Chronic obstructive pulmonary disease (COPD) is characterized by progressive, irreversible airflow limitation, primarily caused by smoking, affecting an estimated 384 million people globally. Symptoms include excessive cough, sputum production, and shortness of breath, with exacerbations often triggered by infections or environmental factors. Diagnosis is determined through pulmonary function tests, and treatment includes smoking cessation, oxygen therapy, and medications such as corticosteroids and theophylline.

1. CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
DR.ALTAF AL-KAMISH

2. Definition
 COPD is characterised by Persistent airflow limitation that is usually
progressives, not reversible and does not change markedly over several
months.
 The disease is predominantly caused by smoking.
 estimates suggest that 384 million people worldwide suffer from moderate to
severe disease 2010.
 more than 3 million deaths (5% of deaths globally

3.  Chronic bronchitis: is a clinical diagnosis defined by
excessive secretion of bronchial mucus and is manifested
by daily productive cough for 3 months or more in at least
2 consecutive years.
 Emphysema: is a pathologic diagnosis that denotes
abnormal permanent enlargement of air spaces distal to
the terminal bronchiole, with destruction of their walls
and without obvious fibrosis

4. Risk factors
 Cigarette smoking is clearly the most important cause of COPD . It is
estimated that 80% of patients seen for COPD have significant exposure to
tobacco smoke.
 The remaining 20% frequently have a combination of exposures to
environmental tobacco smoke, occupational dusts and chemicals, and indoor
air pollution from biomass fuel used for cooking and heating in poorly
ventilated buildings.
 Outdoor air pollution, airway infection, familial factors, and allergy have also
been implicated in chronic bronchitis, and hereditary factors (deficiency of
alpha-1-antiprotease [alpha-1-antitrypsin]) have been implicated

5. Clinical Findings
 Symptoms :
 excessive cough.
 sputum production.
 shortness of breath.
 Dyspnea.
 Exacerbations Often including increased dyspnea, an increased frequency or
severity of cough, increased sputum volume or change in sputum character.
 These exacerbations are commonly precipitated by infection (more often viral
than bacterial) or environmental factors.

6. signs
 Signs of respiratory disease tend to appear as COPD progresses.
 normal,
 Cyanosis.,an elevate respiratory rate at rest in mild disease.
 Hyper inflated chest (increased antero- posterior diameter of the chest wall).
 intercostal in drawing.
 diminished breath sounds.
 prolongation of the expiratory phase of respiration
 wheeze is usually heard during expiration
 Late course inspiratory crackles .
 faint heart sounds (due to hyper inflated lungs).

9. Laboratory Findings
 CBC.
 Serum electrolytes .
 RFT
 LFT.
 ECG P Pulmonal .
 Echocardiography. Pulmonary HTN.
 PFT

10.  provides objective information about pulmonary function
and assesses the response to therapy.
 COPD can be diagnosed when forced expiratory volume in
1 second/forced vital capacity (FEV1/FVC) <0.7 and FEV1
< 80% predictedI
 f the FEV1 is ≥80% predicted of normal, a diagnosis of
COPD should only be made in the presence of typical
respiratory symptoms.

11. Normal volume/time tracing

12. obstructive ventilatory defect
;

13. Flow/volume

14. Imaging
 Plain radiographs are insensitive for the diagnosis of
emphysema; they show hyperinflation with flattening of
the diaphragm or peripheral arterial deficiency.
 CT of the chest, particularly using high-resolution CT, is
more sensitive and specific than plain radiographs for its
diagnosis.

15. Chest X-ray showing typical changes of
chronic obstructive pulmonary disease

16. High-resolution computed tomogram of the chest
showing widespread upper lobe emphysematous bullae

17. GOLD CLASSIFICATION
 MILD: FEV1 ≥ 80%.
 Moderate : FEV1 50–79%.
 Severe : FEV1 30–49% .
 Very severe : FEV1 < 30% (or when< 50% with
respiratory failure

18. Complication
 Acute bronchitis.
 pneumonia.
 pulmonary thromboembolism.
 atrial dysrhythmias .
 Pulmonary hypertension

19. TREATMENT
 1. Smoking cessation
 2. Home oxygen therapy
 Resting pao2<or=55.
 O2 sat (SaO2)<88%
 Pao2<or=59mmHg O2Sat <or=89% with
 Corpulmonale
 Erythrocytosis.

20. (
GOLD
)
guidelines for treatment of COPD

21.  Corticosteroids-
 :Inhaler corticosteroids
 reduction in the frequency of COPD exacerbations
 an increase functional status
 Systemic corticosteroids:
 Only used in COPD EXACERPATION..
 Theophylline is one of the oldest oral therapeutic agents available for the
treatment of COPD .

22. Non-invasive ventilation (NIV)
 Non-invasive ventilation (NIV) reduces mortality and the need for intubation in
patients with a respiratory acidosis (pH < 7.35 and PaCO2 > 6 kPa)
 NIV should be considered within the first 60 minutes of hospital arrival in all
patients in whom a respiratory acidosis persists despite maximum medical
therapy
 NIV should be initiated only by trained staff; monitoring should include
respiratory rate, arterial blood gases, pulse oximetry, synchrony and compliance
 NIV should be continued until the underlying acute cause has
 resolved
 All patients should have a clear plan recorded and agreed upon
 in the event of NIV failure