This document provides information about COPD (chronic obstructive pulmonary disease). It defines COPD as a preventable and treatable lung disease characterized by persistent airflow limitation. The primary cause is cigarette smoking. COPD is the 4th leading cause of death and is expected to rise to 3rd by 2020. The document discusses the clinical presentation, diagnosis through spirometry testing, and management through smoking cessation and bronchodilator medications.
Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disorder characterized by airflow obstruction that does not change markedly over time. The obstruction is caused by emphysema, chronic bronchitis, or both. Emphysema involves destruction of lung tissue, while chronic bronchitis involves inflammation of the airways accompanied by mucus hypersecretion. Symptoms include cough, sputum production, wheezing and shortness of breath. Diagnosis is based on patient history, symptoms, and lung function tests showing airflow obstruction. Management involves reducing risk factors, treating stable disease and exacerbations, and rehabilitation.
Pleurisy is inflammation of the pleura covering the lungs and chest wall. It is commonly caused by pneumonia, tuberculosis, pulmonary embolism, or trauma. The inflammation irritates sensory fibers and causes sharp, knifelike pain during inspiration that may radiate to the shoulder or abdomen. Diagnosis involves chest x-ray, sputum examination, or thoracentesis. Treatment focuses on the underlying cause and pain relief through analgesics, heat/cold, or nerve blocks. Complications can include pleural effusions or respiratory issues from shallow breathing.
An old presentation that I made when I was an Intern in Pediatric department.
The presentation contains 71 slides. It discusses bronchial asthma in pediatric age group starting from the definition of bronchial asthma and its pathophysiology and ending by the management of acute attacks of asthma and long-term management of bronchial asthma patients.
Pneumothorax is the presence of air in the pleural space and can be spontaneous, due to trauma, or iatrogenic. It is classified as primary spontaneous which occurs without lung disease usually in young males, secondary spontaneous which occurs with underlying lung pathology, or traumatic. Types include closed which seals off, open with a bronchopleural fistula, and tension which increases pressure. Clinical features include chest pain and shortness of breath. Diagnosis is made with chest x-ray showing increased radiolucency. Small primary pneumothoraces may resolve on their own while secondary pneumothoraces and those with symptoms require tube thoracostomy drainage. Recurrent cases require pleurodesis or surgery.
- 20-year-old male presented with acute onset of dyspnea and cough after visiting a friend where he played with a dog. He has a history of similar episodes and wheezing.
- He has a family history of asthma and became asymptomatic after using inhalers in the past.
- The document discusses the definition, etiology, pathophysiology, diagnosis, assessment of severity and treatment of asthma. Key points include atopy and infections as common triggers, airway inflammation as the pathophysiology, and use of controllers and relievers for treatment.
Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
Status asthmaticus is an acute severe asthma attack that does not improve with usual bronchodilator treatment. It is characterized by hypoxemia, hypercarbia, and respiratory failure. Triggers include respiratory infections, stress, pollution, and poorly controlled asthma. Diagnosis is made through symptoms, peak flow measurements, and blood gases showing respiratory acidosis. Treatment involves nebulized bronchodilators, corticosteroids, magnesium sulfate, and noninvasive ventilation or intubation. Patients are monitored until symptoms and lung function improve before discharge with medication and follow-up.
Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disorder characterized by airflow obstruction that does not change markedly over time. The obstruction is caused by emphysema, chronic bronchitis, or both. Emphysema involves destruction of lung tissue, while chronic bronchitis involves inflammation of the airways accompanied by mucus hypersecretion. Symptoms include cough, sputum production, wheezing and shortness of breath. Diagnosis is based on patient history, symptoms, and lung function tests showing airflow obstruction. Management involves reducing risk factors, treating stable disease and exacerbations, and rehabilitation.
Pleurisy is inflammation of the pleura covering the lungs and chest wall. It is commonly caused by pneumonia, tuberculosis, pulmonary embolism, or trauma. The inflammation irritates sensory fibers and causes sharp, knifelike pain during inspiration that may radiate to the shoulder or abdomen. Diagnosis involves chest x-ray, sputum examination, or thoracentesis. Treatment focuses on the underlying cause and pain relief through analgesics, heat/cold, or nerve blocks. Complications can include pleural effusions or respiratory issues from shallow breathing.
An old presentation that I made when I was an Intern in Pediatric department.
The presentation contains 71 slides. It discusses bronchial asthma in pediatric age group starting from the definition of bronchial asthma and its pathophysiology and ending by the management of acute attacks of asthma and long-term management of bronchial asthma patients.
Pneumothorax is the presence of air in the pleural space and can be spontaneous, due to trauma, or iatrogenic. It is classified as primary spontaneous which occurs without lung disease usually in young males, secondary spontaneous which occurs with underlying lung pathology, or traumatic. Types include closed which seals off, open with a bronchopleural fistula, and tension which increases pressure. Clinical features include chest pain and shortness of breath. Diagnosis is made with chest x-ray showing increased radiolucency. Small primary pneumothoraces may resolve on their own while secondary pneumothoraces and those with symptoms require tube thoracostomy drainage. Recurrent cases require pleurodesis or surgery.
- 20-year-old male presented with acute onset of dyspnea and cough after visiting a friend where he played with a dog. He has a history of similar episodes and wheezing.
- He has a family history of asthma and became asymptomatic after using inhalers in the past.
- The document discusses the definition, etiology, pathophysiology, diagnosis, assessment of severity and treatment of asthma. Key points include atopy and infections as common triggers, airway inflammation as the pathophysiology, and use of controllers and relievers for treatment.
Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
Status asthmaticus is an acute severe asthma attack that does not improve with usual bronchodilator treatment. It is characterized by hypoxemia, hypercarbia, and respiratory failure. Triggers include respiratory infections, stress, pollution, and poorly controlled asthma. Diagnosis is made through symptoms, peak flow measurements, and blood gases showing respiratory acidosis. Treatment involves nebulized bronchodilators, corticosteroids, magnesium sulfate, and noninvasive ventilation or intubation. Patients are monitored until symptoms and lung function improve before discharge with medication and follow-up.
Management of asthma exacerbation in childrenAzad Haleem
This document discusses the management of acute asthma exacerbations from home through hospitalization. It begins with the clinical assessment and severity classification of exacerbations. For home management, it recommends immediate use of rescue medications and contacting a physician for worsening or incomplete responses. In the emergency department, treatment focuses on correcting hypoxemia, improving airflow, and preventing progression using oxygen, frequent bronchodilators, and systemic corticosteroids. Hospital admission is indicated for moderate-severe exacerbations not improving within 1-2 hours of intensive treatment or for patients with high-risk features. Intensive care is needed for severe respiratory distress or failure to respond to therapy.
Bronchiectasis is a chronic lung condition defined by the permanent dilation of the bronchi. It has both congenital and acquired causes such as infections from tuberculosis, pneumonia, or cystic fibrosis. Symptoms include chronic cough, production of large amounts of purulent sputum, and recurrent lung infections. Diagnosis involves imaging like CT scans and pulmonary function tests. Treatment focuses on airway clearance techniques, antibiotics for infections, and surgery in severe cases. Nursing care aims to improve lung function and prevent infections through techniques like postural drainage and breathing exercises.
