This document discusses chronic obstructive pulmonary disease (COPD), including epidemiology, etiology, pathogenesis, clinical presentation, diagnosis, treatment and prognosis. It covers definitions and classifications of emphysema and chronic bronchitis. Risk factors include smoking, pollution, genetics and infections. Symptoms include dyspnea, cough and sputum production. Diagnosis involves spirometry showing airflow limitation. Treatment includes smoking cessation, medications, oxygen therapy and management of exacerbations with antibiotics and ventilation if needed. Prognosis can be assessed using indices like BODE.

2. INTRODUCCION
EPOC
ENFISEMA
BRONQUITIS
CRONICA
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease, available
in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf, October 2014.

3. EPIDEMIOLOGIA
14% hombres
8% Mujeres
3er causa de mortalidad en el mundo
64 millones de personas sufren una EPOC
Available in : http://www.who.int/respiratory/copd/es/

4. Globalstrategyforthediagnosis,management,andpreventionofchronic
obstructivepulmonarydisease,Update2014;GlobalinitiativeforChronic
ObstructiveLungDisease,availablein:
http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf,
October2014.
2012

5. ETIOLOGIA
QUIMICOSPROFESION
TABAQUISMO CONTAMINACION
ALCOHOLINFECCIONES
AMBIENTE
POBREZA
CTO 8va ed, Neumologia y cirugia toracica, pag 23

6. ETIOLOGIA
Desarrollo
pulmonarGENES
EDAD
GENERORAZA
HUESPED
• α1 antitripsina (AAT)
• α1-antiquimiotripsina (AACT)
• Hidrolasa epóxida micosomal
(EPHX)
• Glutatión-S-transferasa (GSTs)
• Hemooxigenasa-1 (EPHx)
HIPERREACTIVIDAD
BRONQUIAL
CTO 8va ed, Neumologia y cirugia toracica, pag 23

7. PATOGENIA

9. Patogenia Enfisema

10. Enfisema
Clasificación
Centroacinar
Panacinar
Acinar distal
Irregular
KUMAR, V., ABBAS, A.K.,FAUSTO, N.: Robbins Patología Humana. 8va edicion. Ed. Elsevier España, 2008

11. Glossary ofTerms forThoracic Imaging ,Hansell et al, Fleischner Society, Radiology: Volume 246: Number 3—March 2009

12. Glossary ofTerms forThoracic Imaging ,Hansell et al, Fleischner Society, Radiology: Volume 246: Number 3—March 2009

13. Glossary ofTerms forThoracic Imaging ,Hansell et al, Fleischner Society, Radiology: Volume 246: Number 3—March 2009

14. KUMAR, V., ABBAS, A.K.,FAUSTO, N.: Robbins Patología Humana. 8va edicion. Ed. Elsevier España, 2008
Patogenia Bronquitis crónica
Irritantes: tabaquismo,
contaminación ambiental
Proceso inflamatorio deVR
Engrosamiento de la mucosa e
hipersecreción de moco
Obstrucción difusa del flujo de aireVR
pequeñas
Limpieza mucociliar deficiente
Tos productiva
Hipoxemia
Infecciones recurrentes

15. ANATOMIA PATOLOGICA
VA PROXIMALES
• > Cels caliciormes
• Hipertrofia glandulas submucosas
• Metaplasia escamosa
VA DISTALES
• Engrosamiento
• Fibrosis
• Exudados
• Bronquiolitis obstructiva
PARENQUIMA
• Destrucción de pared
• Necrosis epitelial y endotelial
VASOS SANGUINEOS
• Engrosamiento de intima
• Disfunción endotelial
• Hipertrofia muscular
• Hipertensión pulmonar

16. FISIOPATOLOGIA
Reduccion FEV1 FEV1 / FVC Hiperinflación VQ
Hipertensión
pulmonar
Hipoxemia e
hipercapnia
HVD-> Cor pulmonale
CTO 8va ed, Neumologia y cirugia toracica, pag 23

17. CLINICA
CTO 8va ed, Neumologia y cirugia toracica, pag 23

18. CLINICA

19. EXPLORACION FISICA
Enfermedad pulmonar obstructiva crónica. GPC. Guía de PrácticaClínica, available in:
http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/037_GPC_EPOC/IMSS_037_08_EyR.pdf

20. EXPLORACION FISICA
Enfermedad pulmonar obstructiva crónica. GPC. Guía de PrácticaClínica, available in:
http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/037_GPC_EPOC/IMSS_037_08_EyR.pdf

21. EXPLORACION FISICA
Enfermedad pulmonar obstructiva crónica. GPC. Guía de PrácticaClínica, available in:
http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/037_GPC_EPOC/IMSS_037_08_EyR.pdf

22. EXPLORACION FISICA
Enfermedad pulmonar obstructiva crónica. GPC. Guía de PrácticaClínica, available in:
http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/037_GPC_EPOC/IMSS_037_08_EyR.pdf

