COPDCHRONIC

OBSTRUCTIVE PULMONARY DISEASE

According to According to American Thoracic American Thoracic Society,Society,

COPD is defined asCOPD is defined as A disorder characterized by A disorder characterized by

abnormal test of expiratory flow abnormal test of expiratory flow (structural or functional) that do (structural or functional) that do not change markedly over periods not change markedly over periods of several months of obstruction.of several months of obstruction.

It is a It is a progressiveprogressive disease that disease that makes it hard to breath. makes it hard to breath. ProgressiveProgressive means this gets worse means this gets worse over time over time

COPD is a very COPD is a very frequent respiratory frequent respiratory disorder affecting disorder affecting millions of people in millions of people in India. It forms the India. It forms the most important most important cause of chronic cause of chronic cor pulmonale.

SYNONYMS• Chronic obstructive lung

disease (COLD)• Chronic obstructive

airways disease (COAD)• Chronic airflow obstruction

(CAO)

• COPD is a common term applied to

• CHRONIC BRONCHITIS• EMPHYSEMA• Small airways disease• ASTHMA NOT included in

COPD

CHRONIC CHRONIC BRONCHITIBRONCHITI

SS

• Chronic bronchitis is defined on the basis of the history as

Cough productive of sputum on most days for at least three months of the year for more than one year.

• Air passages become swollen and narrowed, and the lining of each bronchiole makes excess mucus. This makes breathing difficult

Bronchioles with chronic bronchitis

EMPHYSEMAEMPHYSEMA

• ..

••EmphysemaEmphysema is defined is defined pathologically aspathologically as

Dilatation and Dilatation and destruction of the lung destruction of the lung tissue distal to the tissue distal to the terminal bronchioles terminal bronchioles

Emphysema classified according to site Emphysema classified according to site of damageof damage::

••Centri-acinar emphysemaCentri-acinar emphysema:Distension :Distension and damage of lung tissue is and damage of lung tissue is concentrated around the respiratory concentrated around the respiratory bronchioles,whilst the more distal bronchioles,whilst the more distal alveolar ducts and alveoli tend to be well alveolar ducts and alveoli tend to be well preserved.This form of emphysema is preserved.This form of emphysema is extremely common;when of modest extremely common;when of modest extent,it is not necessarily associated extent,it is not necessarily associated with disability. with disability.

 

•Pan-acinar emphysema:. This is less :. This is less common.Here,distension and common.Here,distension and destruction appear to involve the whole destruction appear to involve the whole of the acinus,and in the extreme form the of the acinus,and in the extreme form the lung becomes a mass of bullae. Severe lung becomes a mass of bullae. Severe airflow limitation and VA/Q mismatch airflow limitation and VA/Q mismatch occur. occur.

••Occurs in Occurs in alpha1-antitrypsin deficiencyalpha1-antitrypsin deficiency

Irregular emphysema:There is :There is scarring and scarring and damage affecting the lung damage affecting the lung parenchyma patchily without parenchyma patchily without particular regard for acinar particular regard for acinar structure.structure.

 

• Clinical observations Clinical observations led to led to suggestions that there were two suggestions that there were two distinct type of patientsdistinct type of patients

• TYPE-ATYPE-A fighter is pink and puffing.Although the person is breathless,arterial tensions of oxygen and carbon dioxide are normal and there is no cor pulmonale.These individuals were thought to be suffering predominantly from emphysema with little emphysema.

• TYPE-B TYPE-B non-fighter,on the other hand,is blue and bloated blue and bloated . .The person does not appear to be breathless but has marked arterial hypoxemia,carbon dioxide retention,secondary polycythemia and cor pulmonale.these patients were thought to be suffering predominantly from chronic bronchitis.

WHAT CAUSES WHAT CAUSES COPD?COPD?

• COPD is usually related to a history of COPD is usually related to a history of tobacco smoking,cigarette smoking,pipe&cigar smoke..

• Breathing in Breathing in air pollutionair pollution and and chemical fumes or dust from the environment or or workplace also can contribute to COPD.workplace also can contribute to COPD.

• In rare cases a genetic condition called In rare cases a genetic condition called alpha1-antitrypsin deficiency may play a may play a role in causing COPDrole in causing COPD

SIGNS AND SYMPTOMS OF COPD

• An ongoing cough or a cough that produces An ongoing cough or a cough that produces large amount of mucus (smoker’s cough)large amount of mucus (smoker’s cough)

• Shortness of breath , especially with physical Shortness of breath , especially with physical activity.activity.

• WheezingWheezing• Chest tightnessChest tightness• Some of the COPD are similar to symptoms of Some of the COPD are similar to symptoms of

other diseases and conditions.other diseases and conditions.

INVESTIGATIONS• LUNG FNCTION TESTS : LUNG FNCTION TESTS : show

evidence of airflow limitation. The ratio of FEV1 to FVC is reduced and PEFR is low. Lung volumes may be normal or increased, and the gas transfer coefficient of CO is low when significant emphysema is present.

severity spirometryspirometry symptoms

MildMild FEV1 60-90% Smoker’s cough +_ exertional breathlessness

ModerateModerate FEV1 40-59% exertional breathlessness+_wheeze, cough+_ sputum

SevereSevere FEV1 40% Breathlessness, wheeze, cough prominent, swollen legs

Classification and diagnosis of copd

• CHEST X-RAY is often normal, even when the disease is advanced. Classic features are presence of bullae, severe overinflation of lungs with low, flattened diaphragms, a large retrosternal airspace on the lateral film.

• Hb-LEVEL AND PCV can be elevated as a result of persistent hypoxemia.

• BLOOD GASES are often normal. In the advanced case there is evidence of hypoxemia and hypercapnia .

• SPUTUM examination unnecessary in ordinary cases.

• ECG: In corpulmonale the P-wave is taller (P-pulmonale)

• ECHOCARDIOGRAM: to assess cardiac function• ALPHA1-ANTITRYPSIN:normal range is 2-4 g/L

TREATMENT• The single most important aspect in management of COPD is to persuade the patient to stop smoking.

DRUG THERAPY

This is used both for the short-term management of exacerbations and for long term relief of symptoms.

PREVENTION

IF NOT IF NOT PREVENTEDPREVENTED

PRESENTED BY:PRESENTED BY:RENU SHARDARENU SHARDA2008 BATCH2008 BATCH