This document provides information about chronic obstructive pulmonary disease (COPD) including its definition, causes, diagnosis, management, and related conditions like emphysema and bronchiectasis. COPD is a progressive lung disease characterized by limited airflow in the lungs. The primary cause is cigarette smoking which leads to an abnormal inflammatory response in the lungs. Symptoms include breathlessness, chronic cough, and sputum production. Spirometry is required for diagnosis and shows airflow limitation. Management involves smoking cessation, bronchodilators, steroids, vaccines, and oxygen supplementation during exacerbations. Related conditions like emphysema and bronchiectasis are also discussed.
1. Interstitial lung diseases (ILDs) involve the lung parenchyma including the alveoli, capillaries, and spaces between.
2. ILDs are classified based on known causes, idiopathic forms, and granulomatous types. Idiopathic pulmonary fibrosis is the most common idiopathic form.
3. Clinical presentation involves breathlessness, cough, and reduced lung function. Investigations include chest imaging showing infiltrates and fibrosis, and lung biopsies to determine classification. Treatment focuses on removing exposures, suppressing inflammation, and palliating symptoms primarily using corticosteroids.
This patient presented with shortness of breath and was found to have pulmonary edema based on physical exam findings and chest x-ray results. Pulmonary edema can be caused by left ventricular failure from conditions like heart attack or hypertension. Key findings included elevated jugular venous pressure, crackles on lung auscultation, and hypoxemia. The patient was treated with oxygen, diuretics, and other medications to reduce pre- and afterload on the heart to resolve the pulmonary fluid buildup. Lifestyle changes and strict control of risk factors like diabetes and hypertension were advised to prevent further episodes.
Atelectasis is the collapse or closure of part or all of the lung resulting in reduced gas exchange. It can be primary, due to prematurity or lung immaturity, or secondary due to obstruction from mucus, tumors, or surgery. Symptoms include rapid shallow breathing, cough, hypoxia, and fever. Diagnosis involves chest x-ray, sputum tests, and CT scans. Treatment focuses on positioning, suctioning mucus, oxygen therapy, and preventing infections. Nursing care manages breathing, airway clearance, gas exchange, and monitors for complications like infections.
This document provides information on the management of acute exacerbations of asthma. It defines an exacerbation as an increase in cough, wheeze and breathlessness. Exacerbations are classified as mild, moderate or severe/life-threatening based on symptoms and measurements like peak expiratory flow rate (PEFR). For mild exacerbations, short-acting beta agonists are recommended. For moderate/severe exacerbations, additional treatments like oral corticosteroids and oxygen are used. Life-threatening exacerbations require emergency treatments including supplemental oxygen, nebulized bronchodilators and injectable medications, and patients may require intensive care or ventilation if symptoms do not improve. Clinical signs, response to treatment and measurements are used to
The document discusses acute respiratory failure, defining it as a rapid and significant compromise in the lungs' ability to exchange carbon dioxide and oxygen. There are two main types: type 1 is impaired gas exchange seen as hypoxemia, while type 2 is impaired ventilation seen as hypercapnia. Causes include conditions affecting the lungs like pneumonia as well as non-pulmonary issues. Surgery, anesthesia, COPD and smoking can also impact pulmonary function and risk of postoperative respiratory failure. Good preoperative optimization is important to reduce risks.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
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https://www.facebook.com/groups/690331650977113/
Wheeze is a high-pitched whistling sound caused by airflow moving through partially obstructed airways. It is produced when air passes through narrowed portions of the airways at high velocity, causing the airway walls to vibrate and alternately flatten and reopen. This vibration creates a continuous musical sound. Wheeze can be caused by conditions that narrow the airways such as asthma, bronchitis, pneumonia, and foreign body obstruction.
Status asthmaticus is an acute exacerbation of asthma that does not respond to initial bronchodilator treatment. It can range from mild to severe, causing difficulty breathing, carbon dioxide retention, hypoxemia and respiratory failure. The airway obstruction is due to spasm, edema, increased secretions, inflammation and injury of the airway walls. Treatment involves bronchodilators, corticosteroids, oxygen and monitoring for ICU admission if the patient does not improve or their condition worsens. Prevention focuses on medication compliance and avoiding triggers.
Pneumothorax is defined as air in the pleural space between the lungs and chest wall. It is classified as spontaneous, traumatic, or iatrogenic. A tension pneumothorax occurs when air enters the pleural space during inspiration but cannot escape during expiration, causing rising pressure and potential cardiovascular compromise. Symptoms include chest pain and breathlessness. Diagnosis is made through chest x-ray showing increased radiolucency. Small primary pneumothorax may resolve on its own, while secondary pneumothorax requires tube drainage. Tension pneumothorax is a medical emergency treated with needle decompression followed by tube insertion.
Bronchiectasis is a chronic lung condition defined by abnormal dilation of the bronchi caused by inflammation and damage to the bronchial walls. It has several causes including post-infection, airway obstruction, immune deficiencies, and genetic disorders. Patients experience excessive sputum production, chronic cough, recurrent pneumonia, and sometimes hemoptysis. Diagnosis involves imaging like CT scans showing characteristic findings and ruling out other conditions. Treatment focuses on airway clearance and long-term antibiotics tailored to sputum cultures. Surgery may be considered for severe, localized cases or massive hemoptysis.
1) High altitude illness includes acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). AMS causes headache, nausea, fatigue, and dizziness. HACE is a neurological deterioration in someone with AMS. HAPE causes cough, dyspnea, and chest tightness. (2) Risk factors for these illnesses include rapid ascent, exertion, prior history, age under 50, and underlying lung/heart conditions. (3) Treatment depends on the illness but may include descent, oxygen, medications like dexamethasone or nifedipine, and hyperbaric bags that simulate lower altitudes.
The document summarizes acute epiglottitis, an inflammatory condition of the supraglottic structures including the epiglottis, aryepiglottic folds, and arytenoids that can cause airway obstruction. It describes the anatomy of the epiglottis, causes including H. influenzae infection, symptoms of sore throat and difficulty swallowing, signs of fever and swelling of the epiglottis, diagnosis through examination and imaging, complications of spread of infection, treatment with antibiotics, steroids, and intubation if needed, and good prognosis with timely treatment but risk of sudden airway obstruction.
This document discusses community-acquired pneumonia (CAP), including its causes, diagnosis, clinical features, imaging findings, and treatment. It begins by defining CAP and describing its historical significance as a major cause of death. It then covers common, less common, and uncommon infectious and non-infectious causes of CAP. The document outlines approaches to diagnosis including microbiological testing and the roles of imaging like chest X-rays, CT scans, and lung ultrasounds. It details typical patterns seen on imaging for different pathogens. It also discusses clinical features associated with certain causes and poor prognostic factors. The document concludes by addressing empirical outpatient and inpatient treatment of CAP.
This document provides information on asthma, including its definition, types, pathophysiology, etiology, symptoms, diagnosis, and treatment. Asthma is defined as a chronic inflammatory disease of the airways characterized by variable airflow obstruction and airway hyperresponsiveness. It discusses the different types of asthma including allergic, non-allergic, cough variant, occupational, and exercise-induced asthma. Treatment involves both controller medications to reduce inflammation and reliver medications for acute symptoms. Treatment is escalated in steps based on asthma severity and control.
