Chronic obstructive pulmonary disease (COPD) Aka.

COLD: CHRONIC OBSTRUCTIVE LUNG DISEASE COAD: CHRONIC OBSTRUCTIVE AIRWAY DYSFUNCTION

slowly progressive airways obstruction, usually associated with smoking. Diseases classified as COPD Chronic bronchitis Emphysema Asthma Cystic fibrosis Bronchiostais

Characteristic of patient with COPD Patients exhibit persistent resistance of airflow, which causes prolonged and forced expiration Vital capacity decreased Exercise tolerance is diminished

General clinical problems Frequent episodes of SOB Prolonged and labored expiration Chronic accumulation of pulmonary secretion

Anatomy and function of respiratory tract: UPPER RESPIRATORY TRACT:

Nasal cavity Pharynx -filters and remove particles

Larynx -controls airflow -prevent liquid or foreign object from entering the airway

LOWER RESPIRATORY TRACT: Trachea -contains an equal number of ciliated cells and mucu containing goblet cells 2 mainstem bronchi -right & left Bronchioles Alveoli -gas exchange occurs tracheao-bronchial tree filters the air

Anatomy of the lungs: 1. Right lung 3 lobes upper, middle, lower 2. Left lung 2 lobes upper, lower plus lingual 3. Each lung is covered with pleura Visceral

Parietal Pulmonary volume: 1. Tidal volume air inspired & expired with each normal breath;amounts 500 milliliters in average young man 2. Inspiratory reserve volume - extra volume of air that can be inspired over and above tidal volume: 3000 milliliters 3. Expiratory reserve volume - extra volume of air that can be expired by forceful expiration after the end of a normal tidal volume:1100 milliliters 4. Residual volume air remaining in the lungs after the most forceful expiration: 1200 milliliters Pulmonary capacity: 1. Inspiratory capacity amount of air can breathe in after a resting expiration: 3500 2. Functional residual capacity amount of air that remain in the lungs at the end of normal expiration 3. Vital capacity amount of air can expel from the lungs after first filling the lungs to their maximum extent and then expiring to the maximum extent: 4600 4. Total lung capacity maximum volume to which the lungs can be expanded with the greatest possible inspiratory effort: 5800

Respiratory muscles comprise of 2 functional groups Inspiratory muscle: Diaphragm External intercostals Accessory muscle (scalene, trapezius) Expiratory muscle: Intercostals

Abdominals muscle (rectus abdominis, internal and external oblique, transverse abdominis)

Specific COPD Chronic bronchitis a) Is an inflammation of the bronchi that causes an irritating and productive cough that last 3 months and recurs over at least 2 consecutive years b) Usually develop in smoker c) General appearance Etiology: Pneumococcus Bacilli of influenza Cyanotic Sob Bloated Often overweight

Epidemiology: >40 yrs. Old M>F

Pathophysiology: Prolonged smoking hypertrophy of mucus gland of trachea, bronchi, bronchioles in mucous gland content & number of goblet cell especially in bronchioles thickening of mucous membrane and excessive mucus production + some bronchial wall hypertrophyimpairment of removal inhaled particles and infection within the trachea-bronchial tree sputum retention and airway obstruction = chronic bronchitis.

Signs & Symptoms: cough Wheezing Dyspnea Hemoptysis

Prognosis bad prognosis in elderly good prognosis if still not severe airway obstruction favorable on patient with self medication program

Medical Mx: Bronchodilators (methylxanthines) -are best given as aerosol such as salbutamol Nebulizers Anti biotic Co trimoxazole

Emphysema is an abnormal in size of air spaces distal to the terminal bronchiole & alveoli chronic inflammation,narrowing, thickening and destruction of respiratory bronchioles & alveoli.

-usually develop secondary to chronic bronchitis 2 principal types of emphysema

1. Centrilobular seen in smokers primarily involves bronchioles usually occur in upper lobe M>F

2. panlobular not associated with smoking can involves entire lobes chiefly lower lobe M=F

General appearance: pink abnormal posture clubbing of fingers hypertrophy of accessory muscle purse lip breathing during expiration increase A-P diameter of chest

Etiology: smoking air pollution genetic factors (deficiency of alpha - 1 antitrysin)

Infection

Epidemiology: 50 above M>F

Pathophysiology: genetic prediposition antitrypsin deficiency digestion of elastase in lung tissue anti elastase imbalance destruction of alveolar and bronchiole loss of elastic recoil of lungs residual volume & functional residual capacity trapped air = obstruction

Signs & Symptoms: dyspnea wheezing respiration with prolonged expiration cough (rare) hypertrophy of accessory muscle abnormal posture increase A-P diameter of chest

Prognosis bad prognosis in elderly favorable on patient with self medication program

Medical Mx: Bronchodilators (methylxanthines)

Asthma -recurrent episodes of airway obstruction that resolve spontaneously or as a result of Rx -obstructive lung disease in young patients .related to hyper sensitivity of trachea and bronchi causes difficulties with respiration because of bronchospasm & increased mucus production. Etiology: Genetic idiosyncratic

Epidemiology: age 10 70% age 40 30% M>F

Pathophysiology: Stimulant severe spasm of smooth muscle on bronchial tree narrowing of the airways inflammation of the mucosal lining of the tracheo-bronchial tree & number of goblet cell =obstruction Signs & Symptoms:

dyspnea wheezing cough tachypnea tachycardia

hypoxia hypocapnia

Prognosis bad prognosis in elderly favorable on patient with self medication program

Medical Mx: Bronchodilators (methylxanthines)