COPD

(CHRONIC OBSTRUCTIVE
PULMONARY DISEASE )
KELOMPOK D

DEFINITION

Chronic Obstructive Pulmonary Disease is a

preventable and treatable disease with some
significant extrapulmonary effects.

The pulmonary component is characterized by

airflow limitation that is not fully reversible.

Healthy
Alveolus

COPD

The airflow limitation in COPD is usually progressive

and associated with an abnormal inflammatory
response of the lungs to noxious particles and gases

Severe COPD leads to respiratory failure,

hospitalization and eventually death from suffocation

PATHOLOGY

Pathological changes characteristic of COPD

are found in the airways, lung parenchyma,
and pulmonary vasculature. The pathological
changes include chronic inflammation, with
increased numbers of specific inflammatory
cell types in different parts of the lung, and
structural changes resulting from repeated
injury and repair.

PATHOLOGY
In general, the inflammatory and structural
changes in the airways increase with disease
severity and persist on smoking cessation

PHATOGENESIS

Oxidative stress
Protease antiprotease imbalance
Inflammatory cells
Inflammatory mediators
Differences in inflammatory between COPD
and Asthma

PHATOPHYSIOLOGY

Airflow limitation and air trapping

Gas exchange abnormalities
Mucus hypersecretion
Pulmonary hypertension
Exacerbation
Systemic features

DIAGNOSIS

Risk Factors for COPD

Nutrition
Infections
Socio-economic
status

Aging Populations

SYMPTOMS
Dyspnea
Cough
Sputum
Wheezing and Chest Tightness

Additional features in severe disease

DIAGNOSIS

Medical hystory
Physical examination
Spirometry

ASSESSMENT OF DISEASE

ASSESSMENT OF SYMPTOMS

Modified Medical Research Council (mMRC)

COPD Assessment Test (CAT)
Clinical COPD Questionnaire (CCQ)

SPIROMETRIC ASSESSMENT

Classification of COPD Severity by Spirometry

Stage I: Mild
FEV1/FVC < 0.70
FEV1 > 80% predicted

Stage II: Moderate

Stage III: Severe

Stage IV: Very Severe FEV1/FVC < 0.70

FEV1 < 30% predicted or
FEV1 < 50% predicted plus
chronic respiratory failure

FEV1/FVC < 0.70

50% < FEV1 < 80% predicted
FEV1/FVC < 0.70
30% < FEV1 < 50% predicted

Differential Diagnosis

Diagnosis
COPD

Asthma

COPD and its Differential Diagnosis

Suggestive Features
Onset in mid-life,symptoms slowly progressive,
history of tobacco smoking or exposure to other types
of smoke
Onset early in life (often childhood),symptoms vary
widely from day to day, symptoms worse at night/
early morning, allergy/rhinitis and or eczema also
present,family history of asthma

Congestive Heart failure

Chest X-ray shows dilated heart, pulmonary edema,

pulmonary function tests indicate volume
restriction,not airflow limitation

Bronchiectasis

Large volumes of purulent sputum, commonly

associated with bacterial infection, chest x-ray/ CT
shows bronchial dilation, bronchial wall thickening

Differential Diagnosis
COPD and its Differential Diagnosis
Diagnosis
Tuberculosis

Suggestive Features
Onset all ages, Chest x-ray shows lung infiltrate, microbiological
comfirmation, high local prevalence of tuberculosis

Obliterative Bronchiolitis

Onset at younger age, nonsmokers, may have history of

rheumatoid arthritis or acute fume exposure, seen after or bone
marrow transplantation, CT on expiration shows hypodense areas

Diffuse Panbronchiolitis

Predominantly seen in patients of asian descent, Most patients are

male and nonsmokers, almost all have chronic sinusitis, chest Xray and HRTC show diffuse small centrilobular nodular opacities
and hyperinflation.

These features tend to be characteristic of the respective diseases, but are not mandatory. For
example, a person who has never smoked may develop COPD (especially in the developing world
where other risk factors may be more important than cigarette smoking); asthma may develop in
adult and even in elderly patients.