Cor pulmonale, or right heart failure, is caused by high blood pressure in the pulmonary artery and right ventricle due to conditions that restrict pulmonary blood flow such as chronic lung diseases. It develops when pulmonary hypertension leads to enlargement and failure of the right ventricle. Symptoms include shortness of breath, leg swelling, and fatigue. Diagnosis involves physical exam, imaging like echocardiogram and chest x-ray, and assessing pulmonary pressures. Treatment focuses on managing the underlying lung condition, giving diuretics and vasodilators, and may involve oxygen therapy or lung transplantation in severe cases.
1. Chronic obstructive pulmonary disease (COPD) is a preventable and treatable lung disease characterized by airflow limitation caused by cigarette smoking.
2. COPD symptoms include cough, sputum production, and breathlessness. It is a major cause of death and disability worldwide and is expected to be the third leading cause of death by 2020.
3. COPD is diagnosed based on symptoms and spirometry showing airflow limitation that is not fully reversible. The two main phenotypes are chronic bronchitis and emphysema.
This document provides information on chronic obstructive pulmonary disease (COPD). It discusses the epidemiology, definition, risk factors, pathogenesis, pathology, classification, management, and exacerbations of COPD. Key points include: cigarette smoking is the primary cause of COPD worldwide; the disease involves inflammation in the lungs from noxious particles leading to airflow limitation; emphysema and chronic bronchitis are the major pathological changes; severity is classified based on lung function tests; and management involves reducing risk factors, treating stable COPD, and managing exacerbations.
Management of asthma exacerbation in childrenAzad Haleem
This document discusses the management of acute asthma exacerbations from home through hospitalization. It begins with the clinical assessment and severity classification of exacerbations. For home management, it recommends immediate use of rescue medications and contacting a physician for worsening or incomplete responses. In the emergency department, treatment focuses on correcting hypoxemia, improving airflow, and preventing progression using oxygen, frequent bronchodilators, and systemic corticosteroids. Hospital admission is indicated for moderate-severe exacerbations not improving within 1-2 hours of intensive treatment or for patients with high-risk features. Intensive care is needed for severe respiratory distress or failure to respond to therapy.
Bronchiectasis is a chronic lung condition defined by the permanent dilation of the bronchi. It has both congenital and acquired causes such as infections from tuberculosis, pneumonia, or cystic fibrosis. Symptoms include chronic cough, production of large amounts of purulent sputum, and recurrent lung infections. Diagnosis involves imaging like CT scans and pulmonary function tests. Treatment focuses on airway clearance techniques, antibiotics for infections, and surgery in severe cases. Nursing care aims to improve lung function and prevent infections through techniques like postural drainage and breathing exercises.
This document provides information about chronic obstructive pulmonary disease (COPD) including its definition, causes, diagnosis, management, and related conditions like emphysema and bronchiectasis. COPD is a progressive lung disease characterized by limited airflow in the lungs. The primary cause is cigarette smoking which leads to an abnormal inflammatory response in the lungs. Symptoms include breathlessness, chronic cough, and sputum production. Spirometry is required for diagnosis and shows airflow limitation. Management involves smoking cessation, bronchodilators, steroids, vaccines, and oxygen supplementation during exacerbations. Related conditions like emphysema and bronchiectasis are also discussed.
1. Interstitial lung diseases (ILDs) involve the lung parenchyma including the alveoli, capillaries, and spaces between.
2. ILDs are classified based on known causes, idiopathic forms, and granulomatous types. Idiopathic pulmonary fibrosis is the most common idiopathic form.
3. Clinical presentation involves breathlessness, cough, and reduced lung function. Investigations include chest imaging showing infiltrates and fibrosis, and lung biopsies to determine classification. Treatment focuses on removing exposures, suppressing inflammation, and palliating symptoms primarily using corticosteroids.
This patient presented with shortness of breath and was found to have pulmonary edema based on physical exam findings and chest x-ray results. Pulmonary edema can be caused by left ventricular failure from conditions like heart attack or hypertension. Key findings included elevated jugular venous pressure, crackles on lung auscultation, and hypoxemia. The patient was treated with oxygen, diuretics, and other medications to reduce pre- and afterload on the heart to resolve the pulmonary fluid buildup. Lifestyle changes and strict control of risk factors like diabetes and hypertension were advised to prevent further episodes.
Atelectasis is the collapse or closure of part or all of the lung resulting in reduced gas exchange. It can be primary, due to prematurity or lung immaturity, or secondary due to obstruction from mucus, tumors, or surgery. Symptoms include rapid shallow breathing, cough, hypoxia, and fever. Diagnosis involves chest x-ray, sputum tests, and CT scans. Treatment focuses on positioning, suctioning mucus, oxygen therapy, and preventing infections. Nursing care manages breathing, airway clearance, gas exchange, and monitors for complications like infections.
This document provides information on the management of acute exacerbations of asthma. It defines an exacerbation as an increase in cough, wheeze and breathlessness. Exacerbations are classified as mild, moderate or severe/life-threatening based on symptoms and measurements like peak expiratory flow rate (PEFR). For mild exacerbations, short-acting beta agonists are recommended. For moderate/severe exacerbations, additional treatments like oral corticosteroids and oxygen are used. Life-threatening exacerbations require emergency treatments including supplemental oxygen, nebulized bronchodilators and injectable medications, and patients may require intensive care or ventilation if symptoms do not improve. Clinical signs, response to treatment and measurements are used to
The document discusses acute respiratory failure, defining it as a rapid and significant compromise in the lungs' ability to exchange carbon dioxide and oxygen. There are two main types: type 1 is impaired gas exchange seen as hypoxemia, while type 2 is impaired ventilation seen as hypercapnia. Causes include conditions affecting the lungs like pneumonia as well as non-pulmonary issues. Surgery, anesthesia, COPD and smoking can also impact pulmonary function and risk of postoperative respiratory failure. Good preoperative optimization is important to reduce risks.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
AND
https://www.facebook.com/groups/690331650977113/
Wheeze is a high-pitched whistling sound caused by airflow moving through partially obstructed airways. It is produced when air passes through narrowed portions of the airways at high velocity, causing the airway walls to vibrate and alternately flatten and reopen. This vibration creates a continuous musical sound. Wheeze can be caused by conditions that narrow the airways such as asthma, bronchitis, pneumonia, and foreign body obstruction.
Status asthmaticus is an acute exacerbation of asthma that does not respond to initial bronchodilator treatment. It can range from mild to severe, causing difficulty breathing, carbon dioxide retention, hypoxemia and respiratory failure. The airway obstruction is due to spasm, edema, increased secretions, inflammation and injury of the airway walls. Treatment involves bronchodilators, corticosteroids, oxygen and monitoring for ICU admission if the patient does not improve or their condition worsens. Prevention focuses on medication compliance and avoiding triggers.
Pneumothorax is defined as air in the pleural space between the lungs and chest wall. It is classified as spontaneous, traumatic, or iatrogenic. A tension pneumothorax occurs when air enters the pleural space during inspiration but cannot escape during expiration, causing rising pressure and potential cardiovascular compromise. Symptoms include chest pain and breathlessness. Diagnosis is made through chest x-ray showing increased radiolucency. Small primary pneumothorax may resolve on its own, while secondary pneumothorax requires tube drainage. Tension pneumothorax is a medical emergency treated with needle decompression followed by tube insertion.
