CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

DEFINITION:
It is defined as the airflow limitation that is not fully reversible
characterized by the airflow obstruction resulting from Chronic Bronchitis or
Emphysema.
INCIDENCE:
The prevalence rate of COPD in Indian males is 5% and in women 2.7%,
male to female ratio being 1.6:1.
ETIOLOGY:

Smoking.
Air pollution.
Second-hand smoker.
History of childhood respiratory tract infections.
Heredity.
Occupation exposure to certain industrial pollutions.

PATHOPHYSIOLOGY:
Due to the etiological factors
(tobacco smoking, air pollution)

Continual bronchial irritation &

inflammation

breakdown of elastin in connective

tissue of lungs

EMPHYSEMA

CHRONIC BRONCHITIS:

Destruction of alveolar
septa
Airway instability

Bronchial edema
Hyper secretion of
mucus
Chronic productive
cough
bronchospasm

Mucus Hypersecretion
Cilia Dysfunction
Airflow Limitation
Hyperinflation of lungs
Gas Exchange Abnormalities
Pulmonary Hypertension
Cor Pulmonale
CLINICAL MANIFESTATIONS:
Chronic cough
Sputum production
Shortness of breath

Lack of energy
Dyspnea
Dry mouth
Weight loss
Feeling nervous
Barrel chest
Difficulty sleeping
Loss of lung elasticity
Slower expiration
Hypoxemia
Wheezing on forced expiration
Hyperinflation
Breath sounds decreased
Prolonged expiration
Coarse crackles sound at lung base
Distant heart sounds
Respiratory tract infections

STAGES
I
(Mild)
II
(Moderate)
III
(Severe)
IV
(Very severe)

FEV1
>80%

FEV1 / FVC
<70%

<50-80%

<70%

<30-50%

<70%

<30-50%

<70%

S/S
With / without symptoms of
cough & sputum production
Shortness of breath
Shortness of breath, reduced
exercise capacity, repeated
excerbations
Signs & symptoms of
chronic respiratory failure

DRUGS
SABD
SABD &
LABD
BD & glucocarticoids
BD & glucocarticoids

DIAGNOSTIC FEATURES:
History collection any kind respiratory diseases, family history any bad
Habits, any triggering factors.
Physical examination On Inspection engorged neck veins. On Palpation
pulse rate, respiratory rate is increased. Any cyanosis, assessment of
sputum characteristics, breathing sounds, peripheral edema.

Chest X-Ray Shows low, flat diaphragm, increased Anterior Posterior

diameter of thorax and over distension of lungs.
Arterial Blood Gas (ABG) Analysis Shows mild to moderate hypoxemia
without hypercapnea.
Sputum & Hematology Gram stain, culture and sensitivity test to detect
the bacterial growths.
Pulmonary Function Tests (Spirometery) The FEV 1 / FVC ratio is less
than 70%.
MANAGEMENT:
a) Medical Management:
1. Broncho-dilators: It will relieve bronchospasm by altering smooth
muscle tone and reduce airway obstruction by allowing increased oxygen
distribution.
GROUP
Beta2-Adrenergic

DRUG NAME
Salbutamol
Albuterol

Agonist

Salmeterol

Antichollinergics

Ipratropium Bromide
Aminophylline
Theophylline

Methyxanthines

DOSE
2-3 puffs every 4-8
hrs/day
2-3 puffs every 2 hrs/day

ROUTE
Inhalation

2 puffs every 4 hrs/day

Inhalation

As per physician order

Intravenous

2. Corticosteroids: It shortens the recovery times, improves the lung

function and reduces the hypoxemia. A short trial course is only used and

it is usually combined with Beta2 Agonist (Corticosteroids + Beta2

Agonist) such as Formoterol, Salmeterol.
3. Mucolytics: It is used to reduce the mucus production or enhance the
elimination of mucus in patients with COPD.
4. Antibiotics: Usually low-cost broad spectrum antibitoics are preferred to
reduce the episodes of infection process. But it is not routinely
recommended for COPD patients.
5. Alpha 1 Antitrypsin (AAT): IV infusion of AAT can be given weekly
or biweekly basis.
6. Oxygen Therapy: Oxygen therapy can be administered (15 Hrs/Day) as
long term continuous therapy to prevent the acute dyspnea. Oxygen by
nasal cannula should increase Partial Arterial Pressure of Oxygen
(PaO2 > 60 mm Hg) and Arterial Oxygen Saturation (SaO2 > 90%).
7. Vaccination: Pneumococcal and influenza vaccination are
recommended for all the patients with COPD at the earlier stage to reduce
the symptoms.
b) Surgical Management:
1. Bullectomy: Bullae are enlarged airspaces that dont contribute to
ventilation, but occupy space in thorax. These areas are surgically
excised procedure called as Bullectomy. It can be done by Video Assisted
Thorascope or by limited thoracotomy incision.
2. Lung Volume Reduction Surgery (LVRS): It involves the removal of a
portion of the diseased lung parenchyma, so that the patients chest
wall and diaphragm can return to normal positions and thereby easing
breathing. It can be done by either Mediastinoscopy or Video Assisted
Thorascopic surgery.

3.

Lung Transplantation: It can be performed for the patient under 65

yrs of age with an FEV1 below 30% without an evidence of pulmonary
hypertension. Long term services is patient undergo bilateral lung
transplantation rather than single lung. Infection is the most significant
complication.