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    Salman Khan
    COPD is a preventable and treatable lung disease characterized by airflow limitation. It is caused primarily by cigarette smoking and is the third leading cause of death worldwide. The key symptoms include chronic cough, sputum production, and shortness of breath. Diagnosis is based on patient history, exposure to risk factors, and confirmation of airflow limitation via spirometry testing. Treatment involves bronchodilators, steroids, smoking cessation, pulmonary rehabilitation, and oxygen therapy as needed.

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    COPD is a preventable and treatable lung disease characterized by airflow limitation. It is caused primarily by cigarette smoking and is the third leading cause of death worldwide. The key symptoms include chronic cough, sputum production, and shortness of breath. Diagnosis is based on patient history, exposure to risk factors, and confirmation of airflow limitation via spirometry testing. Treatment involves bronchodilators, steroids, smoking cessation, pulmonary rehabilitation, and oxygen therapy as needed.

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    COPD is a preventable and treatable lung disease characterized by airflow limitation. It is caused primarily by cigarette smoking and is the third leading cause of death worldwide. The key symptoms include chronic cough, sputum production, and shortness of breath. Diagnosis is based on patient history, exposure to risk factors, and confirmation of airflow limitation via spirometry testing. Treatment involves bronchodilators, steroids, smoking cessation, pulmonary rehabilitation, and oxygen therapy as needed.

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    15 views18 pages

    Copd

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    Salman Khan
    COPD is a preventable and treatable lung disease characterized by airflow limitation. It is caused primarily by cigarette smoking and is the third leading cause of death worldwide. The key symptoms include chronic cough, sputum production, and shortness of breath. Diagnosis is based on patient history, exposure to risk factors, and confirmation of airflow limitation via spirometry testing. Treatment involves bronchodilators, steroids, smoking cessation, pulmonary rehabilitation, and oxygen therapy as needed.

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    COPD

    LECTURE NO 5
     COPD is the only chronic disease that is
    showing progressive upward trend in both
    mortality and morbidity
     It is expected to be the third leading cause of
    death by 2020
    Definition
     Chronic obstructive pulmonary disease (COPD) is
    a preventable and treatable disease state
    characterised by airflow limitation that is not fully
    reversible.
     The airflow limitation is usually progressive and is
    associated with an abnormal inflammatory
    response of the lungs to noxious particles or
    gases, primarily caused by cigarette smoking.
     Although COPD affects the lungs, it also produces
    significant systemic consequences.
    Risk Factors
     Smoke from home cooking and heating fuel
     Occupational dust and chemicals
     Gender: More common in men.
     M:F ratio is 5%:2.7%
     Increasing age
     Others: Infection, nutrition and deficiency
    of a1 antitrypsin
    Pathophysiology of COPD
     Increased mucus production and reduced
    mucociliary clearance - cough and sputum
    production
     Loss of elastic recoil - airway collapse
     Increase smooth muscle tone
     Pulmonary hyperinflation
     Gas exchange abnormalities - hypoxemia
    and/or hypercapnia
    Key Indicators for COPD Diagnosis
    Chronic cough Present intermittently or every day
    often present throughout the day;
    seldom only nocturnal
    Chronic sputum production Present for many years, worst in
    winters. Initially mucoid – becomes
    purulent with exacerbation
    Dyspnoea that is Progressive (worsens over time)
    Persistent (present every day)
    Worse on exercise
    Worse during respiratory infections
    Acute bronchitis Repeated episodes
    History of exposure to risk Tobacco smoke (including beedi)
    factors occupational dusts and chemical
    smoke from home cooking and
    heating fuel
    Physical signs
     Large barrel shaped chest
    (hyperinflation)
     Prominent accessory
    respiratory muscles in neck
    and use of accessory
    muscle in respiration
     Low, flat diaphragm

     Diminished breath sound


    Algorithm for Diagnosis at Primary Care

    Pt reporting with respiratory symptoms

    Assess by

    - H/o exposure to risk factors


    - Physical examination

    Sputum for AFB (Acid fast baccillii )


    +ve -ve

    Treat as TB Provisional Diagnosis


    of COPD

    Treat as COPD Poor response refer


    to secondary care
    Spirometry

     Diagnosis
     Assessing severity
     Assessing prognosis
     Monitoring
    progression
    Spirometry
     FEV1 – Forced expired volume in the first
    second
     FVC – Total volume of air that can be
    exhaled from maximal inhalation to
    maximal exhalation
     FEV1/FVC% - The ratio of FEV1 to FVC,
    expressed as a percentage.
    Pharmacotherapy for Stable COPD
    Bronchodilators
    Steroids
     Short-acting b2-agonist  Oral – Prednisolone
    – Salbutamol  Inhaled - Fluticasone,
     Long-acting b2-agonist Budesonide
    - Salmeterol and Formoterol
     Anticholinergics –
    Ipratropium, Tiiotropium

     Methylxanthines -
    Theophylline
    COPD Classification
    Pulmonary Obstructive Conditions
    1. Bronchopulmonary Dysplasia
    2. Cystic fibrosis
    3. Asthma
    4. Bronchiectasis

    Adult Obstructive Lung Condition


    5. Chronic Bronchitis
    6. Emphysema
    Bronchopulmonary Dysplasia
     BPD is a chronic lung disease of prematurity. Classically it
    follows a course of primary lung disease (RDS, MAS, etc) that
    requires exposure to mechanical ventilation and high oxygen
    concentration.
     Pathophysiology
    • Alveolar stage of lung development begins at 36 weeks and
    continues postnatally. BPD occurs when insults result in
    defective repair, impede alveolarization, and cause vascular
    dysgenesis. Classically, BPD results from a primary lung
    disease (often RDS) requiring long-term mechanical
    ventilation or exposure to high oxygen concentration. It can
    occur without antecedent illness, particularly in the setting of
    extreme prematurity or sepsis.
     Neonatal respiratory distress syndrome (RDS)
     meconium aspiration syndrome (MAS)
    • Key contributors to BPD:
     Oxygen exposure: decreased alveolar septation (causing
    fewer, larger alveoli), alveolar vascularization, increases lung
    fibrosis and inhibits lung growth.
     Mechanical ventiliation: Barotrauma and bacterial
    colonization can cause lung injury
     Inflammation: Those who later develop BPD have been
    shown to have an early exaggerated inflammatory response
    in the lungs.
     Risk Factors
    • Lung immaturity, low birthweight, prematurity, exposure to
    high oxygen concentration,
    Bronchopulmonary Dysplasia
     Clinical Presentation
    • Progressive, idiopathic pulmonary deterioration in
    susceptible neonates:, oxygen dependence, retractions,
    diffuse rales/wheeze, hypoxemia, hypercapnea,
    compensatory metabolic alkalosis

    • May develop right sided heart failure

    • Poor weight gain with increased energy intake


    Bronchopulmonary Dysplasia
     Differential Diagnosis
    • Cardiovascular anomalies
    • Airway obstruction
    • Tracheomalacia
    • Immunodeficiency
    • Aspiration, reflux
    • Cystic fibrosis
     Treatment
    • Maintain oxygenation
    • PPV
    • Fluid restriction
    • Diuretic therapy
    • Bronchodilation
    • Corticosteroids
    Progression of
    Bronchopulmonary Dysplasia

    Day 8: R>L small cystic lucencies;


    (“bubbly”) Day 12: widespread small cystic
    lucencies

    Images from ADHB Teaching Resources

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