Bronchiectasis is a chronic lung condition defined by abnormal dilation of the bronchi caused by inflammation and damage to the bronchial walls. It has several causes including post-infection, airway obstruction, immune deficiencies, and genetic disorders. Patients experience excessive sputum production, chronic cough, recurrent pneumonia, and sometimes hemoptysis. Diagnosis involves imaging like CT scans showing characteristic findings and ruling out other conditions. Treatment focuses on airway clearance and long-term antibiotics tailored to sputum cultures. Surgery may be considered for severe, localized cases or massive hemoptysis.
1) High altitude illness includes acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). AMS causes headache, nausea, fatigue, and dizziness. HACE is a neurological deterioration in someone with AMS. HAPE causes cough, dyspnea, and chest tightness. (2) Risk factors for these illnesses include rapid ascent, exertion, prior history, age under 50, and underlying lung/heart conditions. (3) Treatment depends on the illness but may include descent, oxygen, medications like dexamethasone or nifedipine, and hyperbaric bags that simulate lower altitudes.
The document summarizes acute epiglottitis, an inflammatory condition of the supraglottic structures including the epiglottis, aryepiglottic folds, and arytenoids that can cause airway obstruction. It describes the anatomy of the epiglottis, causes including H. influenzae infection, symptoms of sore throat and difficulty swallowing, signs of fever and swelling of the epiglottis, diagnosis through examination and imaging, complications of spread of infection, treatment with antibiotics, steroids, and intubation if needed, and good prognosis with timely treatment but risk of sudden airway obstruction.
This document discusses community-acquired pneumonia (CAP), including its causes, diagnosis, clinical features, imaging findings, and treatment. It begins by defining CAP and describing its historical significance as a major cause of death. It then covers common, less common, and uncommon infectious and non-infectious causes of CAP. The document outlines approaches to diagnosis including microbiological testing and the roles of imaging like chest X-rays, CT scans, and lung ultrasounds. It details typical patterns seen on imaging for different pathogens. It also discusses clinical features associated with certain causes and poor prognostic factors. The document concludes by addressing empirical outpatient and inpatient treatment of CAP.
This document provides information on asthma, including its definition, types, pathophysiology, etiology, symptoms, diagnosis, and treatment. Asthma is defined as a chronic inflammatory disease of the airways characterized by variable airflow obstruction and airway hyperresponsiveness. It discusses the different types of asthma including allergic, non-allergic, cough variant, occupational, and exercise-induced asthma. Treatment involves both controller medications to reduce inflammation and reliver medications for acute symptoms. Treatment is escalated in steps based on asthma severity and control.
Cor pulmonale, or right heart failure, is caused by high blood pressure in the pulmonary artery and right ventricle due to conditions that restrict pulmonary blood flow such as chronic lung diseases. It develops when pulmonary hypertension leads to enlargement and failure of the right ventricle. Symptoms include shortness of breath, leg swelling, and fatigue. Diagnosis involves physical exam, imaging like echocardiogram and chest x-ray, and assessing pulmonary pressures. Treatment focuses on managing the underlying lung condition, giving diuretics and vasodilators, and may involve oxygen therapy or lung transplantation in severe cases.
1. Chronic obstructive pulmonary disease (COPD) is a preventable and treatable lung disease characterized by airflow limitation caused by cigarette smoking.
2. COPD symptoms include cough, sputum production, and breathlessness. It is a major cause of death and disability worldwide and is expected to be the third leading cause of death by 2020.
3. COPD is diagnosed based on symptoms and spirometry showing airflow limitation that is not fully reversible. The two main phenotypes are chronic bronchitis and emphysema.
This document provides information on chronic obstructive pulmonary disease (COPD). It discusses the epidemiology, definition, risk factors, pathogenesis, pathology, classification, management, and exacerbations of COPD. Key points include: cigarette smoking is the primary cause of COPD worldwide; the disease involves inflammation in the lungs from noxious particles leading to airflow limitation; emphysema and chronic bronchitis are the major pathological changes; severity is classified based on lung function tests; and management involves reducing risk factors, treating stable COPD, and managing exacerbations.
Chronic obstructive pulmonary disease (COPD) is characterized by airflow obstruction that is not fully reversible. The two main conditions that cause COPD are chronic bronchitis and emphysema. Chronic bronchitis involves a long-term cough with mucus, while emphysema involves destruction of lung tissue leading to fewer and larger air spaces. The primary risk factor is cigarette smoking. Symptoms include cough, sputum production, wheezing and shortness of breath. Diagnosis is made based on history of symptoms and spirometry showing airflow limitation. Treatment focuses on smoking cessation and medications to relieve symptoms.
Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow limitation that is usually progressive. It is the third leading cause of death in the United States. The two main conditions that make up COPD are chronic bronchitis and emphysema. Cigarette smoking is the leading risk factor. Symptoms include dyspnea, chronic cough, and sputum production. Diagnosis is confirmed by spirometry showing airflow limitation. Management focuses on smoking cessation, bronchodilators, glucocorticoids, pulmonary rehabilitation, oxygen therapy, and managing exacerbations and comorbidities.
COPD is a common lung disease characterized by persistent airflow limitation caused by damage to the lungs, usually from smoking. It is the fourth leading cause of death. Symptoms include shortness of breath, chronic cough, and sputum production. Diagnosis is confirmed by pulmonary function tests showing airflow limitation that is not fully reversible. Treatment focuses on reducing symptoms and exacerbations through bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, oxygen therapy, and managing comorbidities.
COPD is a progressive lung disease defined by abnormal airflow that worsens over time. It encompasses chronic bronchitis and emphysema and is usually caused by smoking or air pollution. Symptoms include a chronic cough, shortness of breath, wheezing and chest tightness. Diagnosis involves lung function tests showing reduced airflow. Treatment focuses on stopping smoking and medications to relieve symptoms.
Respiratory failure is characterized by severe dysfunction of pulmonary ventilation and/or oxygenation caused by various diseases, resulting in hypoxia and retention of carbon dioxide. It is defined as a PaO2 of less than 8.0 kPa (60 mmHg), and/or a PaCO2 of greater than 6.67 kPa (50 mmHg). The main causes are ventilation dysfunction due to airway obstruction or limitation, and oxygenation dysfunction due to pulmonary edema, interstitial lung disease, or ARDS. The key pathophysiological changes are hypoxia, retention of carbon dioxide, and acidosis, which can affect multiple organ systems and lead to complications.
Chronic obstructive pulmonary disease (COPD) refers to two lung diseases, chronic bronchitis and emphysema, that are typically caused by smoking. In COPD, airflow to the lungs is limited by narrowing of the airways and destruction of lung tissue, causing shortness of breath. The main symptoms include cough, sputum production, wheezing, and chest tightness. COPD is diagnosed through lung function tests and imaging. Treatment focuses on improving ventilation with bronchodilators, corticosteroids, and oxygen therapy. Managing symptoms and preventing complications are also important aspects of COPD care.
Chronic obstructive pulmonary disease (COPD) refers to two lung diseases, chronic bronchitis and emphysema, that are typically caused by smoking and limit airflow. In COPD, the airways and air sacs within the lungs are damaged, making it difficult to breathe. The document discusses the causes, symptoms, diagnosis, and treatment of COPD, including medications and surgery to improve lung function and quality of life. Nursing care focuses on improving ventilation, clearing secretions, managing anxiety and activity intolerance, and preventing complications like infection.
