COPD

Abdul Waris KhanSoepel: 2

Det: Internal medicine

SOEPEL

• Subjective: A 55 years old male smoker presented to ER with shortness of breath and productive cough.

• H/O presenting illness: The symptoms have been there for 3 years and now worsened. He is a chain smoker more than pack a day for the past 20 years. He is known to be hypertensive. No other past medical or family history.

• Objective: physical examination

• Pulse: 77

• RR: 20

• BP: 125/90

• Evaluation: DD: COPD, Asthma

• Plan: Spirometry, sputum culture

• Elaboration: Bronchodilators, corticosteroids, antibiotics

Learning goals: COPD

Definition

• Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible.

• The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.

• Chronic bronchitis is defined clinically as chronic productive cough for 3 months for most of the days in 2 successive years.

• Emphysema is defined as the presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.

Tobacco smoke is the most important risk factor for COPD worldwide.

Pathophysiology

Tobacco smoking is the main risk factor for COPD.

This causes an inflammatory response in the lungs, which is exaggerated in some smokers, and leads to the characteristic pathological lesions of COPD.

In addition to inflammation, an imbalance of proteinases and antiproteinases in the lungs occur.

•The major antiproteinases involved in the pathogenesis of COPD include:

Alpha-1-antitrypsinSecretory leukoproteinase inhibitor Tissue inhibitors of MMPs.

Bronchitis

Emphysema

Mucous hyper secretionCiliary dysfunctionAirflow limitation HyperinflationGas exchange abnormalities

What abnormalities arise?

Symptoms.

Cough Sputum Dyspnea

Investigations

CBC, ESR, CRPSputum cultureABGsChest X rayECG

Flow-Volume Loops

Obstructive vs. Restrictive

• Obstructive Disorders– Characterized by a limitation of

expiratory airflow so that airways cannot empty as rapidly compared to normal (such as through narrowed airways from bronchospasm, inflammation, etc.)

Examples:– Asthma– Emphysema/Bronchitis– Cystic Fibrosis

• Restrictive Disorders– Characterized by reduced lung

volumes/decreased lung complianceExamples:– Interstitial Fibrosis– Scoliosis– Obesity– Lung Resection– Neuromuscular diseases– Cystic Fibrosis

• Obstructive Disorders– FVC normal or↓– FEV1 ↓– FEF25-75% ↓

– FEV1/FVC ↓

– TLC normal or ↑

• Restrictive Disorders– FVC ↓– FEV1 ↓ – FEF 25-75% normal to ↓

– FEV1/FVC normal to ↑

– TLC ↓

References

• Kumar and Clark's clinical medicine 7 th edition

• Davidson principals and practice of medicine 21st edition