copd(chronic obstructive pulmonary disease)
TRANSCRIPT
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CHRONIC OBSTRUCTIVE PULMONARY DISEASE
prepared by,
Likhila abraham
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DEFINITION OF COPD Chronic obstructive pulmonary disease
(COPD) is a preventable and treatable disease state characterized by air flow limitation that is not fully reversible.(ask.com)
Air flow limitation is usually progressive and is associated with an abnormal inflammatory response of lungs to noxious particles or gases,primarily caused by cigarette smoking.
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COPD is a lung disease defined poor air flow as a result of break down of lung tissue or dysfunction of small air ways .primary symptom include shortness of breath ,cough ,and sputum production( medical dictionary)
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Etiology
1.Cigerette smoking2.Infections3.Heriditory4.Occupational dusts and chemicals5.Air pollution6.aging
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classification of COPD
The definition Include chronic bronchitis ,emphysema with airflow limitation.
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Chronic Bronchitis
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Chronic Bronchitis
Chronic bronchitis is defined clinically as the presence of a cough productive of sputum not attributable to other causes on most days for at least 3 months over 2 consecutive years.
Chronic inflammation of the bronchii
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Chronic Bronchitis
Chronic nonspecific inflammation Symptoms of cough and sputum
production with or without gaspingRecurrent attacksChronic proceeding
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Classification of Chronic Bronchitis
Simple type of Chronic Bronchitis
(without gasping)
Cough
Sputum expectoration
Chronic Bronchitis with
gasping
Cough
Sputum expectoration
Gasping
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Stages of Chronic Bronchitis
Stages Time Courses
Exacerbation In a week
Chronic lag phase
One month or longer
stable Lasts for two months
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Clinical manifestations
Productive cough
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breathlessness
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Chest pain
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Fever,fatigue
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Weight loss and anorexiaInsomniaAir hungerCyanosis
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Diagnosis of chronic bronchitisHistory Cough & Sputum expectoration &
Gasping Three months /per year or longerContinuously longer than two yearsExclude other lung and heart disease
If shorter than three months /per year then definite objective evidences are demanded (such as X-Ray and lung function et al.)to diagnose.
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1.Physical examination ( .Diminished breath sounds)2.Pulmonary function test3.Chest x ray 4.Blood test5.CT
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Obstructive Emphysema
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Definition of EmphysemaPulmonary emphysema (a pathological term) is characterized by abnormal,permanent
enlargement of air spaces distal to the terminal bronchioles ,accompanied by destruction of their walls and hyperdistension leading to reduction in lung elastics recoil and airway obstruction.
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Classification of Emphysema
Obstructive Emphysema
Emphysema without
Obstruction
senile emphysema(Physiological)
Interstitial Emphysema
Compensating Emphysema
Scarred Emphysema
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CLINICAL MANIFESTATIONS1.Wheezing2.cyanosis
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Chest painNon productive coughFatigue malaiseWeight loss
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•Lung parenchyma (respiratory bronchioles and alveoli)
Alveolar wall destruction, apoptosis of epithelial
and endothelial cells.
• Centrilobular emphysema: dilatation and destruction of respiratory bronchioles; most commonly seen in smokers
• Panacinar emphysema: destruction of alveolar sacs as well as respiratory bronchioles; most commonly seen in alpha-1 antitrypsin deficiency
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Normal distal lung acinus
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Centriacinar(centrilobular) emphysema
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Panacinar emphysema
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spirometric classification of COPD
FEV1/FVC FEV1%pred
mild <70%<70% ≥80% ≥80%
moderate <70%<70% 50~80% 50~80% severe disease <70%<70% 30~50% 30~50%
Very severe < 70%< 70% ≤ 30%or ≤ 30%or<50%<50%
following with respiratory failurefollowing with respiratory failure
& right heart failure & right heart failure
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Pathophysiology of copd
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•Pulmonary vasculature
Thickening of intima, endothelial cell
dysfunction, smooth muscle
pulmonary hypertension.
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Clinical Manifestations of copd
Symptoms: Gradually progressive
dyspnea is the most common presenting character.
Dyspnea that is: Progressive (worsens over time)Usually worse with exercisePersistent (present every day)Described by the patient as an “increased effort to
breathe,”“heaviness,” “air hunger,” or “gasping.”
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Recurrent respiratory infection
Recurrent attacks leading to cor pulmonal
heart disease
Unexpected weigh loss
Decreased food appetite
•Chronic Cough
May be intermittent and may be unproductive.
•Chronic sputum production:
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Physical Signs:Earlier period:Minimal/Nonspecific signs
Advanced Stage: *Inspection:
Barrel-shaped chest ,
accessory respiratory muscle participate ,
prolonged expiration during quiet breathing.
