the most popular topic in respiratory illness.

1. COPD

2.  COPD, a common preventable and treatable disease, is characterized by
persistent airflow limitation that is usually progressive and associated with an
enhanced chronic inflammatory response in the airways and the lung to
noxious particles or gases.
 Exacerbations and comorbidities contribute to the overall severity in
individual patients.
Global Strategy for Diagnosis, Management and Prevention of COPD
Definition of COPD

3. Risk Factors for COPD
Infections
Genes
Socio-
economic
status
Aging Populations

4. Presenting Features
 Over 35 years
 Smokers or ex-smokers
 Breathlessness on exertion initial stage, then continuously in advanced stages
 tachypnea
 Chronic cough
 Regular sputum production usually in the morning
 Prolonged expiratory phase, end-expiratory wheezing,crackles,muffled breath
sounds, and or coarse rhonchi on auscultation
 Cyanosis due to hypoxemia
 Pursed lip breathing
 tachycardia

5. Presenting Features
On examination the following may be present:
 Hyper inflated chest(barrel chest,mostly in individuals emphysema)
 Use of accessory muscles of respiration
 Asynchronous movement of the chest and abdomen during respiration
 Hyperresonant lungs,reduced relative cardiac dullness on percussion
 Decreased breath sounds on auscultation”silent lung”
 Peripheral oedema( most often ankle edema)
 Raised JVP(1st due to Phypertension and later to cor pulmonale)
 Right V Hypertrophy with signs of right heart failure and cor pulmonale
 Hepatomegaly
 Often weight loss and cachexia
 Secondary polycythemia
 Confusion due to hypoxemia and hypercapnia

6. CLINICAL APPEARANCE OF COPD PATIENT
PINK PUFFER
MAIN PATHOMECHANISM EMPHYSEMA
CLINICAL
FEATURES
Non cyanotic
Cachetic
Pursed lips
Mild cough
PaO2 Slightly reduced
PaCO2 normal
BLUE BLOATER
MAIN PHATHOMECHANISM CHRONIC BRONCHITIS
CLINICAL FEATURES PRODUCTIVE COUGH
OVERWEIGHT
PERIPHERIAL EDEMA
PaO2 Markedly reduced
PaCO2 Increased(early
hypercapnia)

7. DIAGNOSTICS
 PULMONARY FUNCTION TEST(PFT):
 Vital Capacity VC: Is the volume of gas exhaled from complete inspiration to complete expiration
 Forced Vital Capacity FVC: maneuver performed with maximum force
 Forced Expiratory Volume in first second FEV1: Is the volume of air expelled in the first second of a
FVC maneuver
Spirometry: Normal Trace Showing FEV1 and FVC
FEV1 = 4L
FVC = 5L
FEV1/FVC = 0.8

8. Spirometry: Obstructive Disease
 FEV1 = 1.8L
 FVC = 3.2L
 FEV1/FVC = 0.56
COPD produces characteristic results in this test. The amount of air exhaled
(forced vital capacity, or FVC) is reduced, compared to a person with normal lung
function. Furthermore, the amount of air exhaled during the initial 1 second
(FEV1) is reduced and is reduced to a greater degree than the entire FVC.
Therefore, the ratio of air exhaled after 1 second is low compared to the total
amount of air exhaled. In healthy lungs, 70%-75% of all the air exhaled after
maximum inhalation (FVC) is exhaled within the first second (FEV1), known as the
FEV1/FVC ratio. In lungs with COPD, the FEV1/FVC ratio falls below 70%-75%.

9. POSTBRONCHODILATOR TEST
(to assesses reversibility of bronchoconstriction)
 PROCEDURE: Spirometry to establish a baseline. Inhalation(e.g.,salbutamol).
Perform spirometry again after 10 to 15min.
 RESULTS OF PFT: FEV1/FVC<0.7 =COPD
DELTA FEV1<12%(IRREVERSIBLE bronchoconstriction):COPD
DELTA FEV1>12%(REVERSIBLE bronchoconstriction): asthma

10. Other test
 BLOOD GAS AND PULSE OXIMETRY
ABG indicated when O2 is,92% or if patient is serverly ill
-decreased Po2: partial respiratoy failure
-decreased pO2 and increased Pco2: global respiratory failure
-many individuals with severe COPD have chronic hypercapnia due to CO2
trapping from hyperinflation and progressive loss of pulmonary eslastic