COPD

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Martina S., Selda S., Sarah A.G., Dina H., Sonia C.

UMFT Victor Babes`
 1.PATIENT DATA

I.M., 47 years old, male

Risk Factors
male sex
age >40
smoker (until 2012: 40 cig./d, now: 5 cig./d)
mineworker for 18 years occupational dust (SiO2)
BMI: 30
Reasons for admission
dyspnea orthopnea
severe cough
 Personal medical history
Silicosis (2012)
Symptomatology appeared gradually since 2012
Main Symptoms:
Orthopnea
severe dry cough syncope
fatigability
sweating
chest tightness
 2.PATIENT EXAMINATION

Height 1,73m, weight 91kg, BMI 30,4

abdominal obesity gr. I
reddish skin colour
smoker (5 cig./d)
HR: 80bpm, saturation 97%, BP 110/80
auscultation:
Inspiratory wheezing
Basal crackles
 3. PRESUMED DIAGNOSIS

Q1: Based on the patients symptoms (orthopnea,

dry cough, fatigue, sweating) and medical history
which of the following could be a possible diagnosis

a. Lung Embolism
b. Congestive Heart failure
c. COPD
d. Pneumonia
 COPD

Chronic Obstructive Pulmonary Disease

A progressive nonreversible disease

that affects the lungs, making it
difficult to breathe
 COPD: AN UMBRELLA TERM

Umbrella term used to describe progressive

lung diseases which include:

Emphysema
Chronic bronchitis
Refractory (irreversible) asthma
Severe bronchiectasis
 COPD

Chronic obstructive pulmonary disease (COPD) is a

lung ailment that is characterized by a persistent
blockage of airflow from the lungs.

It is an under-diagnosed, life-threatening lung

disease that interferes with normal breathing and is
not fully reversible.
 UNDERSTANDING COPD

Critical to first understand normal lung function

Image courtesy of The National Institute of health

LUNG STRUCTURE AND FUNCTION

Biological Science Freeman, 2010

LUNGS WITH COPD

Image courtesy of The National Institute of health

 CAUSES

Most cases of COPD occur as a result of long-term

exposure to lung irritants that damage the lungs and
the airways

The most common irritant that causes COPD is

cigarette smoke

In rare cases, a genetic condition called alpha-1

antitrypsin deficiency may play a role in causing
COPD
 WHO IS AT RISK?

People who smoke or are exposed to smoke

People who have a family history of COPD are more

likely to develop the disease if they smoke

Long-term exposure to other lung irritants also is a risk

factor for COPD

Almost 90% of COPD deaths occur in low- and middle-

income countries, where effective strategies for
prevention and control are not always implemented or
accessible.
 SYMPTOMS

breathlessness
abnormal sputum (a mix of saliva and mucus in the
airway)
a chronic cough
daily activities can become very difficult as the
condition gradually worsens
 5. DIFFERENTIAL DIAGNOSIS

Q2: Which of the following is a disease known to

have similar symptoms ?

a. Alpha1-antitrypsin deficiency
b. Congestive Heart failure
c. Gastroesophageal reflux disease
d. Acute Tonsilitis
 6. TESTS & INVESTIGATIONS

Q3: Which of the following sets of test and

investigations would you order for differential
diagnosis?

a. X-ray
b. Spirometry
c. CT
d. Audiogram
 DIAGNOSIS

A simple diagnostic test called

"spirometry measures how much air a person can
inhale and exhale, and how fast air can move into
and out of the lungs

Spirometry can detect

COPD long before its
Symptoms appear.
 6. PATIENTS RESULTS

Hematology:
HCT
HB
RBC
polyglobulinemia
TG
Chol.
LDL
Dislipidemia
 Spirometry
FVC: 58%
FEV1: 48%
Ratio: 67.7%
FEF 25-75%: 34
PEF: 28
mixed ventilatory dysfunction
 Bronchodilator Test
FVC : 46 60
FEV1: 42 53

NEGATIVE (<15)
 XRAY
regular micro reticulonodular bilateral masses (silicosis)
pulmonary fibrosis

ECG
Sinus rhythm
HR: 80
Axis: 65
Neg. P-wave in V1 + V2
P-pulmonale
 MRC BREATHLESSNESS SCALE

Grade 4
 CAT SCORE

28
 7. POSITIVE DIAGNOSIS

COPD: chronic bronchitis

Silicosis
Buccal Candidosis (inhalator abuse)
 Q3 Which the following medications is used as a
treatment for COPD?

a. short-acting beta-agonists
b. Beta-blocker
c. mucolytics
d. long-acting beta-agonists
 TREATMENT

COPD has no cure

Quitting smoking is the most important step an

individual can take to treat COPD

Other treatments for COPD may include medicines,

vaccines, pulmonary rehabilitation (rehab), oxygen
therapy, and surgery
Inhaled long-acting beta-agonists
Inhaled corticosteroids
Inhaled anticholingerics
 8.PATIENTS MEDICATION

1. Spiriva 18 ug 1-0-1
anticholinergic
2. Ventoline 100 ug when needed
Salbutamol
3. Symbicort 1- 0-0
bronchodilator
4. Teotard 220mg 1 puff until 5pm (S.E. palpitations)
bronchodilator
 MANAGING COPD

COPD symptoms usually slowly worsen over time

A cold, the flu, or a lung infection may cause

symptoms to intensify

Prescription antibiotics may treat infections and

other medicines, such as bronchodilators and
inhaled steroids, can help facilitate breathing
 MANAGING COPD

Avoid lung irritants

Get ongoing care

Manage the disease and its symptoms

Prepare for emergencies

 PROGNOSIS (BODE INDEX)

a BODE score greater than 7 is associated with a 30

percent 2-year mortality
A score of 5 to 6 is associated with 15 percent 2-
year mortality
If score is less than 5 the 2-year mortality is less than
10 percent
7 points 18% 5 year survival
 COPD: STATISTICS

The National Heart, Lung, and Blood Institute (NHLBI)

estimates that 12 million adults have COPD, and
another 12 million are undiagnosed or developing
COPD

Estimated that over 210 million people worldwide

have COPD
 COPD: STATISTICS

A person with COPD dies every four minutes

COPD will be the third leading cause of death in

the U.S. by 2020
 WHO RESPONSE

Raise awareness about the global epidemic of

chronic diseases
Create more healthy environments, especially for
poor and disadvantaged populations
Decrease common chronic disease risk factors, such
as tobacco use, unhealthy diet and physical
inactivity
Prevent premature deaths and avoidable disabilities
from major chronic diseases
 SOURCES

The World Health Organization

http://www.who.int/mediacentre/factsheets/fs315/en/
The COPD Foundation
http://www.copdfoundation.org/
The US Department of Health and Human Services
http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Co
pd_WhatIs.html
National Heart Lung and Blood Institute
http://www.nhlbi.nih.gov/health/public/lung/other/copd
_breathe.htm
Center for Disease Control and Prevention
http://www.cdc.gov/