23. CLINICA
Pred. Enfisema Pred. Bronquitis
crónica
Habito exterior Astenico Picnico
Edad >60 >50
Disnea Grave Leve
Adquisición de tos Despues de disnea Antes de disnea
Esputo Escaso, mucoso Abundante, purulento
Infecciones Poco frecuentes Mas frecuentes
PaCO2 30-40 mmHg 50-60 mmHg
PaO2 60-75 mmHg 45-60 mmHg
Poliglobulia Rara Frecuente
CTO 8va ed, Neumologia y cirugia toracica, pag 23

24. CLINICA
Pred. enfisema Pred. Bronquitis cronica
Cor pulmonale Raro, (fase terminal) frecuente
Resistencia aVia aerea Normal Aumentada
Capacidad de Difucion Disminuida Normal
Esfuerza espiratorio intenso Moderado
Auscultacion < MV Roncus y sibilancias
RxTorax • Hiperinsuflación
• Aplanamiento Diafragmatico
• Silueta Cardiaca alargada
• Bullas
• Sin patrón característico
• Aumento de trama
• Engrosamiento bronquial
• Cardiomegalia
CTO 8va ed, Neumologia y cirugia toracica, pag 23

25. Glossary ofTerms forThoracic Imaging ,Hansell et al, Fleischner Society, Radiology: Volume 246: Number 3—March 2009

26. EVALUACION Y DIAGNOSTICO
 VALORAR SINTOMAS
 ESPIROMETRIA
 RIESGO DE EXACERBACIONES
 COMORBILIDADES
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease, available
in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf, October 2014.

27. DIAGNOSTICO: Valorar síntomas
 http://www.catestonline.org
 http://www.ccq.nl/
 mMRC
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease, available
in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf, October 2014.

28. DIAGNOSTICO: Valorar síntomas
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease, available
in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf, October 2014.

29. DIAGNOSTICO: Espirometria
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease, available
in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf, October 2014.

30. DIAGNOSTICO: Espirometria
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease, available
in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf, October 2014.

31. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease, available
in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf, October 2014.

32. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease, available
in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf, October 2014.

33. DIAGNOSTICO: Pruebas adicionales
 Rx tórax yTAC
 Oximetría y Gasometría
 Alfa 1 antitripsina
 Prueba de esfuerzo
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease, available
in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf, October 2014.

34. DIAGNOSTICO: Comorbilidades
 Enf. CV
 Osteoporosis
 IVRAS
 Depresion
 DM
 CA pulmon
 Bronquiectasias
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease, available
in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf, October 2014.

35. TRATAMIENTO NO FARMACOLOGICO
Abandono de
tabaquismo
Oxigenoterapia Vacunas
Prevenir
exposición
QX
CTO 8va ed, Neumologia y cirugia toracica, pag 23

36. TRATAMIENTOEPOCESTABLE
Globalstrategyforthediagnosis,management,andpreventionofchronicobstructivepulmonary
disease,Update2014;GlobalinitiativeforChronicObstructiveLungDisease,availablein:
http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf,October2014.

38. EPOC AGUDIZADA
65% bacterianas
35% virales
H. influenzae
S. pneumoniae
M. catarrhalis
¿INICIO DE ANTIBIOTICO?
CTO 8va ed, Neumologia y cirugia toracica, pag 23

39. TRATAMIENTO EPOC AGUDIZADA
Enfermedadpulmonarobstructivacrónica.GPC.GuíadePrácticaClínica,availablein:
http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/037_GPC_EPOC/IMSS_037_08_EyR.pdf

40. MANEJO DE EPOC AGUDIZADA
Ventilación
mecánica
No invasiva
Ventilación
mecánica
invasiva
7.20-7.25
A pesar de
tratamiento
> <
CTO 8va ed, Neumologia y cirugia toracica, pag 26

41. PRONOSTICO: Índice de BODE
Celli, B.The body-mass index, airflow obstruction, dyspnea and exercise capcity index in chronic obstructive pulmonary disease. NEJM 2004; 350: 1005-1012.

42. Global strategy for the diagnosis, management, and prevention of chronic obstructive
pulmonary disease,Update 2014; Global initiative for Chronic Obstructive Lung Disease,
available in: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf,
October 2014.
Enfermedad pulmonar obstructiva crónica. GPC. Guía de PrácticaClínica, available in:
http://www.cenetec.salud.gob.mx/descargas/gpc/CatalogoMaestro/037_GPC_EPOC/IMSS_037_08_EyR.pdf
Glossary ofTerms forThoracic Imaging ,Hansell et al, Fleischner Society, Radiology: Volum
246: Number 3—March 2009
Celli, B.The body-mass index, airflow obstruction, dyspnea and exercise capcity index
in chronic obstructive pulmonary disease. NEJM 2004; 350: 1005-1012.
CTO 8va ed, Neumologia y cirugia toracica, pag 23