Chronic obstructive pulmonary

disease
(COPD)

By
Dr Randula Samarasinghe
Consultant Physician
 Definition
COPD is a disease state
characterized by
airflow limitation that is not fully
reversible.
The airflow limitation is usually both
progressive and associated with an
abnormal inflammatory response of
the lungs to noxious particles or
gases
Other terms used
Chronic bronchitis
-The presence of cough and sputum
production
for at least three months in each two
consecutive years

Emphysema
- Is a pathological term
- Is defined as dilation and destruction of lung
tissue distal to the terminal bronchioles
 Aetiology
Cigarette Smoking
- the main cause ( 90 % )
- The risk of COPD is related to the
number
of cigarette smoked per day
1 antitrypsin deficiency
Inhalation of smoke from biomass fuels
Occupational dusts and chemicals
 Epidemiology

Most epidemiological studies have found that COPD

prevalence ,morbidity and mortality increase over
time and are greater in men than in women.

COPD prevalence is directly related to prevalence

of smoking.
Pathological changes in the air ways
and lung tissue
Hypertrophy and increase number of
mucous secreting goblet cells
Inflammatory cell Infiltration of the
walls of large and small airways
Ulceration of epithelium
Scaring and remodelling of airways
Squamous cell metaplasia
 Pathophysiology
Cigarette smoke
Inflammatory cell recruitment
Release protease and elastases
Chronic inflammation of airways
( chronic bronchitis and chronic
bronchiolitis ) and destruction of lung
tissue ( emphysema )
 Pathophysiology
In the small airways
- chronic inflammation leads to scaring and
remodelling which thickens and narrows the
walls

- Emphysema leads to destruction of lung

tissue in the vicinity of the bronchioles
which reduces support for bronchioles and
leads to their collapse in expiration
Combined effect is small air way obstruction
 Pathophysiology
In the large airways
- the inflammation leads to chronic
cough with sputum production
( chronic bronchitis)

In the alveoli
- the inflammation leads to
destruction and dilation of alveoli
(emphysema)
End result of the persistent
exposure of lungs to cigarette
smoke
1. Small airway obstruction
2. Chronic bronchitis
3. Emphysema

Patients with COPD may have all

three pathological processes at the
same time
Relative contribution of each process
to the overall clinical picture can vary
Normal lung
Emphysematous lung
Note the clusters of dilated air spaces which are
conspicuous in the middle and lower lobes of the right
lung and the lower lobe of the left lung.
Both lungs are markedly enlarged
 Clinical features
Symptoms
- Cough usually productive
- Shortness of breath
- Wheeze

Signs
- May be minimal in early disease but many in moderate
and severe disease
 Investigations
Lung function testing
- Normal FVC
- Low FEV1
- FEV1 / FVC low - < 70 %
- PEFR low
- Irreversible obstruction or < 15 %
change in
FEV1
- TLC increased
 Investigations
Chest X ray
- may be normal in advance disease
- Features of hyperinflation
- Detection of complications
- To exclude other causes of
breathlessness
Normal chest Xray
 Investigations
Full blood count
ECG
Arterial blood gases
Electrocardiogram
Echocardiogram
Alpha one antitrypsin levels
 Diagnosis
COPD is a clinical diagnosis which is
confirmed by demonstration of low
FEV1 / FVC ratio ( < 70 % ) and a
negative outcome when testing
reversibility of air flow obstruction by
spirometry testing
 GOLD Classification of COPD
Stage 0 At Risk normal spirometry
Chronic symptoms (cough and sputum production)

Stage I Mild COPD FEV1 / FVC < 70% but

FEV1 > or equal to 80 % predicted
With or without chronic symptoms cough and sputum production.

Stage II Moderate COPD :FEV1/FVC<70%

30% < or equal FEV1<80% predicted (IIA:50% < or equal FEV1<80% )
(IIB:30% < or equal FEV1<50% )
With or without chronic symptoms (cough, sputum production and dyspnea)
Stage III Severe COPD
FEV1 /FVC < 70%
FEV1 < 30% predicted or
FEV1 <50% predicted +presence of respiratory failure or
clinical signs of right heart failure.
At this stage, quality of life is very impaired and exacerbations
may be life-threatening.
 Complications
Respiratory failure
Cor pulmonale
Pneumonia
Pneumothorax
Weight loss and malnutrtion
Management of the chronic patient

Life style modification

Pharmacological
Surgical
Prevention and rehabilitation
Life style modification

Smoking cessation

Nutrition
Pharmacological management

Bronchodilator therapy
- 2 agonist
- antimuscarinics
Corticosteroids
Antibiotics
Mucolytic therapy
Domiciliary Oxygen
Surgical management

Lung volume reducing surgery

Bullectomy

Single lung transplantation

Prevention of exacerbation and
rehabilitation
Immunization

Pulmonary rehabilitation
- Is a combination of non
pharmacological
approaches with objective to
improve lung
function and exercise capacity
- exercise training is an integral part
 ASTHMA & COPD

Onset in mid-life.
Symptoms slowly progressive.
COPD Long smoking history.
Dyspnea during exercise.
Largely irreversible airflow limitation.

Asthma COPD

Onset early in life (often childhood).

.Symptoms vary from day to day.
Asthma .Symptoms at night/early morning.
.Allergy, rhinitis, and/or eczema also present.
.Family history of asthma.
.Largely reversible airflow limitation.
Thank you