*Palpation:
Weakened fremitus vocalis
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*Percussion :Hyperresonant depressed diaphragm,dimination of the area of absolute cardiac dullness.
*Auscultation: Prolonged expiration ; reduced breath sounds;The presence of wheezing during quiet breathing Crackle can be heard if infection exist.The heart sounds are best heard over the xiphoid area.
Clinical Manifestation
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Diagnostic measures
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History and physical examination
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Chest x-ray
Chest Radiograph(X-Ray)
Non apparent abnormality
Or thickened and increased of the lung markings are noted.
Chronic bronchitis
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Chest X-Ray --emphysema
Chest findings are also varible.Marked over inflation is noted with
flattend and low diaphragm Intercostal space becomes widen A horizontal pattern of ribsA long thin heart shadow Decreased markings of lung peripheral
vessels
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Chest X-Ray
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CT(Computed tomography) : greater sensitivity and specificity for emphysema , especially for the diagnosis of bronchiectasis and evaluation of bullous disease
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Computed Tomography
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Labortory Examination Blood examination In excerbation or acute infection in airway,
leucocytosis may be detected.
Sputum examination streptococcus pneumonia
Haemophilus influenzae Moraxella catarrhalis klebsiella pneumonia
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Blood gas analysis: Arterial blood gas analysis may reveal
hypoxemia,particularly advanced disease.
In patients with severe hypoxemia ,CO2 retention,it shows low arterial PO2 and high arterial PCO2.
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EcgExercise testing with oxymetryEcocardiogramSerum antitripsin
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management AimBased on the principles of prevention of further progress of
disease preservation and enhancement of
pulmonary functional capacity avoidance of exacerbations in order
to improve the quality of life.
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TREATMENTStop smoking Avoid environment pollutionBreathing retrainingChest physiotherapy
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Flutter mucous clearance device
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acapella
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NebulizationHigh frequency chest compressionNutritional therapy
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Drug Therapy
1.BronchodilatorsBronchodilators are central to the
symptomatic management of COPD.
improve emptying of the lungs,reduce dynamic hyperinflation and improve
exercise performance .
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Drug Therapy BronchodilatorsThree major classes of bronchodilators:β2 - agonists:
Short acting: salbutamol & terbutaline
Long acting :Salmeterol & formoterolAnticholinergic agents:
Ipratropium,tiotropium Theophylline (a weak bronchodilator,
which may have some anti-inflammatory properties)
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Drug Therapy2.GlucocorticoidsRegular treatment with inhaled
glucocorticoids is appropriate for symptomatic patients with anFEV1<50%pred and repeated exacerbations.
Chronic treatment with systemic glucocorticoids should be avoided because of an unfavorable benefit-to-risk ratio.
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3. COMBINATION THERAPY3. COMBINATION THERAPY
Combination therapy of long acting Combination therapy of long acting ß2-agonists and inhaled ß2-agonists and inhaled corticosteroids show a significant corticosteroids show a significant additional effect on pulmonary function and a reduction in symptoms.
Mainly in patients with an FEV1<50%pred
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Drug Therapy 4.Others:Antioxidant agents ImmunoreggulatorsAlpha-1 antitrypsin augmentationMucolytic(mucokinetic,mucoregulator) agents Antitussives
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Oxygen TherapyOxygen -- >15 h /d
Long-term oxygen therapy (LTOT) improves survival,exercise,sleep and cognitive performance in patients with respiratory failure.
The therapeutic goal is to maintain SaO2 ≥ 90% and PaO2 ≥ 60mmHg at sea level and rest .
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Long-term Oxygen therapy LTOT
Indication: For patients with a
PaO2 ≤ 55 mmHg or SaO2≤88% ,
with or without hypercapnia
For patients with a
PaO2 of 55~70 ( 60 ) mmHg or SaO2≤89% as well as pulmonary hypertension / heart failure / polycythemia (hematocrit >55%)
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Pulmonary rehabilitation
Nutrition
Surgery:
Bullectomy
Lung volume reduction surgery
Lung transplantation
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bullectomy
Lung volume reduction
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ComplicationsCor pulmonaleExacerbations of copdRespiratory failurePeptic ulcer and GERDDepression
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Clinical featuresDyspneaCracklesS3 gallopsEcg changesHepatomegaly ,splenomegaly ,ascitis
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ManagementVasodialors DigitalisDiureticsElectrolytes
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Nursing management1.Ineffective airway clearance2.Imapaired gas exchange3.Imbalnced nutrition4.Insomnia5.Deficient knowledge6.anxiety
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