CHRONIC OBSTRUCTIVE

PULMONARY DISEASE
(COPD)

Definition of COPD
a common preventable and treatable disease,
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

Types of COPD (Usually pts comes with both type, rarely either one)
Emphysema
Dened as abnormal,
permanent enlargement of air
spaces
distal to terminal bronchiole
accompanied by destruc>on of
their walls
without brosis

Chronic Bronchi>s
causes inamma>on and
irrita>on of the bronchial tubes,
Then, thick mucus begins plug
up over >me
causing dyspnea
and purulent sputum

Emphysema and Chronic Bronchitis

Pathophysiology
Abnormal inammatory
response of the lungs due to
toxic gases.

Pulmonary vascular changes:

-Thickening of vessels
-Collagen deposit
-DestrucAon of capillary beds

Response occurs in the

airways ,parenchyma &
pulmonary vasculature.

DestrucAon of lung
parenchyma leads to an
imbalance of proteinases/
anAproteinases

Narrowing of the airway

takes place

DestrucAon of parenchyma
leads to emphysema.

Mucus hypersecreAon
(cilia dysfuncAon,airow
limitaAon,corpulmonale)

Chronic cough and sputum

producAon

Mechanism underlying Airflow Limitation

Small airway disease

Parenchymal
destruc>on

Airway limita>on
Airway brosis, luminal
plug
Increased airway
resistance

Loss of alveolar
aJachment
Decrease of elas>c recoil

Airow
Limita>on

Risk factors for COPD

1. from heating and cooking
wit
Age (older more than
CigareJe smoking

Indoor air pollu>on

from hea>ng and
cooking with biomass
in poorly ven>lated
dwellings

younger)

Outdoor air pollu>on

(air pollu>on)

Asthma / bronchial
hyperresponsiveness

Occupa>onal dusts
(Mining coal, silica
etc)

Alpha-1 An>trypsin
deciency (gene>c)

Respiratory infec>on

Clinical features
Symptoms
History of heavy smoking
Purulent cough for many years
Breathlessness on exer>on with chest >ghtness
Exacerbate by
Cold
Atmospheric pollu>on
Exercise
Infec>on

Signs
Pts appear tachypneic with prolong expira>on
nico>ne stained on hand
asterixis(CO2 reten>on),
Bounding pulse
Face central cyanosis
Pursing of lips
Wheeze
Use of accessory muscles
Indrawing intercostals
Loss of normal liver and cardiac dullness
Poor chest expansion
Hyperinated lung (Barrel chest)
Reduced breath sounds
Loud S2 (over the pulmonary area)

InvesAgaAons
Lung func>on tests
-By using spirometry : used to assess the severity of airow
obstruc>on
Done by measuring the FEV1 (COPD)
Normal value : Vary depend on sex and age
80% - 120%

The global iniAaAve for chronic obstrucAve lung disease (GOLD)
staging system is a commonly used severity staging system based on
air ow limita>on. According to this, there are 4 key stages:

 FBC
- Hb & PCV may be high : As a result of persistent hypoxaemia &
secondary polycythaemia

Chest x-ray
-may show hyperinated lungs(low,aJened diaphragms)
-Reduced peripheral lungs markings
-May show bullae(complete destruc>on of lung >ssue producing
an airspace greater than 1 cm)
-To rule out other condi>ons with similar symptoms

 ECG
-Assess cardiac status if there are features of cor pulmonale

ABG analysis
-measure oxygen,carbon dioxide and acid in blood ; help to
decide whether need oxygen treatment
Pulse oximetry
-To measures oxygen satura>on in the blood ; for oxygen
treatment

 Sputum culture
-To iden>fy organisms if sputum is persistently present and
purulent
Ct-scan
-give details picture of the lungs
-par>cularly show emphysematous bullae
Alpha-1 an>trypsin (AAT) screening (serum levels and
genotypes)
-Deciency of AAT due to gene>c : contribute to the problem

Management

Bronchodilators
Cor>costeroids
Oxygen
Addi>onal Rx : mucoly>cs, diure>cs

Complica>ons
Respiratory failure
Cor pulmonale, i.e heart disease secondary to disease of the
lung

Preven>on
Cessa>on of smoking
Pneumococcal vaccine, annual inuenza vaccina>on & an>-
bio>cs (prevent acute exacerba>ons of copd)