COPD

(CHRONIC OBSTRUCTIVE
PULMONARY DISEASE )
KELOMPOK D
 DEFINITION
 Chronic Obstructive Pulmonary Disease is a
preventable and treatable disease with some
significant extrapulmonary effects.
 The pulmonary component is characterized by airflow
limitation that is not fully reversible.
Healthy
COPD
Alveolus
 The airflow limitation in COPD is usually progressive
and associated with an abnormal inflammatory
response of the lungs to noxious particles and gases
 Severe COPD leads to respiratory failure,
hospitalization and eventually death from suffocation
 PATHOLOGY
 Pathological changes characteristic of COPD
are found in the airways, lung parenchyma,
and pulmonary vasculature. The pathological
changes include chronic inflammation, with
increased numbers of specific inflammatory
cell types in different parts of the lung, and
structural changes resulting from repeated
injury and repair.
 PATHOLOGY
In general, the inflammatory and structural
changes in the airways increase with disease
severity and persist on smoking cessation
 PHATOGENESIS
 Oxidative stress
 Protease – antiprotease imbalance
 Inflammatory cells
 Inflammatory mediators
 Differences in inflammatory between COPD
and Asthma
 PHATOPHYSIOLOGY
 Airflow limitation and air trapping
 Gas exchange abnormalities
 Mucus hypersecretion
 Pulmonary hypertension
 Exacerbation
 Systemic features
DIAGNOSIS
Risk Factors for COPD

Nutrition
Infections
Socio-economic
status

Aging Populations
 SYMPTOMS
 Dyspnea
 Cough

 Sputum

 Wheezing and Chest Tightness

 Additional features in severe disease

 DIAGNOSIS
 Medical hystory
 Physical examination
 Spirometry
ASSESSMENT OF DISEASE
ASSESSMENT OF SYMPTOMS
 Modified Medical Research Council (mMRC)
 COPD Assessment Test (CAT)
 Clinical COPD Questionnaire (CCQ)
SPIROMETRIC ASSESSMENT
 Classification of COPD Severity by
Spirometry
 Stage I: Mild FEV1/FVC < 0.70
FEV1 > 80% predicted

 Stage II: Moderate FEV1/FVC < 0.70

50% < FEV1 < 80% predicted

 Stage III: Severe FEV1/FVC < 0.70

30% < FEV1 < 50% predicted

 Stage IV: Very Severe FEV1/FVC < 0.70

FEV1 < 30% predicted or
FEV1 < 50% predicted plus
chronic respiratory failure
 Differential Diagnosis
COPD and its Differential Diagnosis
Diagnosis Suggestive Features
COPD Onset in mid-life,symptoms slowly progressive,
history of tobacco smoking or exposure to other types
of smoke
Asthma Onset early in life (often childhood),symptoms vary
widely from day to day, symptoms worse at night/
early morning, allergy/rhinitis and or eczema also
present,family history of asthma

Congestive Heart failure Chest X-ray shows dilated heart, pulmonary edema,
pulmonary function tests indicate volume
restriction,not airflow limitation
Bronchiectasis Large volumes of purulent sputum, commonly
associated with bacterial infection, chest x-ray/ CT
shows bronchial dilation, bronchial wall thickening
 Differential Diagnosis
COPD and its Differential Diagnosis
Diagnosis Suggestive Features
Tuberculosis Onset all ages, Chest x-ray shows lung infiltrate, microbiological
comfirmation, high local prevalence of tuberculosis

Obliterative Bronchiolitis Onset at younger age, nonsmokers, may have history of

rheumatoid arthritis or acute fume exposure, seen after or bone
marrow transplantation, CT on expiration shows hypodense areas

Diffuse Panbronchiolitis Predominantly seen in patients of asian descent, Most patients are
male and nonsmokers, almost all have chronic sinusitis, chest X-
ray and HRTC show diffuse small centrilobular nodular opacities
and hyperinflation.

