Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease

(COPD)

Permanent reduction in airflow in the lung

Caused by smoking, air pollution, dust, lack of alpha1-antitripsien

COPDPatho physiology

Loss in elasticity due to changes in collagen and elastin on alveolar level

Narrowing of airways

COPD

COPDChronic bronchitis

Productive cough for more than 3 months of 2 consecutive years (other conditions excluded)

Chronic bronchitisPathology

↑ mucous production Hypertrophy of mucous glandsThickening of the airway↑ number of goblet cellsThus narrowing of the lumen of the airways and airway obstruction.Infection caused by accumulated secretions.

Chronic bronchitis

COPDEmphysema

Permanent enlargement in the normal size of the air spaces distal to the terminal bronchioles due to destruction of alveolar tissue.

Anatomy

Anatomy

EmphysemaPathology

Lack of alpha1-antitripsien causes

uncontrolled breakdown of collagen and elastin, damaging the alveolar framework

What’s in a cigarette?

EmphysemaClassification

“Blue-bloater”

Moderately severe airflow impairment

Stimulus for breathing ↓ PO2

EmphysemaClassification

“Pink puffer”

Little sputum production, dyspnoea gr.IV

Right heart failure and peripheral oedema

Emphysema and Chronic bronchitis

Clinical signs

Use of accessory musclesDrawing in of supraclavicular fossae and intercostal space↓ chest expansion↓ lung sounds (breath sounds)Dyspnoea with or without productive cough

Emphysema and Chronic bronchitis

X-rays

Hyperinflation

Flattened diaphragms

Lengthening of heart shadow

Prominent hilar vessels

Emphysema X-ray

EmphysemaLung functions

↓ FEV1

↓ forced vital capacity ↓ peak flow↑ total lung capacity and residual volume

EmphysemaCourse of disease

Airflow impairment develops over long timeProductive smoker’s coughAcute bronchitisCannot go to work – severe bronchitisAttacks occur repeatedly – lose jobs

EmphysemaComplications

Cor pulmonale – pulmonary hypertension causes right ventricular failure

Bullae – alveolar walls burst and form large air-filled spaces with thin walls

Cor Pulmonale

Bullae

COPD rehabilitationDyspnoea

Overactivity of accessory muscles inhitis diaphragm

Patient must be taught to breathe with lower part of his chest

COPD rehabilitationDyspnoea

Relaxation positions and breathing control

“Pursed lip breathing”

“Pursed lip breathing”

Maintains airway pressure in lungs, prevents airways from collapsing

↑ airflow

Ontspanningsposisies

Ontspanningsposisies

COPD rehabilitation Bronchodilators

Relieves bronchospasm

Anti-cholinergic drugs (atrovent) and not B2-stimulants

If stimulus for breathing is ↓ PO2 – do

not nebulise with 100% O2

COPD rehabilitation Improve exercise tolerance

Improve physical activity to highest functional levelImprove quality of life6 minute walking testExercise programme

COPD rehabilitation Remove secretions

Nebulise with mucoliticumPercuss, shake and vibratePrecaution – patients on korticosteroids develop osteoperosis. Shaking and vibrating can cause rib fracture.“Huffing”

“Huffing”

Forced expiratory technique

Just as effective as coughing, less effort

Medium-sized breath, mouth and glottis open, force air out using chest wall and abdominal muscles.

References Pryor, J.A. and Prasad, S.A. 2009.

Physiotherapy for respiratory and cardiac problems. Adult and paediatrics. Edinburgh: Churchill Livingstone

FTB 309 Dictate

Images courtesy of Google search engine