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation caused by exposure to noxious particles or gases. It includes chronic bronchitis and emphysema. Clinically, patients are either "blue bloaters", with predominantly bronchitis, or "pink puffers" with predominantly emphysema. Diagnosis is confirmed by spirometry showing FEV1/FVC <70% and severity is classified based on post-bronchodilator FEV1. Management involves smoking cessation, bronchodilators, corticosteroids, oxygen therapy, and surgery in some cases. Acute exacerbations are managed with oxygen, nebulized bronchodilators, oral
Obstructive and restrictive pulmonary diseases can be categorized based on pulmonary function tests. Obstructive diseases like emphysema and chronic bronchitis involve airflow limitation due to airway obstruction. Restrictive diseases like pulmonary fibrosis involve reduced lung expansion and capacity. Chronic obstructive pulmonary disease (COPD) encompasses chronic bronchitis and emphysema, both of which involve irreversible airway obstruction. Emphysema is defined as abnormal enlargement of airspaces distal to terminal bronchioles due to alveolar wall destruction. The main types are centriacinar and panacinar emphysema. Emphysema results from an imbalance between proteases and antiproteases degrading lung tissue in heavy smokers.
ACUTE RESPIRATORY FAILURE MAGDI SASI 2015cardilogy
1. Acute respiratory failure is defined as a severe form of respiratory insufficiency resulting in a PaO2 of less than 60 mmHg or a PaCO2 of more than 50 mmHg.
2. There are two main types - type 1 with low PaO2 and normal or low PaCO2, and type 2 with low PaO2 and high PaCO2.
3. Major causes include diffuse airway obstruction, central airway obstruction, restrictive lung disease, pulmonary vascular disease, pleural and chest wall diseases, and neuromuscular diseases.
Presentation1.pptx, radiological imaging of restrictive lung diseases.Abdellah Nazeer
1. Restrictive lung diseases are characterized by diffuse involvement of the pulmonary connective tissue leading to stiff lungs and reduced expansion.
2. Fibrosis results in the stiffening of the lung tissue, predominantly in the delicate alveolar walls.
3. Common restrictive lung diseases include idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, and pneumoconiosis.
ARDS is a life-threatening form of respiratory failure characterized by diffuse lung inflammation and damage leading to hypoxemia. It has multiple causes but is commonly due to sepsis, pneumonia, or trauma. The pathology involves damage to the lung epithelium and endothelium, resulting in fluid accumulation in the alveoli. Treatment focuses on lung-protective ventilation with low tidal volumes, moderate levels of PEEP, and consideration of prone positioning. Other strategies include corticosteroids, neuromuscular blockade, and restrictive fluid management. More severe cases may require advanced support such as ECMO.
The document discusses obstructive lung diseases, focusing on chronic obstructive pulmonary disease (COPD) and its major types - chronic bronchitis and emphysema. It defines COPD as a common preventable disease characterized by persistent airflow limitation associated with an enhanced chronic inflammatory response in the airways and lungs. The primary causes are cigarette smoking and exposure to occupational pollutants. Spirometry and pulmonary function tests are important for diagnosis and monitoring disease severity. Pathologically, emphysema involves destruction of the alveolar walls while chronic bronchitis features inflammation and thickening of the bronchial walls. Management involves smoking cessation, bronchodilators, steroids, antibiotics and other strategies depending on the individual's condition
COPD refers to chronic bronchitis and emphysema, two commonly co-existing lung diseases where the airways become narrowed leading to limited airflow. The main causes are smoking, occupational exposures, air pollution, and genetic conditions. Symptoms include chronic cough, sputum production, wheezing, chest tightness, and shortness of breath. Management includes bronchodilators, corticosteroids, oxygen therapy, promoting exercise, and controlling complications to improve lung function and general health.
This document provides an overview of COPD, including its pathophysiology, types, diagnosis, and treatment. It defines COPD as chronic airflow obstruction characterized by emphysema and chronic bronchitis. The main types of emphysema discussed are centrilobular, panlobular, and paraseptal. Diagnosis involves assessing symptoms, examining the chest, and spirometry. Severity is classified based on FEV1 levels. Treatment focuses on smoking cessation, pharmacotherapy including bronchodilators and inhaled corticosteroids, pulmonary rehabilitation, oxygen therapy, and vaccines.
The document discusses chronic obstructive pulmonary disease (COPD), which refers to two lung diseases - chronic bronchitis and emphysema - that cause airflow blockage and breathing-related problems. COPD risk factors include smoking, air pollution, and genetic conditions. Symptoms involve shortness of breath, chronic cough, and wheezing. Diagnosis involves lung function tests and chest imaging. Treatment focuses on improving ventilation and managing symptoms.
Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is usually progressive and associated with an abnormal inflammatory response in the lungs. The most common causes of COPD are cigarette smoking and exposure to occupational dusts and fumes. Spirometry is required for diagnosis and shows airflow limitation defined as a reduced FEV1/FVC ratio. The severity of COPD is classified based on post-bronchodilator FEV1 levels. Management involves smoking cessation, vaccinations, rehabilitation, pharmacotherapy including bronchodilators and inhaled corticosteroids, and long-term oxygen therapy in severe cases.
L1.INTRODUCTION to ENDOCRINOLOGY MEDICINE.pptxDr Bilal Natiq
Endocrinology concerns the synthesis, secretion and action of hormones. These are chemical messengers released from endocrine glands that coordinate the activities of many different cells. Endocrine diseases can therefore affect multiple organs and systems.
The thyroid gland is the body's largest single organ specialized for endocrine hormone production. Its function is to secrete an appropriate amount of the thyroid hormones, primarily (thyroxine, T4) , and a lesser quantity of triiodothyronine (T3) , which arises mainly from the subsequent extrathyroidal deiodination ofT4.
L6-8.Disorders of the reproductive system.pptxDr Bilal Natiq
In the male, the testis serves two principal functions: synthesis of testosterone by the interstitial Leydig cells under the control of luteinising hormone (LH), and spermatogenesis by Sertoli cells under the control of follicle-stimulating hormone (FSH) (but also requiring adequate testosterone).
L11-14. Disorders of the pituitary gland and adrenals.pptxDr Bilal Natiq
Hypopituitarism describes combined deficiency of any of the anterior pituitary hormones. The clinical presentation is variable and depends on the underlying lesion and the pattern of resulting hormone deficiency.
Chest pain is one of the most common reasons patients present for medical attention and can be challenging to diagnose. A thorough history and physical exam is important to determine the cause, which could include ischemic heart disease, pulmonary issues, gastrointestinal problems, or other non-cardiac causes. The characteristics of cardiac chest pain often involve pain that builds up over minutes rather than seconds, may radiate to the arm or jaw, and is commonly accompanied by symptoms like sweating, nausea, and shortness of breath. Proper diagnosis requires considering risk factors, symptoms, and test results such as ECG, cardiac enzymes, stress testing, and imaging to correctly identify the source and manage appropriately.
1. Diarrhea is defined as having more than 3 loose or liquid stools per day. It can be acute (lasting less than 2 weeks) or chronic (lasting more than 4 weeks).
