copd as systemic disease
DESCRIPTION
COPD AS Systemic disease. BY Dr/Sami EL-Dahdouh (MD) Lecturer of Pulmonary & Critical care Faculty of Medicine, Menofia University. PATHOGENSIS. Release of mediators & cytokines e.g. IL6, TNF alpha. hypoxemia and its effect on tissues. oxidative stress. - PowerPoint PPT PresentationTRANSCRIPT
COPD AS Systemic disease
BY
Dr/Sami EL-Dahdouh (MD)Lecturer of Pulmonary & Critical care
Faculty of Medicine, Menofia University
PATHOGENSIS
Release of mediators & cytokines e.g. IL6, TNF alpha.
hypoxemia and its effect on tissues. oxidative stress. increase acute phase proteins.
Manifestations
Wt loss and muscle wasting. Endocrinal manifestations. Effect on other systems as heart,
GIT, Neuro- psychiatry, sleep disorders, kidney.
Wt loss & Muscle Weakness
Is due to 1-imbalance between increase catabolism
(TNF alpha, IL1&6) and decrease anabolic hormones( GH, Insulin & Testerone).
2-Decrease caloric intake due to dyspnea, anorexia and GIT disturbances.
Wt loss & muscle weakness lead to impaired excises intolerance & poor outcome of the patients .
This is demonstrated by BODE index.
The BODE IndexThe BODE Index
Predicts survival based on Body mass index (< 21 is associated with
greater mortality) FEV1 (airflow obstruction) Degree of dyspnea (MRC grade) Capacity for exercise (6-minute walk distance)
Can Fam Physician 2008;54:706-11Can Fam Physician 2008;54:706-11
The BODE Index ScorePoints Used To Calculate The BODE Index ScorePoints Used To Calculate
Can Fam Physician 2008;54:706-11Can Fam Physician 2008;54:706-11
Medical Research Council dyspnoea scale
Grade Degree of breathlessness related to activities 0 Not troubled by breathlessness except on
strenuous exercise 1 Short of breath when hurrying or walking up a
slight hill 2 Walks slower than contemporaries on level
ground because of breathlessness, or has to stop for breath when walking at own pace
3 Stops for breath after walking about 100m or after a few minutes on level ground
4 Too breathless to leave the house, or breathless when dressing or undressing
If score more than 7 associated with 30% mortality in 2 years.
If score 5-6 associated with 15% mortality in 2 years.
If less than 5 associated with less than 10% mortality in 2 years.
Endocrinal manifestations
1- Hypogonadism & impotence due to hypoxemia, steroid used, increase s. leptin &
decrease s. testerone.
2- Salt &water retention is due to increase renin –angiotensin system. vasopressin. increase ADH. Hypercapnia ++CAE salt and water
retention.
3- Osteoporosis is due to: mal nutrition, Steroid use, Hypoxemia increase renal exertion of
ca+2 and Acidosis decrease absorption of ca +2.
Other system affections
CVS: cor pulomnale, lt sided dystolic
dysfunction, IHD.GIT: -Reflux oesphgitis due to hypoxemia.
Hypercapnia, hyperinflation, also coughing lead to increase in intra abdominal pressure.
- Peptic ulcer effect of hypoxia and hypercapnia and effect of drugs.
Sleep disturbances is due to Hypoxemia, Nocturnal bronchospasm, Drugs as theophylline, Anxiety , depression & Sleep apnea syndromes may be
associated with COPD (overlap syndrome), or complication of sever air flow obstruction.
Neuro- psychiatric disorders in the form of
depression
psychosis
anxiety
panic disorders.
• High BODE index
• Multiple severe exacerbations
• CVD
• Decreased FEV1
• Dyspnea
• Hyperinflation (IC/TLC = 25%)
• Pulmonary hypertension
• Impaired Exercise Performance
• Depression
• Low BMI
Predictors of COPD Mortality
Treatment
Nutritional problems - high fat diet ( increase caloric intake) - decrease CHO intake. - give anabolic hormone. - give appetizer e.g. megastrol.
O2 therapy. Antioxidants. Anti mediators asTNF alpha
antagonist. Rehabilitation. All COPD patients
benefit from exercise training programs, improving with respect to both exercise tolerance and symptoms of dyspnea and fatigue.