COPD

Chronic Obstructive Pulmonary Disease(COPD)

Prof. Dr. Abdul Hameed Al Qaseer

Chronic obstructive pulmonary disease (COPD) is defined as a disease state characterized by airflow limitation that is not fully reversible COPD includes emphysema, an anatomically defined condition characterized by destruction and enlargement of the lung alveoli; chronic bronchitis, a clinically defined condition with chronic cough and phlegm; and small airways disease, a condition in which small bronchioles are narrowed. COPD is present only if chronic airflow obstruction occurs; chronic bronchitis without chronic airflow obstruction is not included within COPD.

Global Strategy for Diagnosis, Management and Prevention of COPD. Updated 2011

Risk Factors for COPD
Genes
Exposure to particles
• Tobacco smoke
• Occupational dusts
• Indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings
• Outdoor air pollution

Lung growth and development

Gender
Age
Respiratory infections
Socioeconomic status
Asthma/Bronchial hyperreactivity
Chronic Bronchitis


Risk Factors in COPD

COPD – and why?

Fletcher, Peto 1977

No smoker

No smoker
Stop 45 years
Stop 65 years
Current smoker
Disability
Dead
FEV1
YEARS

Pathogenesis of Emphysema

Breathlessness is the cardinal manifestation of COPD
It is a slowly progressive .However , it can acute during exacerbation
The patient may presented with leg edema with or without right sided heart failure ( core pulmonale)
Physical examination : may be minimum
wheeze , rals ……


Clinical Spectrum of COPD ( pink puffers(A)& blue bloaters(B)

PINK PUFFERS (EMPHESYMA)

BLUE BLOATERS ( CHROIN BRONCHITIS)

Modified Medical Council Research Dyspnea

Investigation
Chest X-ray
Spirometry
High resolution CT
Arterial Blood Gas
Bacteriologic , CBC ……

Global Strategy for Diagnosis, Management and Prevention of COPD. Updated 2011

Diagnosis: Spirometry

Volume, liters

Time, seconds


5
4
3
2
1
1
2
3
4
5
6
FEV1 = 1.8L
FVC = 3.2L
FEV1/FVC = 0.56
Normal
Obstructive

Spirometric classification of COPD

Classification of Severity of Airflow Limitation in COPD*
In patients with FEV1/FVC < 0.70:


GOLD 1: Mild FEV1 > 80% predicted

GOLD 2: Moderate 50% < FEV1 < 80% predicted

GOLD 3: Severe 30% < FEV1 < 50% predicted

GOLD 4: Very Severe FEV1 < 30% predicted

*Based on Post-Bronchodilator FEV1

CT of chest shows emphysema

Differential Diagnosis of COPD
Chronic Asthma
Bronchiectasis
Bronchial carcinoma
Heart failure
Pulmonary TB
ILD


What are the deference between asthma & COPD(ch.bronchitis)?

ASTHMA

COPD
ONSET
Mainly childhood
mid-late adult life
smoking
Usually nonsmoker
almost invariably smoker
Chronic cough & sputum
Absent
Frequent
Dyspnea on effort
Variable & reversible
constant , poorly reversible
Nocturnal symptoms
Relatively common
Uncommon
Airflow limitation
Diurnal variability
Normal
Response to bronchodilator
Good
poor


Ancillary tests in the D. Dx. between stable asthma & COPD
TEST
ASTHMA
COPD
Reversibility to bronchodilator & /or corticosteroids
Usually present
usually absent
TLV + RV
usually normal
Increase
DLco
normal

AHR

might be increase

allergy test
Often +
often -
CXR
usually normal
usually abnormal
sputum
eosinophilia
neutrophilia
Exhaled NO
increase
usually normal


Management of COPD
Stop smoking
Vaccination
Bronchodilators
Corticosteroids
Oxygen therapy
Rehabilitation
Others

Smoking cessation

Every attempt should be made to highlight the role of smoking in the development and progress of the disease and encourage, advise and assist the patient toward smoking cessation. On cessation, patients should be warned to expect an apparent worsening of chest symptoms and reassured that this is temporary. Cessation is difficult but highly rewarding and remains the only intervention proven to decelerate the decline in FEV1.

COPD Assessment Score ( CAT)

Smoking cessation

Pharmacological Management of COPD

In advanced disease Long – term oxygen therapy is necessary

COPD in Old age

Management of acute exacerbation of COPD
1. Oxygen therapy : 24%---28% ---
2. Inhaled bronchodilators : SABA , SAMA , LABA ,LAMA
3. Oral corticosteroid: prednisolone 30 mg/d for 10 days
4. Antimicrobial drugs

Prognosis : BODE index( B=BMI;O=airway obstruction= dyspnea; E =exercise capacity)

Prognosis: Calculation of BODE index

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