Chronic obstructive pulmonary disease (COPD) is a progressive and irreversible condition characterized by chronic dyspnea and airflow limitation, often caused by factors such as tobacco smoke and environmental pollutants. It comprises two main types: chronic bronchitis and emphysema, which may coexist and lead to various symptoms and complications requiring proper diagnosis and management. Effective management includes smoking cessation, bronchodilators, corticosteroids, oxygen therapy, and pulmonary rehabilitation, alongside patient education and monitoring.

1. Prepared by : Rafed Abdullrzzaq AL-hendi
Faculty Of Nursing
4th level
Republic of Yemen
Jiblah university for
medical & health
sciences
first term
Chronic obstructive pulmonary disease
Medical and Surgical Nursing

2.  Definition:
Chronic obstructive pulmonary disease
is a preventable and treatable disease characterised by chronic
dyspnea with persistent expiratory airflow limitation that is
usually progressive, and irreversible disease.
Introduction

3. Classification
2- Emphysema :
A pathologic diagnosis: permanent enlargement of air spaces
distal to terminal bronchioles due to destruction of alveolar walls.
People with emphysema are also called “pink puffers”.
1- Chronic bronchitis
A clinical diagnosis: chronic cough productive of sputum for at
least 3 months per year for at least 2 consecutive years.
bronchitis is also termed as “blue bloaters”.
The two often coexist. Pure emphysema or pure chronic
bronchitis is rare.
(see at figure1)
(figure1)

5. 5

6. blue bloaters pink puffers
figure1

7. o Tobacco smoke (indicated in almost 90% of COPD cases).
o α1-Antitrypsin deficiency.
o Environmental factors (e.g., second-hand smoke).
o Chronic asthma.
o Indoor air pollution.
o Occupational exposures, such as coal dust, silica.
o Lung growth: childhood infections or maternal smoking.
o Infections:HIV infection is associated with emphysema.
Risk Factors and Causes

8. o Chronic cough.
o Sputum production.
o Dyspnea (on exertion or at rest, depending on severity).
SIGN AND SYMPTOMS
 SYMPTOMS
 SIGN
o Tachypnea,
o tachycardia
o Cyanosis
o Use of accessory respiratory muscles.

9. o Prolonged forced expiratory time on physical examination
o During auscultation, end-expiratory wheezes on forced
expiration, decreased breath sounds, and/or inspiratory
crackles
o Hyperresonance on percussion
o Barrel chest
o Flushed face.
Cont..
(see at figure2).

10. figure2

11.  Pulmonary function testing (spirometry)
a. This is the definitive diagnostic test.
b. Obstruction is evident based on the following:
Decreased FEV1 and decreased FEV1/FVC ratio
If FEV1 is reduced to 70% of predicted value, mild disease is
suggested.
If FEV1 is reduced to 50% or less of predicted value, severe
disease is present.
Values in between indicate moderate disease
Diagnostic evaluation

12.  Chest X-ray :
 Low sensitivity for diagnosing COPD; only severe, advanced
emphysema will show the typical changes, which include:
Hyperinflation, flattened diaphragm
 Arterial blood gases (ABGs):
 Determines degree and severity of disease process, e.g.,
chronic pCO2 retention and decreased pO2.
(see at figure3).
Cont..

13. figure3

14.  Complete blood count (CBC) and differential:
Increased hemoglobin (advanced emphysema),.
 Screening for alpha1-antitrypsin deficiency.
 Sputum culture: Determines presence of infection
 Cytologic examination: for malignancy
 Electrocardiogram (ECG):,
 CT scan. may help in the differential diagnosis.
Cont..

15.  Acute exacerbations—most common causes are infection.
 Acute Respiratory Failure.
 Spontaneous Pneumothorax.
 Secondary polycythemia: compensatory response to chronic
hypoxemia
 Pulmonary HTN and cor pulmonale—may occur in patients
with severe, longstanding COPD who have chronic hypoxemia
Complications

16.  Smoking cessation:
• The most important intervention
• Disease progression slowed by cessation
• prolongs the survival rate
 Inhaled anticholinergic drugs (ipratropium bromide):
• Bronchodilatos
• Slower onset of action than the β-agonists, but last longer
 Inhaled β2-agonists (e.g., albuterol):
• bronchodilators
• Use long-acting agents (e.g., salmeterol) for patients
requiring frequent use.
MANAGEMENT

17.  Combination of β-agonist albuterol with ipratropium bromide
• More efficacious than either agent alone in bronchodilation
Cont..
 Corticosteroids: may be prescribed for patients to determine
whether pulmonary function improves and symptoms decrease.
 Other medications include alpha1-antitrypsin augmentation
therapy, antibiotic agents, mucolytic agents, antitussive agents,
 Oxygen therapy
• Some patients need continuous oxygen, whereas others only
require it during exertion or sleep.
 Theophylline (oral)—role is controversial
• Only modestly effective and has more side effects than other
bronchodilators.

18. Cont..
 Vaccination:
• Influenza vaccination annually for all patients.
• Vaccination against Streptococcus pneumoniae every 5 to 6
years should be offered to patients with COPD over 65 years
old, or under 65 who have severe disease .
 Pulmonary rehabilitation :
• Education, exercise, physiotherapy:
A major goal is to improve exercise tolerance.
• Pulmonary rehabilitation improves functional status and
quality of life .

19. 1.Bronchodilators (β2-agonist) alone or in combination with
anticholinergics are first-line therapy
2.Systemic corticosteroids
Acute COPD exacerbation
 A persistent increase in dyspnea and Increased sputum
production and cough are common.
 Acute COPD exacerbation can lead to acute respiratory failure
requiring hospitalization, and possibly mechanical ventilation;
potentially fatal.
 Management:
3.Antibiotics (azithromycin or levofloxacin)
4.Supplemental oxygen is used to keep O2 saturation above 90%.
5.Intubation and mechanical ventilation may be required

20. Nursing intervention
 Regularly monitor vital signs and oxygen saturation
,ABG results , the severity of dyspnea and sputum color,odor
and character.
 Elevate head of bed, assist patient to assume position to
ease work of breathing
 Teach the client to use pursed-lip and diaphragmatic
breathing techniques
 Perform chest physiotherapy.
 note use of accessory muscles, pursed lip breathing, inability
to speak.

21.  Teach the client to wash his or her hands after contact with
potentially infectious material.
 Explain the patient about disease including cause, signs and
symptoms, medication, procedures, prevention
 Explain need for adequate nutritional intake
 Explain client about the importance of self care
 Notify the physician if any sign of infections occurs.
 Administer bronchodilators and supplemental oxygen therapy
if ordered
Cont..

22. Thank you