Chronic Obstructive Pulmonary Disease (COPD)

PhD Mazur L.P. Department of Internal Medicine

Plan of the lecture

1. Etiology, pathogenesis of COPD
2. Diagnostic criteria 3. Principles of treatment 4. Step-by-step treatment

 COPD and Bronchial Asthma are the most

common diseases of lungs 4-10 % of adult people are ill with COPD In Europe 7,4 % of people have COPD Mortality of such patients is 10 %

According GOLD 2006

COPD this is disease which is characterized by combination of clinical signs of chronic obstructive bronchitis (inflammation and narrowing of bronchi) and emphysema (changes of lung tissue structure).

Pathogenesis of COPD

Permanent hyperactivity of parasympathetic nervous

system with hyperproduction of acetylcholine, bronchial spasm and hypersecretion of mucus Insufficiency of adrenal receptors in bronchial walls as the result of deep morphological changes with bronchial hypersecretion, bronchial spasm and cough Bronchial hyperreactivity which is characterized by immune inflammation of bronchioles walls All that lead to: 1) narrowing of bronchioles; 2) development of emphysema

Pathophysiology of COPD
1.Hypersecretion of mucus
2.Dysfunction of ciliary epithelium 3.Decreasing of air flow in bronchi 4.Hyperpneumatization of lungs 5.Disturbances of gases-exchange

6.Pulmonary hypertension
7.cor pulmonale

Anamnesis
Severe smoking
Occupational diseases Family anamnesis

Complaints
Chronic cough is the earliest sign of COPD

and arise earlier then dyspnea Sputum as a rool in small amount, after cough Dyspnea persistent, progressive, becomes worse during physical activity and in severe cases even if patient is calm

Physical signs
Central cyanosis, emphysematous chest, additional

breathing muscles are necessary for breathing Increasing of breathing rate, decreasing of its deepness, prolongation of expiration Percussion: decreasing of heart dullness Auscultation: wheezing, dry rales, heart tones are dull

Methods of investigation of patients with COPD according GOLD

Investigation of external breathing (spyrometry); Bronchodilatation test; Cytology of sputum; Blood analysis; X-ray; ECG; Blood gases;

Investigation breathing
expiration after max inspiration; FEV1 (<80 %) FEV1/FVC (<70 %) Peak flow (of expiration)

of

external

FVC max air volume which is expired during forced

X-ray signs of COPD

Lungs are enlarged
Dyaphragm is located lower than normally Narrow heart shadow Sometimes emphysematous bullas

X-ray of patient with COPD

Bronchodilatation test
Is necessary to find bronchial reversibility
Spyrometry has to be provided before and

15 min after inhalation of 400 mkg of Salbutamol (or 30-45 min 80 mkg of Ipratropium) Increasing of FEV1 more than 15 % tells us about reversibility

Classification of COPD
Stage and severity

Signs

, mild

- FEV < 80% , FEV1/FVC < 70% - As a rule chronic cough with sputum - 50%< FEV < 80% - FEV1/FVC < 70% - Symptoms are more significant, presence of dyspnea during physical activity and exacerbation 30%< FEV < 50% FEV1/FVC < 70% - Symptoms cause worsening of life quality - FEV < 30% FEV1/FVC < 70% and CRF

II, moderate

III, severe

IV, very severe

Principles of treatment of COPD

Increasing of intensivity of treatment in

correlation with COPD severity; Permanent basis therapy; Individual sensitivity of patients to different medicines leads to necessarity of permanent control; Inhaled medicines are useful.

Inhaled cholynolytics
Short action (Ipratropium bromid, Berodual ) has more slowly

beginning but longer action than 2-agonists Prolonged action (Thyotropium bromid, Spiriva ) is active for 24 hours

Inhaled broncholytics
agonists of short action (Salbutamol, Fenoterol) fast

beginning of action, but duration 4-6 hours 2-agonists of prolonged action (Salmeterol, Formoterol ) are active for 12 hours.

Methylxantines
Theophyllines of prolonged action are

useful Teopec, Teotard.

Glucocorticosteroids
Are useful for permanent basis therapy for patients

with COPD III-IV st. Inhaled GCS are used. Prednisone may be used only during exacerbation and is not recommended for basis therapy

 Inhaled

GCS (Beclomethasone, Budesonid, Fluticasone). Seretid (GCS+Salmeterol) is used in patients with IIIIV st. of COPD and oftern exacerbations in anamnesis.

Thanks for your attention!