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COPD Lecture 2022

Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation and chronic inflammation, affecting over 5% of the population. Major risk factors include age, smoking, and genetics, while symptoms range from chronic cough and dyspnea to advanced signs like weight loss and cyanosis. Management involves smoking cessation, pharmacological therapy, and addressing acute exacerbations, with prognosis assessed using the BODE index.

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Azain Tayyab
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27 views46 pages

COPD Lecture 2022

Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation and chronic inflammation, affecting over 5% of the population. Major risk factors include age, smoking, and genetics, while symptoms range from chronic cough and dyspnea to advanced signs like weight loss and cyanosis. Management involves smoking cessation, pharmacological therapy, and addressing acute exacerbations, with prognosis assessed using the BODE index.

Uploaded by

Azain Tayyab
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DEFINITION:

“A common preventable and treatable disease, is characterized


by progressive persistent airflow limitation associated with an
enhanced chronic inflammatory response in the airways to
noxious particles or gases ”

✓It affects more than 5% of population and is associated with


high morbidity and mortality.
RISK FACTORS:

Major Risk Factors:


• Age
• Male gender
• Smoking
• Genetics
• Existing impaired
lung function
• Occupational injuries
Minor Risk Factors:

• Socioeconomic status
• Air pollution
• Family history
• Nutritional status
• Respiratory tract infections
Host Factors:

• Genetics
( Alpha-1 Antitrypsin deficiency )

• Airway hyper-reactivity

• Male gender
PATHOPHYSIOLOGY:
• Two components as:
1. Chronic Bronchitis
2. EMPHYSEMA
PATHOPHYSIOLOGY CONT…
PATHOPHYSIOLOGY CONT…
PATHOPHYSIOLOGY CONT…
PATHOPHYSIOLOGY CONT…
PATHOPHYSIOLOGY CONT….
CLINICAL PRESENTATION

General symptoms:

• Fever
• Dyspnea ( Progressive , Persistent & Worsen with exercise/exertion )
• Chronic cough ( Intermittent Productive )
• Chronic sputum production ( Patient commonly cough up sputum )
• Hemoptysis
CLINICAL PRESENTATION

Advanced symptoms:

• Weight loss
• Morning headache
• Edema
• Cyanosis
PHYSICAL SIGNS

❑INSPECTION:
1. Barrel shaped chest : Barrel chest refers to an increase in the anterior
posterior (AP) diameter of the chest wall resembling the shape of a barrel, most
often associated with emphysema.

→There are two main causes of the barrel chest phenomenon in emphysema:
• Increased compliance of the lungs leads to the accumulation of air pockets inside
the thoracic cavity.
• Increased compliance of the lungs increases the intrathoracic pressure. This increase
in pressure allows the chest wall to naturally expand outward
INSPECTION CONT…
2. Use of accessory respiratory muscles

3. Prolonged expiration during quiet breathing


INSPECTION CONT…

4. Expiration through pursed lips


PHYSICAL SIGNS CONT…
6. Tripod position
Leaning forward with arms outstretched and weight supported on the
palms or elbows.
INSPECTION CONT…

7. Bilaterally restricted chest movements

8. Intercostal space full

9. Clubbing of fingers
❑ PALPATION:
• Trachea central
• Apex beat difficult to localize
• Chest expansion reduced
❑ Percussion:
• Percussion note Hyperresonant.
❑ Auscaltation:
• Vesicular breathing sounds with prolonged expiration
• Plenty of Ronchi over both lung fields in both inspiration and
expiration
INVESTIGATIONS

• Complete blood count ( Polycythemia and Increased PCV due to


persistent hypoxemia )

• ECG ( Usually normal but in Cor pulmonale there may be features of


RVH)

• Echo ( Features of Cor pulmonale )

• PEFR ( Reduced )
INVESTIGATIONS CONT…
• Chest X-ray PA view: ( Features of hyperinflation –Increased
translucency , low flat diaphragm , tubular heart , widening of
Intercostal space , emphysematous bullae )
SPIROGRAM
•FEV1: Forced expiratory volume in one
second, or the volume of breath exhaled with
effort in one second

•FVC: Forced vital capacity, or the full amount


of air that can be exhaled with effort in a
complete breath

•FEV1/FVC ratio: is often used in diagnosing


and monitoring the treatment of lung diseases
such as COPD & Asthma.

