COPD

Chronic Obstructive
Lung Disease

Worked:

Accepted:

Edlira Manosopi

Alma Karasaliu

What is COPD?
Defenition:
It is a disease state characterized by presence of air flow
obstruction due to chronic bronchitis or emphysema.

The air flow limitation is generally progressive.

COPD

Emphysema
Chronic bronchitis

Pathologically diagnosed
Chronic bronchitis
Chronic productive cough on most days of 3
consecutive months
in 2 consecutive years.
Providing other causes have been excluded.

 >85% of COPD.

Emphysema
Abnormal and permanent dilatation of air spaces
associated with destruction of their walls.

Etiology
Smoking
the primary risk factor
Long-term smoking is responsible for 80-90 % of cases.

 Prolonged exposures to harmful particles and

gases from:
passive smoke,
Industrial smoke,
Chemical gases, vapors, mists & fumes
Dusts from grains, minerals & other materials
Alpha 1-antitrypsin deficiency >>> emphysema

Pathophysiology
Exposure to inhaled noxious particles
& gases
inflammation
imbalance of proteinases and antiproteinases

Dilatation & destruction + mucus secretion

Clinical features
Hx:
Smoker
Productive cough
Constant

Chest tightness in the morning

Sputum>>>>>> mucoid
If purulent>>>> infection
SOB>>>> on exertion
Aggravated by infection, heavy
smoking.
On Examination:
Inspection:
Pt looks dyspnic
Use of accessory muscles
Burrel shaped chest
Palpation
Decrease chest expansion
Percussion
hyper-resonant
Loss of normal area for cardiac & liver dullness
Auscultation:
Decreased breath sounds
Normal vesicular breathing but prolonged
expiration
Coarse crepitatons>> on both phases

Investigations
Baseline ABG:
important for assessing patients with
severe COPD.
Annual monitoring test
Detect acute & chronic hypercapnia
Respiratory acidosis
Chest X-Ray:
Not sensitive for Dx
To exclude other diseases
Hyper-inflation signs
Pulmonary function testing (spirometry):
Main method for diagnosing COPD.
low FEV1/FVC (< 70%)
Used for classification of COPD severity.

PFT

 Obstructive pattern
FEV1>>>>>>>reduced (<80%)
FEV1/FVC>>>reduced (<70%)
PEF>>>>>>>>reduced
TLC>>>>>>>>increased

Classification of severity of COPD

Mild
FEV1 60-79%
Smoker , cough
Moderate
FEV1 40-59%
SOB, wheeze, cough +/- sputum
Severe
FEV1 < 40%
SOB, wheeze, cough ,RD, swollen legs

Other Investigations
Sputum C/S >> in acute

 ECG
Echo >> assess pulmonary artery pressure
Alpha 1-anti-trypsin

Treatment of COPD
Cessation of Smoking (most important)
Oxygen Therapy
Ongoing assessment & monitoring
Education
Rx of Acute exacerbations.
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Oxygen Therapy
(LTOT)
Home oxygen in low dose
Given at least 15 hrs @ flow rate 1-3L/min
If PaO2 <60%
If SaO2 < 88%
Inhaled bronchodilators

Beta-agonists
Short acting>>> 2-4 puffs bid-qid & PRN

e.g: salbutamol
Long acting >>> twise daily
e.g: salmetrol, formoterol
Side efferct: Tachycardia, tremors, hypokalemia
Anti-cholinergic
Ipratropium bromide (Atrovent) 2-4 puffs
PRN
Steroids
Inhaled:
e.g : fluticasone
Withdrawal may cause exacerbation

 Systemic :
Only for severe cases.

Vaccinations
Influenza
Pneumococcal

Acute exacerbation of COPD

Increased SOB
Wheezing
Causes :
Infections
- Pollutions

Rx of acute exacerbation of COPD

Inhaled bronchodilators>>> short acting
Antibiotics

Mild
Amoxicillin

 Cephalosporins

moderate to severe (G-ve

rods)
Azithromycin
3rd generation Cephalosporins
Oxygen
BiPAP
Mechanical ventilation

Indicaton for ICU admission

Severe dyspnea not medical Rx
Mental status changes
Persistent hypoxemia, hypercapnia or Resp. acidosis
despite medical Rx