2. Acute diarrhea is often infectious and can be classified as watery, bloody, or dysentery. Evaluation is needed if bloody, associated with fever or infection, or not resolving. Chronic diarrhea often has non-infectious causes like IBS.
3. History and symptoms help determine the cause and guide testing/treatment. Infectious acute diarrhea may require antibiotics while watery diarrhea often resolves on its own with rehydration. Chronic diarrhea distinguishes organic from functional causes.
Fever is a common symptom that requires understanding the pattern and timing to determine the potential cause. Not all fevers are due to infections, and infections do not always present with fever. Careful examination of factors like time of rash appearance can help identify specific disorders as the source of the fever.
This document provides an approach to jaundice written by Dr. Bilal Natiq Nuaman, an assistant professor of medicine at Al-Iraqia Medical College. It discusses obstructive jaundice and thanks the reader.
This document provides an introduction to internal medicine, including:
- Internal medicine deals with preventing, diagnosing, and treating non-surgical diseases affecting adults. Doctors in this field are called internists or physicians.
- Internal medicine has many subspecialties including cardiology, endocrinology, gastroenterology, and others focused on specific organ systems.
- The diagnostic process in internal medicine involves taking a history, performing an examination, and ordering relevant investigations to arrive at a diagnosis and guide treatment. Accurately diagnosing patients' conditions is crucial for determining the correct management approach.
Pneumothorax is the presence of air in the pleural space and can occur spontaneously or due to injury. It is classified as primary, occurring without lung disease usually in young, tall smokers, or secondary, affecting those with lung diseases like COPD. Symptoms include chest pain and breathlessness. Examination may find reduced or absent breath sounds on the affected side. Chest x-ray shows the lung edge and any mediastinal shift. Small, asymptomatic primary pneumothoraces may resolve without treatment while larger ones often require chest tube drainage. Surgery is recommended after recurrent episodes to prevent future occurrences.
The 2018-2019 school year was a successful one for our district. Enrollment increased slightly to over 5,000 students across our 10 schools. Academically, our students performed well with above average test scores and graduation rates. Several of our schools received state recognition for narrowing achievement gaps among student groups.
Lung consolidation is caused by pneumonia, malignancy, or infarction and results in the accumulation of solid and liquid material in the air spaces of the lung. Pneumonia is the most common cause and presents with symptoms like fever and productive cough. Malignancy like lung cancer often presents with cachexia, clubbing, and productive cough. The document discusses the diagnosis, causes, and types of pneumonia and lung cancer. Smoking is responsible for 90% of lung cancers. Pneumonia can be classified by pathogen, anatomy, or presentation as lobar, bronchial, or atypical.
Pulmonary embolism is a blockage in the pulmonary arteries usually caused by blood clots. It can be diagnosed based on risk factors, symptoms, and tests like a D-dimer blood test, CT scan, or lung scan. Treatment depends on severity but generally involves blood thinners like heparin or warfarin to prevent further clots. For severe cases, thrombolysis can dissolve clots while a vena cava filter may be placed for recurrent clots or if blood thinners are contraindicated.
This document discusses a medical case involving a patient presenting with yellow, brittle nails and a triad of pleural effusion, bronchiectasis, and lymphedema.
This very short document does not contain enough substantive information to summarize in 3 sentences or less. It is a single date with no other context provided.
This document discusses the pathophysiology and clinical presentation of asthma. It notes that airway hyper-reactivity and inflammation are integral to asthma. Common allergens that can trigger asthma attacks include house dust mites, pets, cockroaches, and fungi. Aspirin can also trigger asthma attacks through its effects on leukotriene production. Clinically, asthma presents with wheezing, coughing, chest tightness, and shortness of breath. Allergic bronchopulmonary aspergillosis is a condition that can complicate asthma and cystic fibrosis through an allergic reaction to fungal spores, and is generally treated with oral corticosteroids and antifungal medications.
This medical document discusses a patient who experienced a unilateral pulmonary embolism in 2018-2019 and has a history of Wegener's granulomatosis and polyarteritis nodosa. The document lists these three conditions but does not provide any other context or details about the patient.
This document discusses an approach to interpreting an electrocardiogram (ECG). It examines the heart rate, identifies any premature atrial contractions, analyzes the axis of the heart, and checks for signs of ST elevation myocardial infarction.
This document discusses approaches to nutrition and appetite. It covers causes of loss of appetite like gastrointestinal issues, chronic diseases, and psychiatric illnesses. Increased appetite can occur with exercise, recovery from illness, mania, and hyperthyroidism. Perverted appetites like pica may be seen with iron deficiency or pregnancy. Obesity is categorized as generalized or central, and central obesity can be measured by waist circumference or waist-to-height ratio. Weight loss is also addressed.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
2. DefinitionDefinition
COPDCOPD ((Chronic obstructive pulmonary diseaseChronic obstructive pulmonary disease))
is a preventable and treatable disease stateis a preventable and treatable disease state
characterized by airflow limitation that ischaracterized by airflow limitation that is notnot
fully reversiblefully reversible..
The airflow limitation is usuallyThe airflow limitation is usually progressiveprogressive andand
is associated with an abnormal inflammatoryis associated with an abnormal inflammatory
response of the lungs, primarily caused byresponse of the lungs, primarily caused by
cigarette smoking.cigarette smoking.
Although COPD affects the lungs, it alsoAlthough COPD affects the lungs, it also
producesproduces significant systemic consequencessignificant systemic consequences.. 2222
4. ➢Major cause of death and disabilityMajor cause of death and disability
➢4th4th leading cause of deathleading cause of death
➢COPD is the only chronic disease that isCOPD is the only chronic disease that is
showing progressive upward trend in bothshowing progressive upward trend in both
mortality and morbiditymortality and morbidity
➢It is expected to be the third leading cause ofIt is expected to be the third leading cause of
death bydeath by 20202020
COPDCOPD
GENERAL FACTSGENERAL FACTS
4444
5. % Change in Age Adjusted Death Rate% Change in Age Adjusted Death Rate
5555
7. ➢ COPD should be suspected in any patientCOPD should be suspected in any patient
over the age ofover the age of 3535 years who presents withyears who presents with
symptoms of persistent cough and sputumsymptoms of persistent cough and sputum
production and/or breathlessness.production and/or breathlessness.
➢ Depending on the presentation importantDepending on the presentation important
differential diagnoses include asthma,differential diagnoses include asthma,
tuberculosis, bronchiectasis and congestivetuberculosis, bronchiectasis and congestive
cardiac failure.cardiac failure.
7777
8. ➢ BreathlessnessBreathlessness usually heralds the first presentation tousually heralds the first presentation to
the health professional.the health professional.
➢ In advanced disease, the presence ofIn advanced disease, the presence of edemaedema andand
morning headachesmorning headaches indicative ofindicative of hypercapniahypercapnia..
➢ CracklesCrackles may accompany infection but if persistent raisemay accompany infection but if persistent raise
the possibility of bronchiectasis.the possibility of bronchiectasis.
➢ Finger clubbingFinger clubbing isis not consistentnot consistent with COPD and shouldwith COPD and should
alert the physician to potentially more serious pathologyalert the physician to potentially more serious pathology
((CA LungCA Lung).).