✓ Normally ratio is 70% or 0.7


✓ In obstructive lung disease ( asthma , copd )
ratio is < 70%
✓ In restrictive lung disease ( fibrosis )
✓ ratio is > 70%
•FEV1 < 80% predicted
•FEV1 : FVC < 70% predicted
•Bronchodilator reversibility test shows <15%
increase in FEV1 after giving bronchodilators
INVESTIGATIONS CONT…

• Lung function tests: FEV1 and FVC are reduced , ratio of FEV1 to
FVC is also reduced which indicates obstructive airway disease ,
Post bronchodilator FEV1 < 80 % of the predicted value and
FEV1 / FVC is < 70%
• Blood gas analysis:
i. Often normal at rest
ii. PO2 ( reduced )
iii. PCO2 ( normal or increased )
iv. pH ( Acidosis )
INVESTIGATIONS CONT…

• High resolution CT chest: Assessment of COPD , features of


emphysema , especially bullae

• Sputum examination: For superadded infections

• Alpha-1-Antitrypsin Deficiency: Usually in young non-smoker


patient with basal emphysema
STAGES / CLASSIFICATION OF COPD

• It is classified on the basis of spirometry findings and


symptoms.
• It is also called as GOLD Criteria.
• Gold criteria has 5 stages which shows different levels of
severity.
Stage Spirometry Symptoms
0 ( At Risk ) Normal Presence of Chronic Symptoms
( Cough , Sputum production )

1 ( Mild ) FEV1 / FVC < 70% None or Mild


FEV1 ≤ 80% Predicted

2 ( Moderate ) FEV1 / FVC < 70% Mild to Moderate Symptoms


FEV1 ≤ 50% , but < 80% Predicted

3 ( Severe ) FEV1 / FVC < 70% Breathlessness on minimal


FEV1 ≤ 30% , but < 50% Predicted exertion
( e.g Dressing )

4 ( Very Severe ) FEV1 / FVC < 70% Breathlessness at Rest


FEV1 < 30% predicted or
FEV1 < 50% predicted plus Chronic
Respiratory Failure
MANAGEMENT OF STABLE COPD PATIENT
1. Smoking cessation
2. Health education
3. Pharmacological therapy
✓Bronchodilators such as:
• Beta Agonists ( SABA , LABA )
• Anti-cholinergics
• Methylxanthines (Phosphodiesterase inhibitors
✓Steroids
✓Combination therapy ( Inhalers , pumps , Rota Capsules )
✓Anti-oxidants
✓Mucolytics
4. Long term oxygen therapy

5. Pulmonary rehabilitation

6. Nutrition

7. Surgery ( Bullectomy , Lung volume reduction surgery (LVRS) ,


Lung transplantation )

8. Vaccination ( Pneumococcal , Influenza )

9. Antibiotics
BRONCHODILATORS
GOAL OF USE OF BRONCHODILATORS
TREATMENT OF COPD ACCORDING TO GOLD
CRITERIA STAGING
Stage Treatment
0 ( At Risk ) Avoid risk factors

1 ( Mild ) Avoid of risk factors , vaccination , SABA if needed

2 ( Moderate ) Above Rx. Plus regular treatment with


LABA or Anti-Cholinergic
Rehabilitation
3 ( Severe ) Above Rx. Plus
Inhaled steroids

4 ( Very Severe ) Above Rx. Plus


Long term oxygen therapy if chronic respiratory failure
Surgical treatment if needed
MANAGEMENT PLAN
ACUTE EXACERBATION OF COPD

“An exacerbation of COPD is a sustained worsening of the patient's


condition, from the stable state and beyond normal day-to-day
variations that is acute in onset and may warrant additional
treatment in a patient with underlying COPD”

• It is also called as type 2 respiratory failure.


MANAGEMENT OF ACUTE EXACERBATION
OF COPD
1. Oxygen ( Continuous low concentration oxygen via venturi mask to raise the
PaO2 > 60 mmHg or 8 kPa )
2. Nebulization with SABA and Anti-cholinergic.
3. Oral prednisolone 30mg daily for 10 days
4. Antibiotics in case of fever and superadded infection
5. Diuretic in case of peripheral edema
6. Chest physiotherapy
7. Respiratory support if above Rx. Fails or acidosis or tachypnea.
8. Non-invasive ventilation technique is used such as BiPAP first , CPAP is
occasionally used.
MANAGEMENT OF ACUTE EXACERBATION
OF COPD

• Indications for hospitalization:


i. Severe symptoms that fails to respond to outpatient management
ii. Presence of cyanosis
iii. Peripheral edema
iv. Altered level of consciousness
v. Co-morbidity
PROGNOSIS
• It is predicted by BODE Index.
• 4 years mortality rate for BODE index 0 to 2 is 10% while for BODE index 7 to 10 is 80%

Variable
Points on BODE Index
0 1 2 3

Body mass index > 21 ≤ 21

Obstruction to airflow ( FEV1 ≥ 65 50 to 64 36 to 49 ≥ 35


% predicted )

Dyspnea ( MMRC Scale ) 0 to 1 2 3 4

Exercise capacity ( meters ≥ 350 250 to 349 150 to 249 ≤ 149


walked in 6 minutes )
COMPLICATIONS:

➢Pulmonary hypertension
➢Cor pulmonale
➢Respiratory failure
➢Secondary infection ( Haemophilus influenza ,
streptococcus pneumoniae , chlamydia pneumoniae )
* Pseudomonas aeruginosa in GOLD 3 & 4 stage
➢Polycythemia
PREVENTION

• No primary prevention.

• Smoking cessation

• Proper vaccination

• Proper nutrition

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