2. Def: COPD
Chronic obstruction to airflow due to chronic
bronchitis and/or emphysema.
Degree of obstruction may be less when the patient
is free from respiratory infection and may improve
with bronchodilator drugs
Significant obstruction is always present
3. Epidemiology of COPD
30% of smokers develop COPD
20% of adult males have COPD
15% of COPD patients are severely symptomatic
4 th leading cause of death (USA)
Mortality rate still rising
prevalence in low birth weight and low
socioeconomic status
Tuberculosis in smokers predisposes to COPD
5. Def: Chronic Bronchitis
Bronchitis is inflammation of the bronchi in the lungs.
Symptoms include coughing up mucus, wheezing,
shortness of breath, and chest discomfort.
Chronic bronchitis isdefined as a productive cough
that lasts for three months or more per year for at least
two years.
6. Pathology: CB
Hypertrophy of mucus-producing glands in submucosa of
large cartilaginous airways
Goblet cell hyperplasia, mucosal and submucosal
inflammatory cell infiltrate, oedema, peribronchial fibrosis,
intraluminal mucus plugs and increased smooth muscle in
small airways
The major site of airflow obstruction is in the small airways
and the inflammatory infiltrate consists of neutrophils (in
asthma eosinophils)
10. Pathology : Emphysema
in number and size of alveolar fenestrae eventual
destruction of alveolar septa and their attachments to
terminal and respiratory bronchioles distention of
alveolar spaces
1. Centriacinar E- respiratory bronchioles (central) affected
2. Panacinar E- central and peripheral portions of acinus
affected
3. Senile E- alveoli and alveolar ducts enlarge (> 50 Y)
4. Periacinar/paraseptal E- distention of alveolar spaces
adjacent to septal and pleural surfaces
11. Diff. b/w Emphysema:CB
Emphysema = pink puffer
Age (Dx) 60 + y
Rest dyspnea mild-mod
Exer dyspnea severe
Cough ±
Sputum scanty, mucoid
Resp infect less often
Resp failure terminal
Cor pulmonale terminal
Chronic Bronchitis = blue
bloater
50 ± y
none
moderate
prominent
large volume, purulent
often
repeatedly
common
12. PHT (rest) 0-mild
(exertion) moderate
Build Asthenic, cachectic
Hematocrit 35-45
Breath pattern use
accessory muscles of
respiration
Sleep pattern Normal
XRC Hyperinflation
Bullae
Mild-moderate
severe
obese, cyanosed
50-55
do not use accessory muscles
of respiration
sleep apnea
bronchovascular markings
Diff. b/w Emphysema:CB
13. Blood gas:
PaO2 ± 65 mm Hg
PaCO2 35-40
Elastic recoil
AW resistance N-
Diffusion Cap
FEV1
Bronchodilator
response Poor
45-60
50-60
Normal
N-
Better but < 12% and 200ml
Diff. b/w Emphysema:CB
14. Symptoms
• Chronic cough
• Sputum production
• Wheezing
• Chest tightness
• Dyspnoea on exertion
• Wt.loss
