2. Definition
• COPD is a common, preventable, and treatable disease that is
characterized by persistent respiratory symptoms and airflow
limitation that is due to airway and/or alveolar abnormalities
usually caused by significant exposure to noxious particles or
gases.
3. COPD includes
• 1. Chronic bronchitis:
is defines as chronic productive cough onmost days for at least 3
consecutive months in 2 successive years.
• 2.Emphysema:
is defined as dilatation and destruction of air spaces distal to
terminal bronchioles without obvious fibrosis.
4. EPIDEMIOLOGY
• Prevalence directly related to tobacco smoking and use of biomass fuel in
low and middle income countries.
• Current estimates suggest that 80 million people worldwide
suffer from moderate to severe disease.
• A/c to BOLD and other large scale epidemiological studies, it is estimated
that no. of COPD cases was 384M in 2010 with global prevalence of 11.7%
• Globally around 3 million deaths occur annually
• With increasing prevalence and ageing , COPD prevalence expected to rise
over next 40 years and by 2060 there may be 5.4 million deaths annually.
8. Clinical features:
• Dyspnea:
- Progressive over time
- Characteristically worse with exercise
- Persistent
• Cough:
- May be Intermittent or may be unproductive
- Recurrent Wheeze
• Chronic Sputum production:
- May be dry or productive
- Usually mucoid in nature
- Mucopurulent during acute exacerbation
9. Physical signs:
• Inspection:
- Barrel-shaped chest ,
- Accessory respiratory muscle participate ,Prolonged
expiration during quiet breathing. Expiration through
pursed lips
- Paradoxical retraction of the lower interspaces during
inspiration (ie, hoover's sign)
- Tripod Position
10.
11. Tripod Position
• Patients with end-stage COPD
may adopt positions that relieve
dyspnea, such as leaning forward
with arms outstretched and
weight supported on the palms or
elbows.
12. • Palpation:
- Decreased vocal fremitus
• Percussion :
- Hyper resonant
- Depressed diaphragm,
- Diminution of the area of absolute cardiac dullness.
13. • Auscultation:
- Vesicular with Prolonged expiration
- Reduced breath sounds
- The presence of wheezing during quiet breathing
- Crackle can be heard if infection exist.
14.
15.
16.
17. • The presence of a post-
bronchodilator FEV1/FVC <
0.70 confirms the presence
of persistent airflow
limitation and thus of
COPD.
18.
19.
20.
21.
22. • ABG: pH<7.3- sign of acute respiratory compromise
Type II RF: Chronic Bronchitis
Type I RF: Emphysema
• CBC: Polycythemia
Hematocrit>50
• Sputum examination:
Streptococcus pneumonia
Hemophilus influenzae
Moraxella catarrhalis
Klebsiella pneumonia
23. Chest x-ray-Chronic Bronchitis
• No apparent
abnormality
• Or thickened and
increased lung
markings are noted.
No apparent
abnormality
Or thickened and
increased lung
markings are noted.
24. Chest X-Ray -Emphysema
• Marked over inflation is noted
with flattened and low diaphragm
• Intercostal space becomes widen
• A horizontal
pattern of ribs
• A long thin
heart shadow
• Decreased markings of lung
peripheral vessels
28. • General: Exercise and management of Nutritional status
Weight loss if obese
• Reduce exposure to noxious agents:
1.Smoking cessation: aided by Bupropion(Noradrenergic
antidepressant), varenicline(Nicotinic receptor agonist antagonist)
2.Reduce Indoor and outdoor air pollution
3.Avoid dusty and smoke laden environment
39. Acute exacerbation of COPD
• Is defined as any event in natural course of COPD characterized by a
change in patient’s baseline dyspnoea, cough and/or sputum that is
beyond normal day to day variations.
• Causes:
1.Infection
2.Air pollution
3.Cold
40. Management
• Initial treatment: 1. Position the patient up in bed
2. O2 therapy
3. If condition is not improving, intubation may be
required
• Bronchodilator: 1. SABA: Nebulized Salbutamol 2.5mg every 20 min
for initial 1-2 hr &/or
2. Short anticholinergic: Nebulized Ipratropium
bromide 0.5mg &/or
3. IV Aminophylline: Failure of above treatment
Loading dose:250mg IV in 20 min
Maintenance dose: 0.5-0.7mg/kg/hr
in 1 ltr of saline at 2.4ml/kg/hr
41. • Antibiotics:
1. Outpatient:
a. Doxycycline,cotrimoxazole or amoxiclav
b. Hospitalized pt >65 yrs: give one of the newer
FQs(Levoflox,Gemiflox,Moxiflox)
2. Hosptalized: IV anibiotics: Azithro or FQs or 3rd gen
Cephalosporins
3. Severe exacerbations: 3rd gen Cephalosporin + FQs or an
aminoglycoside
• Antibiotics should cover S. pneumoniae, H. influenza, Legionella sp.
42. • Steroids: Shortens recovery time, improve Lung function and hypoxia.
Hydrocortisone 200mg IV repea 6-8 hrly
or
Methyl prednisolone1-2mg/kg IV 6hrly not to exceed 125mg
: F/U with oral steroid: Presdnisolone 40-60mg/day in
tapering dose
• Monitoring
• Mgso4 IV single dose : 1.2-2gm infused over 20 min
• Diuretics: In pts with gross Rt. Ventricular failure