The document discusses chronic obstructive pulmonary disease (COPD), including its diagnosis, management, and emergency treatment measures. It covers key clinical features, diagnostic tests, and various treatment options such as smoking cessation, medication types, and surgical interventions. The document also highlights the importance of assessing exacerbations and outlines the prognosis for patients with different stages of COPD.

1. COPD
Chronic Obstructive Pulmonary disease
Dr. Fahad

2. 1.Proper understanding of COPD
2.How to diagnose COPD
3.How to manage COPD
4.How to manage COPD in an Emergency Setting
Aims of this Presentation

5. COPD
Emphysema Chronic Bronchitis
Old….
Pink Puffers Blue Bloaters

6. Clinical syndrome of:
• Chronic respiratory symptoms,
• Structure pulmonary abnormalities (airway or alveoli), and
• Impaired lung functioning,
rising from multiple cause that result in airflow limitation that is not fully
reversible and is often Progressive
Evolved to….

7. Lets manage a case….
A 62-year-old male walks into the outpatient department (OPD).
Chief Complaint:
• Progressive shortness of breath during activity and rest
• cough for the past 2 years,
• occasional sputum production.
Vitals on Presentation
• Temperature: 98.4°F (afebrile)
• Pulse: 102 beats per minute (tachycardia)
• Respiratory Rate: 36 breaths per minute
(tachypnea)
• Blood Pressure: 130/80 mmHg
• Oxygen Saturation: 90% on room air

8. History
• Smoking history: 30 pack-years (currently smokes).
• Frequent episodes of cough and breathlessness, worse in winter.
• Denies tuberculosis exposure.
Relevant Examination
1.Inspection:
Barrel shaped chest,

9. • refers to the paradoxical inspiratory
retraction of the rib cage and lower
intercostal
• In COPD with hyperinflation the normal
outward movement of the lower ribs on
inspiration is replaced by paradoxical
inward movement, caused by
contraction of the abnormally low flat
diaphragm (Paradoxical Rib Movement)
Hoover’s sign
Hoover’s sign

10. Dahl’s sign
• A dermititis due to patient
staying in tripod position
for too long
Tripod Position Dahl’s sign

11. Campbell Sign or Tracheal Descent
• Campbell sign is a physical sign that indicates a downward displacement
of the trachea (Adam’s Apple) during inhalation
Using Accessory Muscles of Respiration

12. 2. Palpation
• Reduced chest expansion
bilaterally.
Chest Expansion
Chest Asymmetry : Normal

13. 3. Percussion
• Either resonant or hyper-resonant
TECHNIQUE
PROPER

14. 4. AUSCULTATION

15. Wheeze

16. • CBC (Complete Blood Count)
• Chest X ray
• ABG (Commonly respiratory acidosis)
• ECG
• Serum Electrolytes (transient hyperkalemia)
• Spi`rometry ( Diagnostic )
Investigations

17. 11 Ribs
Flat Diaphragm
NORMAL : 8-10 RIBS

18. Spirometry FEV1: FVC <0.7

19. The global initiative for chronic obstructive
lung disease (GOLD) staging system
• Stage I: mild, FEV1 > 80% of normal
• Stage II: moderate, FEV1 = 50-79% of normal
• Stage III: severe, FEV1 = 30-49% of normal
• Stage IV: very severe, FEV1 <30% of normal or <50% of normal
with presence of chronic respiratory failure present

20. MANAGEMENT
• Smoking cessation (All Grades ) single most important intervention
• Oxygen Therapy (LTOT) 1-3 liter O2 (Stage 4 resting hypoxia)
therapeutic atleast 16 hours of continous oxygen therapy, ideally 24 hours
• Management according to Gold criteria
• Pulmonary Rehabilitation Walking 20 Min. 3 times weekly or bicycling
• Surgical Intervention:
1.Lung Transplant
2.Lung volume reduction surgery
3.Bullectomy
Expectorants- Mucolytics therapy is unhelpful. Cough suppressants
and sedatives are avoided

21. SABA: Albuterol/ Salbutamol(rapid
Action, less expensive )
LAMA: Tiotropium( first line in mild
disease and no exacerbation)
LABA: Formoterol , Salmeterol
SAMA: Ipratropium (slow onset, longer
duration, less side effects)

22. Long term Oral steroid are not
recommended
PDE-4 inhibitor:
Roflumilast,
reduce exacerbation

24. When and What Antibiotic to give ?
When ?
(1) to treat an acute exacerbation,
(2) to treat acute bronchitis, and
(3) to prevent acute exacerbations of chronic bronchitis (prophylactic antibiotics)
Antibiotic to consider
1.Doxycycline (100mg BD)
2.Trimethoprim-sulfamethoxazole (160/800 mg BD),
3.Cephalosporin (eg, cefpodoxime 200 mg BD or cefprozil 500 mg BD),
4.Macrolide (eg, azithromycin 500 mg followed by 250 mg daily for 5 days),
5.Fluoroquinolone (eg, ciprofloxacin 500 mg BD, Moxifloxacin 400 mg OD),
and
6.Moxicillin-clavulanate (875/125 mg BD).
Suggested duration of therapy is 3–5 days and depends on response to therapy

25. (1) Supplemental oxygen (Sao2 between 90% and 94%)
(2) Inhaled beta-2-agonists or ipratropium bromide
(3) Corticosteroids (prednisone 0.5 mg/kg/day orally for 7–10 days is usually
sufficient, and even 5 days may be adequate)
(4) Broad-spectrum antibiotics; and
(5) Chest physiotherapy. in selected cases
Hospitilized patient

26. Without Pseudomonas
• Fluoroquinolone (eg, levofloxacin 750 mg orally or I/V OD)
• Moxifloxacin (400 mg orally or I/V OD)
• 3rd generation cephalosporin (eg, ceftriaxone 1 g I/V OD, or Cefotaxime (1 g I/V
TDS).
Risk factors for Pseudomonas
• Piperacillin-tazobactam (4.5 g I/V QID),
• Ceftazidime (1 g I/V TDS),
• Cefepime (1 g I/V BD),
• Evofloxacin (750 mg orally or intravenously per day for 3–7 days).

27. How Manage COPD
Exacerbation
In a emergency setting always do an ABCDE assessment to make
sure patient is stable or Unstable;
• Airway
• Breathing
• Circulation

31. Prognosis
An important predictor of survival:
• median survival of patients with FEV1 of 1 L or less is about 4 years.
Multidimensional index (the BODE index);
• BMI,
• Airway Obstruction (FEV1),
• Dyspnea (modified Medical Research Council dyspnea score), and
• Exercise capacity,
is a tool that predicts death and hospitalization better than FEV1 alone

32. “Half of what you are taught in medical school
will be wrong in 10 years’ time. The trouble is,
nobody knows which half”.
Dr. Sidney Burwell

33. Finally !!!
we are done

34. References used