of these deaths occur in the
developing world.
The number of deaths is projected to increase
further because of higher smoking rates in the
developing world, and an aging population in
many countries.

11.  1)Smoking
 2) Occupational exposures- exposure to
workplace dusts found in coal mining, gold
mining, and the cotton textile industry and
chemicals such as cadmium, isocyanates, and
fumes from welding have been implicated in
the development of airflow obstruction.
 3) Air pollution
 4) sudden airway constriction in response to
inhaled irritants,
 5) Bronchial hyperresponsiveness, is a
characteristic of asthma.

12.  6) Genetics-Alpha 1-antitrypsin deficiency
is a genetic condition that is responsible
for about 2% of cases of COPD. In this
condition, the body does not make enough
of a protein, alpha 1-antitrypsin. Alpha 1-
antitrypsin protects the lungs from
damage caused by protease enzymes, such
as elastase and trypsin, that can be
released as a result of an inflammatory
response to tobacco smoke.

13. NUTRITION
INFECTIONS
SOCIO ECONOMIC STATUS
AGING POPULATION

14. Risk factors
• Most cases of COPD are caused by
inhaling pollutants; that includes smoking
(cigarettes, pipes, cigars, etc.), and
second-hand smoke.
• Fumes, chemicals and dust found in
many work environments are contributing
factors for many individuals who develop
COPD.
• Genetics can also play a role in an
individual’s development of COPD—even
if the person has never smoked or has
ever been exposed to strong lung irritants

15.  Abnormal inflammatory response of the
lungs due to toxic gases.
 Response occurs in the airways
,parenchyma & pulmonary vasculature.
 Narrowing of the airway takes place
 Destruction of parenchyma leads to
emphysema.

16.  Destruction of lung parenchyma leads to an
imbalance of proteinases/antiproteinases.
(this proteinases inhibitors prevents the
destructive process)
 Pulmonary vascularchanges
 Thickening of vessels
 Collagen deposit
 Destruction of capillary beds.

Mucus hypersecretion(cilia dysfunction,airflow
limitation,corpulmonale(RVF))


Chronic cough and sputum production

18. Stages of COPD
Mild COPD or Stage 1—Mild COPD with
a FEV1 about 80 percent or more of
normal.
Moderate COPD or Stage 2—Moderate
COPD with a FEV1 between 50 and 80
percent of normal.
Severe COPD or Stage 3—Severe
emphysema with a FEV1 between 30 and
50 percent of normal.
Very Severe COPD or Stage 4—Very
severe or End-Stage COPD with a lower
FEV1 than Stage 3, or people with low

19.  Chronic cough
 Sputum production
 Wheezing
 Chest tightness
 Dyspnoea on exertion
 Wt.loss
 Respiratory insufficiency
 Respiratory infections
 Barrel chest- chronic hyperinflation leads
to loss of lung elasticity.

20. • The most common symptoms of COPD are
• sputum production,
• shortness of breath
• and a productive cough.
• These symptoms are present for a prolonged
period of time and typically worsen over time.It is
unclear if different types of COPD exist.While
previously divided into emphysema and chronic
bronchitis, emphysema is only a description of
lung changes rather than a disease itself, and
chronic bronchitis is simply a descriptor of
symptoms that may or may not occur with COPD

21.  Cough
 A chronic cough is often the first symptom to develop.
When it persists for more than three months each year for
at least two years, in combination with sputum production,
there is by definition chronic bronchitis.
 This condition can occur before COPD fully develops. The
amount of sputum produced can change over hours to
days. In some cases, the cough may not be present or may
only occur occasionally and may not be productive. Some
people with COPD attribute the symptoms to a "smoker's
cough".
 Sputum may be swallowed or spat out, depending often on
social and cultural factors.
 Vigorous coughing may lead to rib fractures or a brief loss of
consciousness. Those with COPD often have a history of
"common colds" that last a long time.

22.  Shortness of breath
 Shortness of breath is often the symptom that
most bothers people.I t is commonly described
as: "my breathing requires effort," "I feel out of
breath," or "I can't get enough air in".
 the shortness of breath is worse on exertion of a
prolonged duration and worsens over time.In the
advanced stages, it occurs during rest and may
be always present. It is a source of both anxiety
and a poor quality of life in those with COPD.
Many people with more advanced COPD breathe
through pursed lips and this action can improve
shortness of breath in some.

23.  Other features
 In COPD, it may take longer to breathe out than to breathe in.
Chest tightness may occur.Those with obstructed airflow may
have wheezing or decreased sounds with air entry on
examination of the chest with a stethoscope.
 A barrel chest is a characteristic sign of COPD, but is
relatively uncommon.
 Tripod positioning may occur as the disease worsens.
 Advanced COPD leads to high pressure on the lung arteries,
which strains the right ventricle of the heart.This situation is
referred to as cor pulmonale, and leads to symptoms of leg
swelling and bulging neck veins.
 Cor pulmonale has become less common since the use of
supplemental oxygen.
 Fingernail clubbing is not specific to COPD and should
prompt investigations for an underlying lung cancer.

24.  Exacerbation
 An acute exacerbation of COPD is defined as
increased shortness of breath, increased sputum
production, a change in the color of the sputum
from clear to green or yellow, or an increase in
cough in someone with COPD.
 This may present with signs of increased work of
breathing such as fast breathing, a fast heart
rate, sweating, active use of muscles in the neck,
a bluish tinge to the skin, and confusion or
combative behavior in very severe
exacerbations.Crackles may also be heard over
the lungs on examination with a stethoscope.