THERAPEUTIC OPTIONS

SMOKING CESSATION
Smoking cessation is the intervention with the
greatest capasity to influence the natural
history of COPD. Evaluation of the smoking
cessation component in a longterm,
multicenter study indicates that if effective
resources and time are dedicated to smoking
cessation, 25% longterm quit rates can be
achieved

Pharmacotherapies for Smoking Cessation :

Nicotine Replacement Products (nicotine
gum, inhaler, nasal spray, transdermal patch,
sublingual tablet, or lozenge)
Realibly increases long term smoking
abstinence rates
Significantly more effective than placebo

Pharmacologic

Varenicline,bupropion, nortriptyline have been

shown to increase long term quit rates.

Recommendations for treating tobacco use

and dependence are summarized in table.

Treating tobacco Use and Dependence: A clinical Practice Guidline-Major findings and
Recommendations
Tobacco dependence is a chronic condition that warrants repeated treatmenrt until long
term or permanent abstinence is achieved
Effective treatments for tobacco dependence exist and all tobacco users should be offered
these treatments
Clinicians and health care delivery systems must inztitutionalize the consistent
identification, documentation, and treatment of every tobacco user at every visit
Brief smoking cessation counseling is effective and every tobacco user should be offered such
advise at every contactwith health care providers
There is a strong dose response relaton between the intensity of tobacco dependence
counseling and its effectiveness.
Three types of counseling have been found to be especially effective: practical counseling,
social support as part of treatment, and social support arranged outside of treatment.
First line pharmacotherapies for tobacco dependence-varenicline,bupropion,SR, nicotone
gum, nicotone inhaler, nicotine nasal spray, and nicotine patch- are effective and at least one
of these medications should be prescribed in the absence of contraindications.
Tobacco dependence treatments are cost effective relative to other medical and disease
prevention interventions.

BRIEF STRATEGIES TO HELP THE PATIENT WILLING TO QUIT

ASK: systematically identify all tobacco users at every visit. Implement an office wide system
that ensures that, for EVERY patient at EVERY clinic visit,tobacco use status is queried and
documented.
ADVISE: strongly urge all tobacco users to quit. In clear, strong, and personalized manner, urge
every tobacco users to quit
ASSES: ddetermine willingness to make a quit attempt. Ask every tobacco user if he or she
willing to make a quit attempt at this time
ASSIST: aid the patient in quitting. Help the patient with a quit plan; provide practical
counseling; provide intra treatment social support; help the patient obtain extra treatment
social support; recommend use of approved pharmacotherapy except in special
circumtances; provide suplementary materials
ARRANGE: schedule follow up contact. Schedule follow up contact, either in person or via
telephone.

PHARMACOLOGIC THERAPY FOR STABLE COPD

Overview of the medications: Pharmacologis

therapy for COPD is used to reduce symptoms,
reduce the frequency and severity of
exacerbations, and improve health status and
exercise tolerance.
Bronchodilators
Beta2-agonist
Anticholinergics
Methylxanthines

PHARMACOLOGIC THERAPY FOR

STABLE COPD

Combination Bronchodilator therapy

Corticosteroids
Combination Inhaled
corticosteroid/bronchodilator therapy
Oral corticosteroid
Phosphodiesterase-4 Inhibitor
Other pharmacologic treatments (Vaccines,alpha1 antitrypsin augmentation therapy,
antibiotics,mucolytic, immunoregulators,
antitussives, vasodilators,narcotics,etc)

NON PHARMACOLOGIC THERAPIES

Rehabilitation :
Exercise training
Education
Assesment and follow up
Nutrition Counseling

OTHER TREATMENTS

Oxygen therapy
Ventilatory support
Surgical treatments
Lung Volume Reduction Surgery (LVRS)

OTHER TREATMENTS

Bronchoscopic Lung Volume Reduction

(BVLR)
Lung Transplantation
Bullectomy
Palliative care, End of Life care, and Hospice
care.

REFEENCES

Global initiative for Chronic Obstructive

Pulmonary Disease Updated 2013.

THANKYOU