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
Chronic Obstructive Pulmonary Disease BY
Dr Akram Yousuf
Resident Internal Medicine
Liaquat University of Medical Health and Sciences Jamshoro Pakistan
Chronic Obstructive Pulmonary Disease BY
Dr Akram Yousuf
Resident Internal Medicine
Liaquat University of Medical Health and Sciences Jamshoro Pakistan
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness
chronic obstructive pulmonary disease and its management
chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease.
Dr Kishore Kumar Ubrangala, MD
Professor, Dept. of Medicine,
Yenepoya Medical College,
Yenepoya (Deemed to be) University, Mangalore, India.
sankish@gmail.com
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness
chronic obstructive pulmonary disease and its management
chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease.
Dr Kishore Kumar Ubrangala, MD
Professor, Dept. of Medicine,
Yenepoya Medical College,
Yenepoya (Deemed to be) University, Mangalore, India.
sankish@gmail.com
Using non-clinical workers to prevent hospital (re)admissionsDave Chase
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Preventive home monitoring of COPD patients across sectors–an advantage for the patients and healthcare professionals. Birthe Dinesen, Associate professor,
Department of Health Science and Technology, Aalborg University, Denmark
Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), and chronic obstructive airway disease (COAD), among others, is a type of obstructive lung disease characterized by chronically poor airflow. It typically worsens over time. The main symptoms include shortness of breath, cough, and sputum production. Most people with chronic bronchitis have COPD.
COPD is a lung disease that makes it hard to breathe. It is caused by damage to the lungs over many years, usually from smoking.
The main symptoms are:
• A long-lasting (chronic) cough.
• Mucus that comes up when you cough.
• Shortness of breath that gets worse when you exercise.
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𝐓𝐡𝐞 𝐭𝐞𝐦𝐩𝐥𝐚𝐭𝐞 𝐜𝐨𝐯𝐞𝐫𝐬 𝐭𝐡𝐞 𝐟𝐨𝐥𝐥𝐨𝐰𝐢𝐧𝐠 𝐭𝐨𝐩𝐢𝐜𝐬
𝐃𝐞𝐟𝐢𝐧𝐢𝐭𝐢𝐨𝐧
Chronic obstructive pulmonary disease (𝐂𝐎𝐏𝐃) is a group of lung diseases that cause airflow blockage and breathing-related problems.
𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞
COPD is more prevalent in developing countries, but it is also a growing problem in developed countries. In the United States, COPD is the third leading cause of death.
Forms of 𝐂𝐎𝐏𝐃
• Chronic bronchitis
• Emphysema
𝐏𝐚𝐭𝐡𝐨𝐩𝐡𝐲𝐬𝐢𝐨𝐥𝐨𝐠𝐲
In normal lungs, air flows freely in and out of the bronchi and alveoli. However, in people with COPD, the airflow is blocked. This can be caused by inflammation of the airways, mucus production, or damage to the air sacs.
𝐑𝐢𝐬𝐤 𝐅𝐚𝐜𝐭𝐨𝐫𝐬
There are several risk factors for COPD, including smoking, air pollution, and genetics. Smoking is the most common risk factor for COPD. Smoking is responsible for about 80% of COPD cases. Air pollution, particularly indoor air pollution from cooking and burning fuels, can also increase the risk of COPD. Genetics can also play a role in COPD. People with a family history of COPD are more likely to develop the disease.
𝐜𝐚𝐮𝐬𝐞𝐬
The main causes of COPD are smoking and air pollution. Smoking damages the lungs and makes it difficult to breathe
𝐒𝐭𝐚𝐠𝐞𝐬
• Stage 1
• Stage 2
• Stage 3
.
𝐒𝐲𝐦𝐩𝐭𝐨𝐦𝐬
The most common symptoms of COPD are:
• Shortness of breath
• Cough
• Wheezing
• Chest tightness
• Fatigue
𝐂𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬
COPD can lead to several complications, including:
• Anemia
• Right-sided heart failure
• Muscle weakness
• Lung infections
• Bone thinning
• Collapsed lungs
𝐃𝐢𝐚𝐠𝐧𝐨𝐬𝐭𝐢𝐜 𝐦𝐞𝐭𝐡𝐨𝐝𝐬
COPD is diagnosed with a spirometry test, which measures how much air a person can exhale.
𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐎𝐩𝐭𝐢𝐨𝐧𝐬
There is no cure for COPD, but there are treatments that can help manage the symptoms and slow the progression of the disease. Treatment options include:
• Bronchodilators
• Antibiotics
• Supplemental oxygen
• Vaccination
𝐏𝐫𝐞𝐯𝐞𝐧𝐭𝐢𝐯𝐞 𝐌𝐞𝐭𝐡𝐨𝐝𝐬
The best way to prevent COPD is to avoid smoking and air pollution. Several lifestyle changes can help reduce the risk of COPD, such as eating a healthy diet and exercising regularly.
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What is emphysema?
Emphysema is a condition that forms part of chronic obstructive pulmonary disease (COPD) and involves the enlargement of the air sacs in the lung.
The alveoli at the end of the bronchioles of the lung become enlarged because of the breakdown of their walls. The fewer and larger damaged sacs that result mean there is a reduced surface area for the exchange of oxygen into the blood and carbon dioxide out of it.
Definition
Emphysema is a condition in which the alveoli become stiff expands and continuously filled the air even after expiration. Emphysema is a chronic obstructive disease due to lack of elasticity in the lungs and alveoli surface area.
Classification
Panlobular (panacinar)
It is damage to the respiratory bronchi, alveolar ducts and alveoli. All air space in the little lobes much enlarged, with little inflammatory disease. The characteristics that have chest hyperinflation, and is characterized by dyspnea on exertion, and weight loss.
CENTRILOBULAR (CENTROACINAR)
The pathological changes mainly occur in the centre of the secondary lobes, and peripheral of acini remain good. Often there is chaos-ventilation perfusion ratio, which lead to hypoxia, hypercapnia (increased CO2 in the arterial blood), polycythaemia and heart failure episodes right. The condition leads to cyanosis, peripheral oedema, and respiratory failure.
CAUSES OF EMPHYSEMA
The biggest known cause or risk factor for emphysema - and for COPD - is smoking. Cigarette smoking is responsible for around 90% of cases of COPD. However, COPD will develop only in smokers who are genetically susceptible - smoking does not always lead to the disease.
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2. DEFINITION OF COPD
Chronic obstructive 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.
3.
4. COPD is a lung 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)
8. Chronic Bronchitis
Chronic
bronchitis is 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
9.
10. Chronic Bronchitis
Chronic
nonspecific inflammation
Symptoms of cough and sputum
production with or without gasping
Recurrent attacks
Chronic proceeding
11. Classification of Chronic Bronchitis
Simple type
of Chronic
Bronchitis
(without
gasping)
Cough
Sputum expectoration
Chronic
Bronchitis
with
gasping
Cough
Sputum expectoration
Gasping
12. Stages of Chronic Bronchitis
Stages
Time Courses
Exacerbation
In a week
Chronic lag
phase
One month or longer
stable
Lasts for two months
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.
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
Obstructive Emphysema
senile
Emphysema emphysema(Physiological)
without
Interstitial Emphysema
Obstruction
Compensating Emphysema
Scarred Emphysema
25. •Lung parenchyma (respiratory bronchioles 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
29. spirometric classification of COPD
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
32. Clinical Manifestations of copd
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 be intermittent and may be unproductive.
•Chronic sputum production:
Recurrent
respiratory infection
Recurrent
attacks leading to cor pulmonal
heart disease
Unexpected
Decreased
weigh loss
food appetite
35. Clinical Manifestation
*Percussion :
Hyperresonant
depressed diaphragm,
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.
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
43. Labortory Examination
Blood examination
In excerbation or acute infection in airway,
leucocytosis may be detected.
Sputum examination
streptococcus pneumonia
Haemophilus influenzae
Moraxella catarrhalis
klebsiella pneumonia
44. Blood
gas analysis:
Arterial blood gas analysis may reveal
hypoxemia,particularly advanced
disease.
In patients with severe hypoxemia ,CO2
retention,it shows low arterial PO2 and
high arterial PCO2.
46. management
Aim
Based on the principles 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.
52. Drug Therapy
Bronchodilators
Three major classes 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
Regular treatment 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
Combination therapy 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
56. Oxygen Therapy
Oxygen
--
>15 h /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:
For patients 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%)