These features tend to be characteristic of the respective diseases, but are not mandatory. For
example, a person who has never smoked may develop COPD (especially in the developing
world where other risk factors may be more important than cigarette smoking); asthma may
develop in adult and even in elderly patients.
 THERAPEUTIC OPTIONS

 SMOKING CESSATION
Smoking cessation is the intervention with the
greatest capasity to influence the natural
history of COPD. Evaluation of the smoking
cessation component in a longterm,
multicenter study indicates that if effective
resources and time are dedicated to smoking
cessation, 25% longterm quit rates can be
achieved
 Pharmacotherapies for Smoking Cessation :
 Nicotine Replacement Products (nicotine
gum, inhaler, nasal spray, transdermal patch,
sublingual tablet, or lozenge)
Realibly increases long term smoking
abstinence rates
Significantly more effective than placebo
 Pharmacologic
 Varenicline,bupropion, nortriptyline have been
shown to increase long term quit rates.
Recommendations for treating tobacco use
and dependence are summarized in table.
•Treating tobacco Use and Dependence: A clinical Practice Guidline-Major findings and
Recommendations
• Tobacco dependence is a chronic condition that warrants repeated treatmenrt until long
term or permanent abstinence is achieved
• Effective treatments for tobacco dependence exist and all tobacco users should be offered
these treatments
• Clinicians and health care delivery systems must inztitutionalize the consistent
identification, documentation, and treatment of every tobacco user at every visit
• Brief smoking cessation counseling is effective and every tobacco user should be offered
such advise at every contactwith health care providers
• There is a strong dose response relaton between the intensity of tobacco dependence
counseling and its effectiveness.
• Three types of counseling have been found to be especially effective: practical counseling,
social support as part of treatment, and social support arranged outside of treatment.
• First line pharmacotherapies for tobacco dependence-varenicline,bupropion,SR, nicotone
gum, nicotone inhaler, nicotine nasal spray, and nicotine patch- are effective and at least
one of these medications should be prescribed in the absence of contraindications.
• Tobacco dependence treatments are cost effective relative to other medical and disease
 BRIEF STRATEGIES TO HELP THE PATIENT WILLING TO QUIT
ASK: systematically identify all tobacco users at every visit. Implement an office wide system
that ensures that, for EVERY patient at EVERY clinic visit,tobacco use status is queried and
documented.

ADVISE: strongly urge all tobacco users to quit. In clear, strong, and personalized manner, urge
every tobacco users to quit

ASSES: ddetermine willingness to make a quit attempt. Ask every tobacco user if he or she
willing to make a quit attempt at this time

ASSIST: aid the patient in quitting. Help the patient with a quit plan; provide practical
counseling; provide intra treatment social support; help the patient obtain extra treatment
social support; recommend use of approved pharmacotherapy except in special
circumtances; provide suplementary materials

ARRANGE: schedule follow up contact. Schedule follow up contact, either in person or via
telephone.
PHARMACOLOGIC THERAPY
FOR STABLE COPD
Overview of the medications: Pharmacologis
therapy for COPD is used to reduce symptoms,
reduce the frequency and severity of
exacerbations, and improve health status and
exercise tolerance.
 Bronchodilators
 Beta2-agonist
 Anticholinergics
 Methylxanthines
PHARMACOLOGIC THERAPY
FOR STABLE COPD
 Combination Bronchodilator therapy
 Corticosteroids
 Combination Inhaled
corticosteroid/bronchodilator therapy
 Oral corticosteroid
 Phosphodiesterase-4 Inhibitor
 Other pharmacologic treatments (Vaccines,alpha-
1 antitrypsin augmentation therapy,
antibiotics,mucolytic, immunoregulators,
antitussives, vasodilators,narcotics,etc)
 NON PHARMACOLOGIC
THERAPIES
 Rehabilitation :
 Exercise training
 Education
 Assesment and follow up
 Nutrition Counseling
 OTHER TREATMENTS

 Oxygen therapy
 Ventilatory support
 Surgical treatments
 Lung Volume Reduction Surgery (LVRS)
 OTHER TREATMENTS
 Bronchoscopic Lung Volume Reduction
(BVLR)
 Lung Transplantation
 Bullectomy
 Palliative care, End of Life care, and Hospice
care.
REFEENCES
 Global initiative for Chronic Obstructive
Pulmonary Disease Updated 2013.
THANKYOU