Copd

COPDCHRONIC

OBSTRUCTIVE PULMONARY DISEASE

According to American Thoracic Society,

COPD is defined as A disorder characterized by

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

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

COPD is a very frequent respiratory disorder affecting millions of people in India. It forms the most important 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 BRONCHITI

S

•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

EMPHYSEMA

• .

•Emphysema is defined pathologically as

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

Emphysema classified according to site of damage:

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

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

•Occurs in alpha1-antitrypsin deficiency

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

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

• TYPE-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 non-fighter,on the other hand,is 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 COPD?

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

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

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

SIGNS AND SYMPTOMS OF COPD

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

• Shortness of breath , especially with physical activity.

• Wheezing• Chest tightness• Some of the COPD are similar to symptoms of

other diseases and conditions.

INVESTIGATIONS• 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 spirometry symptoms

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

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

Severe 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 PREVENTED

PRESENTED BY:RENU SHARDA2008 BATCH