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PULMONARY DISEASE
(COPD)
Definition of COPD
a common preventable and treatable disease,
characterized by persistent airflow limitation
that is usually progressive and associated with an enhanced
chronic inflammatory response
in the airways and the lung to noxious particles or gases
Types of COPD (Usually
pts
comes
with
both
type,
rarely
either
one)
Emphysema
Dened
as
abnormal,
permanent
enlargement
of
air
spaces
distal
to
terminal
bronchiole
accompanied
by
destruc>on
of
their
walls
without
brosis
Chronic
Bronchi>s
causes
inamma>on
and
irrita>on
of
the
bronchial
tubes,
Then,
thick
mucus
begins
plug
up
over
>me
causing
dyspnea
and
purulent
sputum
Pathophysiology
Abnormal
inammatory
response
of
the
lungs
due
to
toxic
gases.
DestrucAon
of
lung
parenchyma
leads
to
an
imbalance
of
proteinases/
anAproteinases
DestrucAon
of
parenchyma
leads
to
emphysema.
Mucus
hypersecreAon
(cilia
dysfuncAon,airow
limitaAon,corpulmonale)
Parenchymal
destruc>on
Airway
limita>on
Airway
brosis,
luminal
plug
Increased
airway
resistance
Loss
of
alveolar
aJachment
Decrease
of
elas>c
recoil
Airow
Limita>on
younger)
Asthma
/
bronchial
hyperresponsiveness
Occupa>onal
dusts
(Mining
coal,
silica
etc)
Alpha-1
An>trypsin
deciency
(gene>c)
Respiratory infec>on
Clinical features
Symptoms
History
of
heavy
smoking
Purulent
cough
for
many
years
Breathlessness
on
exer>on
with
chest
>ghtness
Exacerbate
by
Cold
Atmospheric
pollu>on
Exercise
Infec>on
Signs
Pts
appear
tachypneic
with
prolong
expira>on
nico>ne
stained
on
hand
asterixis(CO2
reten>on),
Bounding
pulse
Face
central
cyanosis
Pursing
of
lips
Wheeze
Use
of
accessory
muscles
Indrawing
intercostals
Loss
of
normal
liver
and
cardiac
dullness
Poor
chest
expansion
Hyperinated
lung
(Barrel
chest)
Reduced
breath
sounds
Loud
S2
(over
the
pulmonary
area)
InvesAgaAons
Lung
func>on
tests
-By
using
spirometry
:
used
to
assess
the
severity
of
airow
obstruc>on
Done
by
measuring
the
FEV1
(COPD)
Normal
value
:
Vary
depend
on
sex
and
age
80%
-
120%
The
global
iniAaAve
for
chronic
obstrucAve
lung
disease
(GOLD)
staging
system
is
a
commonly
used
severity
staging
system
based
on
air
ow
limita>on.
According
to
this,
there
are
4
key
stages:
FBC
-
Hb
&
PCV
may
be
high
:
As
a
result
of
persistent
hypoxaemia
&
secondary
polycythaemia
Chest
x-ray
-may
show
hyperinated
lungs(low,aJened
diaphragms)
-Reduced
peripheral
lungs
markings
-May
show
bullae(complete
destruc>on
of
lung
>ssue
producing
an
airspace
greater
than
1
cm)
-To
rule
out
other
condi>ons
with
similar
symptoms
ECG
-Assess
cardiac
status
if
there
are
features
of
cor
pulmonale
ABG
analysis
-measure
oxygen,carbon
dioxide
and
acid
in
blood
;
help
to
decide
whether
need
oxygen
treatment
Pulse
oximetry
-To
measures
oxygen
satura>on
in
the
blood
;
for
oxygen
treatment
Sputum
culture
-To
iden>fy
organisms
if
sputum
is
persistently
present
and
purulent
Ct-scan
-give
details
picture
of
the
lungs
-par>cularly
show
emphysematous
bullae
Alpha-1
an>trypsin
(AAT)
screening
(serum
levels
and
genotypes)
-Deciency
of
AAT
due
to
gene>c
:
contribute
to
the
problem
Management
Bronchodilators
Cor>costeroids
Oxygen
Addi>onal
Rx
:
mucoly>cs,
diure>cs
Complica>ons
Respiratory
failure
Cor
pulmonale,
i.e
heart
disease
secondary
to
disease
of
the
lung
Preven>on
Cessa>on
of
smoking
Pneumococcal
vaccine,
annual
inuenza
vaccina>on
&
an>-
bio>cs
(prevent
acute
exacerba>ons
of
copd)