25. diagnosis
• The diagnosis of COPD should be considered in
anyone over the age of 35 to 40 who has
shortness of breath, a chronic cough, sputum
production, or frequent winter colds and a history
of exposure to risk factors for the disease.
Spirometry is then used to confirm the diagnosis.
Screening those without symptoms is not
recommended.
• Lung function test
• ABG analysis
• Pulse oximetry
• Alpha 1 antitrypsin level

26. • Spirometry
• Spirometry measures the amount of airflow
obstruction present and is generally carried out after
the use of a bronchodilator .
• Two main components are measured to make the
diagnosis: the forced expiratory volume in one
second (FEV1), which is the greatest volume of air
that can be breathed out in the first second of a
breath, and the forced vital capacity(FVC), which is
the greatest volume of air that can be breathed out
in a single large breath.
• Normally, 75–80% of the FVC comes out in the first
secondand a FEV1/FVC ratio of less than 70% in
someone with symptoms of COPD defines a person
as having the disease.

27.  GOLD grade
 Severity FEV1 % predicted
 Mild (GOLD 1) ≥80
 Moderate (GOLD 2) 50–79
 Severe (GOLD 3) 30–49
 Very severe (GOLD 4) <30

28.  MRC shortness of breath scale
 Grade Activity affected
 1 Only strenuous activity
 2 Vigorous walking
 3 With normal walking
 4 After a few minutes of walking
 5 With changing clothing

29.  Other tests
 chest X-ray - Characteristic signs on X-ray are
overexpanded lungs, a flattened diaphragm, increased
retrosternal airspace, and bullae while it can help
exclude other lung diseases, such as pneumonia,
pulmonary edema or a pneumothorax.
 complete blood count
 A high-resolution computed tomography scan of the
chest may show the distribution of emphysema
throughout the lungs and can also be useful to exclude
other lung diseases.
 An analysis of arterial blood is used to determine the
need for oxygen; this is recommended in those with an
FEV1 less than 35% predicted, those with a peripheral
oxygen saturation of less than 92% and those with

30.  Management
 no known cure for COPD, but the symptoms
are treatable and its progression can be
delayed
 smoking cessation and supplemental oxygen
 Stopping smoking decreases the risk of death
by 18%.
 influenza vaccination once a year,
pneumococcal vaccination once every five
years, and reduction in exposure to
environmental air pollution.
 In those with advanced disease, palliative care
may reduce symptoms, with morphine

31.  Exercise
• Pulmonary rehabilitation - exercise, disease management
and counseling
• Breathing exercises & Pursed lip breathing exercises
 Bronchodilators
• Inhaled bronchodilators
• two major types, β2 agonists and anticholinergics; They
reduce shortness of breath, wheeze and exercise limitation,
resulting in an improved quality of life.
• If long-acting bronchodilators are insufficient, then inhaled
corticosteroids are typically added. tiotropium (a long-acting
anticholinergic) or long-acting beta agonists (LABAs)
• short-acting β2 agonists - salbutamol (albuterol) and
terbutaline , provide some relief of symptoms for four to six
hours
• Long-acting β2 agonists - salmeterol, formoterol and
indacaterol
• two main anticholinergics, ipratropium and tiotropium.
• Aclidinium, another long acting agent, reduces

32.  Other medication
 Long-term antibiotics - macrolide class such as
erythromycin, reduce the frequency of
exacerbations in those who have two or more a
year.
 Methylxanthines such as theophylline generally
cause more harm than benefit and thus are
usually not recommended, but may be used as
a second-line agent in those not controlled by
other measures.
 Mucolytics may help to reduce exacerbations in
some people with chronic bronchitis.
 Cough medicines are not recommended

33.  Oxygen
 Supplemental oxygen - low oxygen levels at rest (a
partial pressure of oxygen of less than 50–55 mmHg
or oxygen saturations of less than 88%).
 oxygen supplementation may improve shortness of
breath when given during exercise, but may not
improve breathlessness during normal daily activities
or impact the quality of life
 Surgery
 lung transplantation or lung volume reduction
surgery.
 Lung volume reduction surgery involves removing the
parts of the lung most damaged by emphysema
allowing the remaining, relatively good lung to
expand and work better.

34. • Exacerbations
• Acute exacerbations - short-acting bronchodilators
or combination of a short-acting inhaled beta
agonist and anticholinergic , can be given either
via a metered-dose inhaler with a spacer or via a
nebulizer with both appearing to be equally
effective
• Nebulization
• Oxygen supplementation
• Corticosteroids
• antibiotics - amoxicillin, doxycycline and
azithromycin

35.  Respiratory insufficiency
 Respiratory failure
 Pneumonia
 Atelectasis
 Pneumothorax
 Pulmonary artery hypertension.
 Status asthmaticus
 hypoxemia
 respiratory infections, including colds, flu
 heart problems
 lung cancer

36. Complications
• Respiratory acidosis
• Corpulmonale
• Dysrhythmias
• Skeletal muscle depression

38.  TAKE YOUR MEDICATIONS REGULARLY AS
PRESCRIBED,IF YOU HAVE ANY DOUBT RING
YOUR HOSPITAL.
 EXERCISE REGULARLY EVERYDAY OR ELSE
ATLEAST 4 OUT OF 7 DAYS.

46. THANK YOU!