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Copd Pbl Sept 13

Copd Pbl Sept 13

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Published by Tareq Sawan

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Published by: Tareq Sawan on Feb 15, 2014
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COPD: -Long-term exposure to toxic particlesand gases.

-In developed countries smoking accounts for over 90% of cases with climate and air pollution playing smaller role.(but only 10-20% of smokers have copd) Pathophys: - increased numbers of mucus secreting goblet cells in bronchial mucosa  becomes inflamed in sever cases.  followed by scarring and thickening of walls  narrowing airways. - Often associated with emphysema: loss of elastic recoil  cannot expel all air in alveoli as airways collapse.  Limited airflow in small airways due to : - Loss of elasticity and alveolar attachements of airways due to emphysema  airways collapse during expiration. - Inflammation and scarring causes small airways to narrow. - Mucus secretion blocks airways. = this leads to hyperinflation and breathlessness CO2/ O2 linkage: CO2 is usual respiratory drive… when CO2 increases due to harder breathing, the respiratory drive increases over shorterm…but in long term the receptors become insensitive to CO2 and hypoxaema now drives respiration  if u give high O2 as treatment, this may lead to loss of respiratory drive. Symptoms: -Productive cough with white/clear sputum (purulent if underlying infection), wheeze, breathlessness Signs: -Tachypnoes with prolonged expiration and usually purse lips on expiration to help build up pressure in lung to prevent collape. Hyperinflatoin of chest. Note: respiratory failure occurs when long standing hypoxia ( less than 60 mmhg or hypercania (more than 55 mmHg)  persistently low oxygen leads to pulmonary arteriolar constriction leading to pulomanary HT (may lead to RVT hypertrophy  ankle oedema and raised JVP). Also hypoxia contrics renal arteries  salt and water retained ( HT) Diagnose: Signs and symptoms + Investigations: Include FEV1/ FVC

ipratropium.more prolonged and greater dilation is achieved with antimuscuranic agents : (Tiotropium. ipratropium) Corticosteoids: Reverse inflammation  Prednisalone 30 mg for 2 weeks and monitor for change in FEV1…if you see difference then put on inhaled beclamethasone ) Atibiotics for exhaberrations.Bronchodilators: Beta Adrenergic agonist (eg.Management: -Smoking Cessation. . Oxygen therapy: . . Salbutamol for shorterm) or a Beta2 agonist for long term.DRUGS: .

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