COPD

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Mrs.Sumathigopinath ACN Lecturer

Chronic obstructive pulmonary disease: 

Chronic obstructive pulmonary disease COPD is also known as chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic airflow limitation (CAL) and chronic obstructive respiratory disease ( CORD) Chronic obstructive pulmonary disease (COPD) refers to chronic bronchitis and emphysema, a pair of two commonly co-existing diseases of the lungs in which the airways become narrowed. This leads to a limitation of the flow of air to and from the lungs causing shortness of breath.

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In COPD, less air flows in and out of the airways because of one or more of the following: The airways and air sacs lose their elastic quality. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. The airways make more mucus than usual, which tends to clog them.

Incidence : 

Incidence It is the 4 th leading cause of mortality and 12 th leading cause of disability in the united states. In 2020 COPD is the 3 rd leading cause of death.

Causes : 

Causes 1)Smoking 2) Occupational exposures- exposure to workplace dusts found in coal mining, gold mining, and the cotton textile industry and chemicals such as cadmium, isocyanates , and fumes from welding have been implicated in the development of airflow obstruction. 3) Air pollution 4) sudden airway constriction in response to inhaled irritants, 5) Bronchial hyperresponsiveness , is a characteristic of asthma.

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6 ) Genetics-Alpha 1-antitrypsin deficiency is a genetic condition that is responsible for about 2% of cases of COPD. In this condition, the body does not make enough of a protein, alpha 1-antitrypsin. Alpha 1-antitrypsin protects the lungs from damage caused by protease enzymes, such as elastase and trypsin, that can be released as a result of an inflammatory response to tobacco smoke.

Pathophysiology : 

Pathophysiology Abnormal inflammatory response of the lungs due to toxic gases. Response occurs in the airways ,parenchyma & pulmonary vasculature. Narrowing of the airway takes place Destruction of parenchyma leads to emphysema.

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Destruction of lung parenchyma leads to an imbalance of proteinases/ antiproteinases . (this proteinases inhibitors prevents the destructive process) Pulmonary vascularchanges Thickening of vessels Collagen deposit Destruction of capillary beds. Mucus hypersecretion (cilia dysfunction,airflow limitation,corpulmonale (RVF)) Chronic cough and sputum production

Clinical features : 

Clinical features Chronic cough Sputum production Wheezing Chest tightness Dyspnoea on exertion Wt.loss Respiratory insufficiency Respiratory infections Barrel chest- chronic hyperinflation leads to loss of lung elasticity.

COPD includes : 

COPD includes 1) Bronchitis 2) Emphysema Bronchitis :- Bronchitis ( bron -KI-tis) is a condition in which the bronchial tubes become inflamed.

Two types : 

Two types acute (short term) and chronic (ongoing ). Infections or lung irritants cause acute bronchitis . Chronic bronchitis is an ongoing, serious condition. It occurs if the lining of the bronchial tubes is constantly irritated and inflamed, causing a long-term cough with mucus.

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Chronic bronchitis: It is defined as the presence of cough and sputum production for atleast 3 months.

Pathology Chronic bronchitis : 

Pathology Chronic bronchitis Irritants irrritate the airway Excess mucus production Inflammation Cause the mucus secreting glands and goblet cells to increase in number. Ciliary function is reduced. More mucus production Bronchial walls become thickened and lumen narrows and mucus plug the airway

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Alveoli adjacent tto the bronchioles may become damaged and fibrosed . Alter function of alveolar macrophages. infection

Signs and symptoms-Acute : 

Signs and symptoms-Acute sore throat, fatigue (tiredness), fever , body aches, stuffy or runny nose, vomiting , and Diarrhea persistent cough cough may produce clear mucus shortness of breath

Chronic symptoms : 

Chronic symptoms coughing , wheezing, and chest discomfort. The coughing may produce large amounts of mucus. This type of cough often is called a smoker's cough.

Diagnostic evaluation : 

Diagnostic evaluation History - medical history •Whether you've recently had a cold or the flu •Whether you smoke or spend time around others who smoke •Whether you've been exposed to dust, fumes, vapors, or air pollution -

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Mucus -to see whether you have a bacterial infection chest x ray, lung function tests, CBC ABG analysis

Management : 

Management Avoid smoking Nicotine replacement ( inhalers,nasal spray,sublingual tablets) Antihypertensive drug-clonidine Bronchodilators can be given ( theophyllineipratropium ( Atrovent ), tiotropium (Spiriva), salmeterol ( Serevent ), formoterol ( Foradil ), or albuterol,) Corticosteroids can be given in IV. O2 therapy can be given A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, and fat-free or low-fat milk or milk products. A healthy diet also is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.

Emphysema : 

Emphysema Definition :-Emphysema is defined as enlargement of the air spaces distal to the terminal bronchioles, with destruction of their walls of the alveoli. Pathology : As the alveoli are destroyed the alveolar surface area in contact with the capillaries decreases. Causing dead spaces (no gas exchange takes place)

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Leads to hypoxia. In later stages: CO2 elimination is disturbed and increase in CO2 tension in arterial blood causing Respiratory acidosis (Decrease pulmonary blood flowis increased forcing the RV to maintain high B.P. in PA.)

Classification: 

Classification Centrilobular -The respiratory bronchiole (proximal and central part of the acinus ) is expanded. The distal acinus or alveoli are unchanged. Occurs more commonly in the upper lobes .

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Panlobular -The entire respiratory acinus , from respiratory bronchiole to alveoli, is expanded. Occurs more commonly in the lower lobes, especially basal segments, and anterior margins of the lungs.

Diagnosis : 

Diagnosis History PFT Spirometry -to find out airflow obstruction. ABG analysis CT scan of the lung. Screening of alpha antitrypsin deficiency X-ray radiography may aid in the diagnosis.

Management : 

Management To stop smoking and avoid all exposure to cigarette smoke and lung irritants. bronchodilators, steroid medication (inhaled or oral), effective body positioning (high Fowler's) supplemental oxygen Anticholinergics-anticholinergics : ipratropium bromide ( Atrovent ) oxitropium bromide ( Oxivent ) tiotropium (Spiriva) Glycopyrrolate ( Robinul ) oxybutinin (Ditropan, Lyrinel XL) Tolterodine (Detrol Retard

Surgical management : 

Surgical management Lung volume reduction surgery, or LVRS, can improve the quality of life for certain COPD and emphysema patients. Parts of the lung that are particularly damaged by emphysema are removed, allowing the remaining, relatively good lung to expand and work better . lung transplant Bullectomy - is a surgical procedure to remove giant bullae from the lungs. Bullae are thin-walled, air-filled spaces in the lungs that are bigger than 1 centimeter .

Complications : 

Complications Respiratory insufficiency Respiratory failure Pneumonia Pneumothorax Pulmonary artery hypertension.