8888
9. ➢ Some patients with severe COPD maySome patients with severe COPD may
demonstrate signs consistent withdemonstrate signs consistent with corpulmonalecorpulmonale
(raised jugular venous pressure, loud P(raised jugular venous pressure, loud P22 due todue to
pulmonary hypertension, tricuspid regurgitation,pulmonary hypertension, tricuspid regurgitation,
pitting peripheral edema and hepatomegaly) andpitting peripheral edema and hepatomegaly) and
its presence usually indicates a poor prognosis.its presence usually indicates a poor prognosis.
9999
10. Skeletal muscle wasting and cachexia maySkeletal muscle wasting and cachexia may
occur in advanced disease, while someoccur in advanced disease, while some
patients may also be overweight.patients may also be overweight.
The body mass index (BMI; weight/height²)The body mass index (BMI; weight/height²)
should be calculated during the initialshould be calculated during the initial
examination.examination.
10101010
16. Pink PuffersPink Puffers
➢Thin and dyspnic ,Thin and dyspnic ,
and maintain Paand maintain Pa COCO22
until the late stage ofuntil the late stage of
disease.disease.
➢EMPHESEMAEMPHESEMA
16161616
17. PPursed liursed lipp breathing occur inbreathing occur in
emempphysemahysema not in chronic bronchitisnot in chronic bronchitis
17171717
22. Clinical FeaturesClinical Features
➢No cyanosisNo cyanosis ((pinkpink))
➢Presents withPresents with severe dyspneasevere dyspnea (puffer(puffer))
➢Have aHave a barrel chestbarrel chest..
➢X-ray showsX-ray shows large volume lung, Heartlarge volume lung, Heart isis
seems buried and diaphragm pushed down.seems buried and diaphragm pushed down.
Alveoli can ruptureAlveoli can rupture pneumothorax.pneumothorax.
➢Don’t usually have cough or expectorationDon’t usually have cough or expectoration
PINK PUFFERPINK PUFFER
22222222
23. BLUE BLOATERBLUE BLOATER
Develop andDevelop and
toleratetolerate
hypercapniahypercapnia
earlier and mayearlier and may
develop edemadevelop edema
andand 22‘‘
polycythemia.polycythemia.
CHRONICCHRONIC
BRONCHITICBRONCHITIC
23232323
24. CHRONIC BRONCHITISCHRONIC BRONCHITIS
➢DefinedDefined clinicallyclinically
Persistent cough with sputumPersistent cough with sputum
production forproduction for at leastat least 33 monthsmonths inin
at leastat least 22 consecutiveconsecutive yearsyears, with, with
exclusion of other causes likeexclusion of other causes like
Bronchiectasis .Bronchiectasis .
24242424
25. PATHOGENESISPATHOGENESIS
SMOKINGSMOKING
4-104-10 times more common in heavy smokerstimes more common in heavy smokers
✓ a smoking history of more thana smoking history of more than 2020 pack yearspack years
➢ Smoke and other irritants causeSmoke and other irritants cause
Hypertrophy of submucosal glands--- hypersecretionHypertrophy of submucosal glands--- hypersecretion
of mucusof mucus
Increase in goblet cellsIncrease in goblet cells
↑↑predisposition to infectionpredisposition to infection
25252525
26. Clinical FeaturesClinical Features
➢CyanosedCyanosed ((BlueBlue))
➢EdematousEdematous ((BloaterBloater))
➢Productive CoughProductive Cough
➢CorPulmonale – heart failureCorPulmonale – heart failure
➢Usually dyspnea triggered by infectionUsually dyspnea triggered by infection
➢Respiratory acidosisRespiratory acidosis
Blue bloaterBlue bloater
26262626
31. DLCO: Transfer FactorDLCO: Transfer Factor
• AsthmaAsthma highhigh
• Chronic bronchitisChronic bronchitis normalnormal
• EmphysemaEmphysema lowlow
31313131
32. Other testsOther tests
➢ HemoglobinHemoglobin andand PCVPCV can be elevated as a result ofcan be elevated as a result of
persistent hypoxemia causing secondarypersistent hypoxemia causing secondary
polycythemia.polycythemia.
➢ Arterial blood gases (ABGs)Arterial blood gases (ABGs) determine the degree ofdetermine the degree of
hypoxia and hypercapnia.hypoxia and hypercapnia.
➢ CXRCXR can be normal or show hyper-expanded lungcan be normal or show hyper-expanded lung
fields with low flattened diaphragms and the presencefields with low flattened diaphragms and the presence
of bullae (emphysemaof bullae (emphysema))..
➢ ECGECG can show advanced cor pulmonalecan show advanced cor pulmonale
➢ Alpha-antitrypsin level and phenotypeAlpha-antitrypsin level and phenotype may be helpfulmay be helpful
(young non smokers, lower lobe emphysema, a family(young non smokers, lower lobe emphysema, a family
history of chest problemshistory of chest problems).). 32323232
34. Disease Progression of a Patients withDisease Progression of a Patients with
COPDCOPD
Symptoms
Exacerbations
Exacerbations
Exacerbations
Deterioration
End of Life
34343434
39. Smoking cessationSmoking cessation
➢The onlyThe only
interventionintervention
proven toproven to
decelerate thedecelerate the
decline indecline in
FEVFEV11.. 39393939
42. BronchodilatorsBronchodilators
Short Acting BetaShort Acting Beta22 Agonist (SABAAgonist (SABA))
➢e.g. Salbutamole.g. Salbutamol
➢Improve pulmonary function/SOB/exerciseImprove pulmonary function/SOB/exercise
performanceperformance
➢Combination SABA’s and anticholinergicsCombination SABA’s and anticholinergics
produce better bronchodilationproduce better bronchodilation
➢For patients with MILD symptomsFor patients with MILD symptoms
●
SOB on exertionSOB on exertion
42424242
43. BronchodilatorsBronchodilators
Long Acting BetaLong Acting Beta22 Agonist (LABAAgonist (LABA))
➢e.g.– Formoterol, Salmeterole.g.– Formoterol, Salmeterol
➢For patients who still have symptoms onFor patients who still have symptoms on
SABA’sSABA’s ((MODERATE diseaseMODERATE disease))
➢More sustained effect on PFT’s, chronic SOBMore sustained effect on PFT’s, chronic SOB
➢Early evidence these may prolong timeEarly evidence these may prolong time
between exacerbationsbetween exacerbations
43434343
44. Inhaled anticholinergicsInhaled anticholinergics
inhaled ipratropium bromide is preferred over
beta-2 agonists by many as the bronchodilator of
choice in COPD for the following reasons:
➢Its minimal cardiac stimulatory effects compared
to those of beta agonists
➢Its greater effectiveness than either beta agonist
or methylxanthine bronchodilators in most studies
of patients with COPD
44444444
46. SteroidsSteroids
Inhaled steroidInhaled steroid
➢ Not recommended as first line therapyNot recommended as first line therapy
➢ No consistent effect on decreasing inflammationNo consistent effect on decreasing inflammation
➢ Consider inhaled form in those with mod-severeConsider inhaled form in those with mod-severe
diseasedisease
➢ Consider in those who have maximalConsider in those who have maximal
bronchodilator therapybronchodilator therapy
➢ Inhaled corticosteroids are currentlyInhaled corticosteroids are currently
recommended inrecommended in severe disease( FEVsevere disease( FEV1<50%1<50% whowho
report two or more exacerbations requiringreport two or more exacerbations requiring
antibiotics or oral steroids per yearantibiotics or oral steroids per year .. 46464646
49. Additional measuresAdditional measures
➢ Vaccines. Patients with COPD should receive a singleVaccines. Patients with COPD should receive a single
ddose of the polyvalent pneumococcal polysaccharideose of the polyvalent pneumococcal polysaccharide
vaccine and yearly influenza vaccinations.vaccine and yearly influenza vaccinations.
