COPD

• COPD


  Chronic obstructive pulmonary disease

  
• COPD


  • Preventable and treatable disease
  • Characterized by persistent airflow limitation (usually non-reversible)
  • Usually progressive
  • Associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases

  
• Chronic bronchitis


  Cough and sputum for at least 3 consecutive months in each of 2 consecutive years
• Emphysema


  Abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis

  
• Pathophysiology of COPD

  1. Airflow limitation

  2. Premature airway closure

  3. Gas trapping

  4. Hyperinflation

  5. Impaired pulmonary and chest wall compliance

  6. Flattening of diaphragmatic muscles

  7. Horizontal alignment of intercostal muscles

  8. Increased work of breathing

  
• Emphysema classification


  • Centriacinar
  • Panacinar
  • Paraseptal
• Clinical features of COPD

  • Cough and sputum production are usually the first symptoms
  • Breathlessness is common
  • Physical signs are non-specific and correlate poorly with lung function
  • Finger clubbing is not a feature of COPD
  • Right heart failure may develop in advanced COPD
  • Fatigue, anorexia and weight loss may occur
  • Prolonged expiratory time >5s, with pursed lip breathing

  
• 'Pink puffers' and 'blue bloaters'


  Classical phenotypes of COPD
• Investigations for COPD


  • CXR
  • CBC
  • Electrolytes
  • Echocardiography
  • Pulmonary function test
  • Measurement of lung volumes
  • Exercise tests
  • HRCT
  • Arterial blood gas analysis

  
• Management of COPD

  1. Reducing exposure to noxious particles and gases

  2. Smoking cessation strategies

  3. Bronchodilator therapy

  4. Combined inhaled glucocorticoids and bronchodilators

  5. Oral glucocorticoids

  6. Pulmonary rehabilitation

  7. Oxygen therapy

  8. Surgical intervention

  9. PDE4 Inhibitors

  10. Theophylline

  11. Influenza and pneumococcal vaccination

  
• Acute exacerbations of COPD


  • Increase in symptoms and deterioration in lung function and health status
  • Usually triggered by bacteria, viruses or a change in air quality
  • May be accompanied by respiratory failure and/or fluid retention

  
• Management of acute exacerbations


  1. Oxygen therapy

  2. Bronchodilators

  3. Glucocorticoids

  4. Antibiotic therapy

  5. Non-invasive ventilation
• Acute exacerbations of COPD represent an important cause of death