Chronic Obstructive Pulmonary Disease

COPD - Definition
Chronic

lung disease characterized by airflow resistance in the respiratory tract that is not fully reversible

 There

are two main forms of COPD

Chronic

bronchitis Emphysema
Most

people with COPD have a combination of both conditions

Bronchitis
Cough

with sputum production on most days for 3 months of a year, for 2 consecutive years increased number (hyperplasia) and increased size (hypertrophy) of the goblet cells and mucous glands of the airway contributing to narrowing of the airways

Emphysema
enlargement

of the air spaces distal to the terminal bronchioles, with destruction of their walls reduces the surface area available for the exchange of oxygen and carbon dioxide during breathing

Bronchitis

Emphysema

Causes/Risk Factors
Smoking
In

the United States, 80 to 90% of cases of COPD are due to smoking

Occupational
coal

exposures

mining, gold mining, and the cotton textile industry, silica dust exposure

Air pollution
Urban

air pollution - industrial waste gas, sulfur dioxide Indoor air pollution - cooking fire smoke

Genetics
Alpha

1-antitrypsin deficiency

Autoimmune
active

disease

inflammation in the lungs mediated by autoantibodies and autor eactive T cells

Symptoms

Cough, with or without sputum Fatigue Frequent respiratory infections Shortness of breath (dyspnoea) that gets worse with mild activity Wheezing and rhonchi Tachypnea Prolonged expiratory phase enlargement of the chest, particularly the front-to-back distance (hyperaeration) active use of accesory muscles in the neck to help with breathing breathing through pursed lips increased anteroposterior to lateral ratio of the chest (i.e. barrel chest).

Diagnosis

Chest X-Ray
Hyperinflation a

flattened diaphragm increased retrosternal airspace bullae

Arterial Blood Gas

Spirometry

Most common of the pulmonary function tests Measuring the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled Procedure
the

patient is asked to take the deepest breath they can then exhale into the sensor as hard as possible, for as long as possible, preferably at least 6 seconds sometimes directly followed by a rapid inhalation (inspiration), in particular when assessing possible upper airway obstruction Sometimes, the test will be preceded by a period of quiet breathing in and out from the sensor (tidal volume), or the rapid breath in (forced inspiratory part) will come before the forced exhalation

Spirometry

Management

Stop smoking
slows

down the rate of progression of the disease it can significantly reduce the rate of deterioration in lung function and delay the onset of disability and death

Occupational health
the

use of respirators and dust control

Air pollution
Patients

experience fewer symptoms if they stay indoors on days when air quality is poor

Medications

Bronchodilators
relax smooth muscle around the airways, increasing the calibre of the airways and improving air flow reduce the symptoms of shortness of breath, wheeze and exercise limitation, resulting in an improved quality of life for people with COPD They do not slow down the rate of progression of the underlying disease usually administered with an inhaler or via a nebulizer

Bronchodilators - 2 agonists
stimulate 2 receptors on airway smooth muscles, causing them to relax short acting 2 agonists

Salbutamol

(Ventolin) and Terbutaline provide rapid relief

Long acting 2 agonists

Salmeterol

and Formoterol used as maintenance therapy and lead to improved airflow, exercise capacity, and quality of life

Ventolin

Bronchodilators - Anticholinergics
cause airway smooth muscles to relax by blocking stimulation from cholinergic nerves Ipratropium

provides short-acting rapid relief of COPD symptoms is a long-acting anticholinergic whose regular use is associated with improvements in airflow, exercise capacity, and quality of life

Tiotropium

Atrovent - Ipratropium

Combivent Ipratripium/albuterol

Spiriva Handihaler Triotropium Bromide

Medication

Corticosteroids
tablet

or inhaled form to treat and prevent acute exacerbations of COPD no effect on overall one-year mortality and are associated with increased rates of pneumonia

Steroid inhalers (MDI)

Symbicort - Budesonide/formoterol

Seretide Accuhaler Fluticasone/salmeterol

Management - Others

Medication
Theophylline bronchodilator and phosphodiesterase inhibitor

Supplemental oxygen
can

be given to people with COPD who have low oxygen levels in the body Oxygen is provided from an oxygen cylinder or an oxygen concentrator and delivered to a person through tubing via a nasal cannula or oxygen mask Does not greatly improve shortness of breath but can allow people with COPD and low oxygen levels to do more exercise and household activity Long-term oxygen therapy for at least 16 hours a day can improve the quality of life and survival

Management - Others

Pulmonary rehabilitation
is

a program of exercise, disease management and counselling coordinated to benefit the individual has been shown to improve shortness of breath and exercise capacity

Regular exercise Annual influenza vaccinations

Prognosis

COPD usually gradually gets worse over time and can lead to death The rate at which it gets worse varies between individuals Factors that predict a poorer prognosis
Severe

airflow obstruction (low FEV1) Poor exercise capacity Shortness of breath Significantly underweight or overweight Complications like respiratory failure or cor pulmonale Continued smoking Frequent acute exacerbations

Thank You