➢ aa11-Antitrypsin replacement. Weekly or monthly-Antitrypsin replacement. Weekly or monthly
Infusions of aInfusions of a11-antitrypsin have been recommended for-antitrypsin have been recommended for
patients withpatients with lowlow serum levels and abnormal lungserum levels and abnormal lung
function.function.
➢ Heart failure should be treated with diuretics .Heart failure should be treated with diuretics .
➢ Secondary polycythemia requires venesection if theSecondary polycythemia requires venesection if the
PCV is >PCV is >5555%%
49494949
50. SURGERYSURGERY
➢ BullectomyBullectomy : young with emphysema: young with emphysema
➢ Lung Volume reduction surgery (LVRS)Lung Volume reduction surgery (LVRS)::
emphysemaemphysema
➢ Lung transplantLung transplant
Have been used for severe COPDHave been used for severe COPD
50505050
51. 5151
Emergency treatment
Emergency treatment
Exacerbations of COPD are characterized by an acute
worsening of symptoms, with
increased breathlessness,
sputum volume and
sputum purulence.
They may occur spontaneously or as a result of infections.
Mild exacerbations can be managed at home but patients with
severe exacerbations require admission to hospital.
key adverse features that indicate a severe
exacerbation : (confusion, cyanosis, severe
respiratory distress) 5151
52. 5252
Patients admitted to hospital should have
• Chest X-ray,
• Arterial blood gas measurement,
• ECG (to exclude comorbidities)
• Full blood count and
• Urea and electrolyte measurements.
• Culture of sputum
• Blood cultures should be taken if the patient is
pyrexial and
• Theophylline level should be measured in patients
on theophylline therapy.
5252
54. ORAL STEROIDSORAL STEROIDS
ORAL STEROIDS are useful during exacerbationsORAL STEROIDS are useful during exacerbations
(rule of(rule of 15)15)
PREDINSOLONPREDINSOLON 1515 mgmg TWICE DAILY GIVENTWICE DAILY GIVEN FORFOR 1515
DAYSDAYS MAY BENEFITMAY BENEFIT 1515%% OF PATIENTS WITHOF PATIENTS WITH
COPD EXACERBATIONCOPD EXACERBATION
54545454
55. 5555
Antibiotics
Common bacteria associated with COPD exacerbation
include
Haemophilus inluenzae,
Streptococcus pneumoniae and
Moraxella catarrhalis.
Treatment
Augmentin(amoxicillin and clavulanic acid),
or doxycycline, or ciprofloxacin or clarithromycin.
5555
56. 5656
Emergency oxygen
treatment should be commenced using controlled oxygen (e.g.
28% Venturi mask in pre-hospital care or 24% Venturi mask in
hospital settings), with an initial target saturation of 88–92%
pending urgent blood gas assessment to determine the patient’s
ventilatory status (pH and PCO2) .
5656
57. 5757
Ventilatory support
if the pH is below the normal range (<7.3) then
noninvasive ventilation (NIV) should be employed
5757
58. BRONCHIECTASISBRONCHIECTASIS
A destructive lung disease characterized by:A destructive lung disease characterized by:
●
Abnormal & permanent dilatation of medium sizedAbnormal & permanent dilatation of medium sized
bronchibronchi
●
An associated, persistent and variable inflammatoryAn associated, persistent and variable inflammatory
process producing damage to bronchial elastic andprocess producing damage to bronchial elastic and
muscular elementsmuscular elements
58585858
61. Physical signsPhysical signs
➢ 11-normal chest exam-normal chest exam. If bronchiectatic airways. If bronchiectatic airways
do not contain secretions and there is nodo not contain secretions and there is no
associated lobar collapse .associated lobar collapse .
➢ 22-coarse crackles-coarse crackles if there is secretions .if there is secretions .
➢ 33- deviated trachea toward side of lesion ,- deviated trachea toward side of lesion ,
dullness ,↓breath sounddullness ,↓breath sound if there is collapse .if there is collapse .
➢ 44- bronchial breathing- bronchial breathing : advanced scarring .: advanced scarring .
61616161
62. INVESTIGATIONSINVESTIGATIONS
11-Sputum culture-Sputum culture
For pseudomonas aeruginosa , fungi , andFor pseudomonas aeruginosa , fungi , and
mycobacteria .mycobacteria .
22- Radiology- Radiology
CXR : early stage normalCXR : early stage normal
Advanced thickened airway walls , cystic spaces ,Advanced thickened airway walls , cystic spaces ,
pneumonic consolidation or collapse .pneumonic consolidation or collapse .
SPIRAL CT SCAN of chest is much moreSPIRAL CT SCAN of chest is much more sensitive .sensitive .
33-Assessment of ciliary function-Assessment of ciliary function
62626262
64. managementmanagement
➢ 11-airway obstruction-airway obstruction :: inhaled bronchodilators andinhaled bronchodilators and
corticosteroids .corticosteroids .
➢ 22-- physiotherapyphysiotherapy
Patients should adopt a position in which the lobePatients should adopt a position in which the lobe
to be drained is uppermost.to be drained is uppermost.
Deep breathing followed by forced expiratoryDeep breathing followed by forced expiratory
maneuvers (the 'active cycle of breathing'maneuvers (the 'active cycle of breathing'
technique) is of help in allowing secretions in thetechnique) is of help in allowing secretions in the
dilated bronchi to gravitate towards the trachea,dilated bronchi to gravitate towards the trachea,
from which they can be cleared by vigorousfrom which they can be cleared by vigorous
coughing.coughing.
64646464
65. 'Percussion' of the chest wall with cupped'Percussion' of the chest wall with cupped
hands may help to dislodge sputum, and ahands may help to dislodge sputum, and a
number of mechanical devices are availablenumber of mechanical devices are available
which cause the chest wall to oscillate, thuswhich cause the chest wall to oscillate, thus
achieving the same effect.achieving the same effect.
The optimum duration and frequency ofThe optimum duration and frequency of
physiotherapy depends on the amount ofphysiotherapy depends on the amount of
sputum butsputum but 55--1010 minutes once or twice dailyminutes once or twice daily
is a minimum for most patients.is a minimum for most patients.
65656565
67. 33- antibiotics- antibiotics
Oral ciprofloxacinOral ciprofloxacin 500500--750750 mg bidmg bid
Or ceftazidime by IV inj. Or infusionOr ceftazidime by IV inj. Or infusion 11--22 gmgm 88--
hourly.hourly.
44- surgery- surgery
Only in unilateral , single lobe in young patientOnly in unilateral , single lobe in young patient
67676767
Diagnosis of COPD is based on a history of exposure to risk factors and the presence of airflow limitation that is not fully reversible, with or without the presence of symptoms.
Patients who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation, even if they do not have dyspnea.
For the diagnosis and assessment of COPD, spirometry is the gold standard.
Health care workers involved in the diagnosis and management of COPD patients should have access to spirometry.