3rd Year 2nd Semester Medicine 1

L13: COPD
Definition:
*Gold 2011: Chronic Obstructive Pulmonary
Disease (COPD), a common preventable
and treatable disease, is characterized by
persistent airflow limitation that is usually
progressive and associated with an enhanced
chronic inflammatory response in the airways
and the lung to noxious particles or gases.
*Gold 2017: Chronic Obstructive Pulmonary
Disease (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.

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BFOM 38 Team
3rd Year 2nd Semester Medicine 1

Physical examination for copd:

• Airflow obstruction :
1- Wheezing during auscultation 2-Prolongation of forced expiratory time
• Hyperinflation of lungs :
1- Low diaphragmatic position 2-Decreased intensity of heart and breath sounds
• Severe disease:
1-Pursed-lip breathing.
2- Use of accessory respiratory muscles
3- Retraction of intercostal spaces.

Common symptoms of copd:

1-increased sputum(mucus or phlegm).
2-chest tightness. 3-persistent cough.
4-wheezing. 5-shorteness of breath.

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3rd Year 2nd Semester Medicine 1

Assessment Criteria Refined:

-Assessment refined to separates spirometric from comprehensive symptom evaluation:
• Consider COPD in any patient with dyspnea. chronic cough or sputum production and/or a
history of exposure to risk factors for COPD.
• Spirometry required for diagnosis : Post-bronchodilator FEV,/FVC <0.70 confirms persistent
airflow limitation.

Manage stable COPD:

1-non pharmacological:
➢ Smoking cessation ➢ Pulmonary rehabilitation
➢ Physical activity ➢ Vaccination: flu/Pneumococcal
2-Pharmacologic Therapy:
➢ Beta2-agonists : 1- Short-acting beta2-agonists 2 - Long-acting betas-agonists
➢ Anticholinergics : 1-Short-acting anticholinergics 2- Long-acting anticholinergics
➢ Corticosteroids : • Inhaled Corticosteroids.
➢ Inhaled Combination:
a. Short-acting beta 2 agonists+ anticholinergics
b. Long acting beta2 agonists +anticholinergic
c. Long acting beta2-agonists +corticosteroids
➢ Others : Methylxanthene and phosphodiesterase inhibitors.
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3rd Year 2nd Semester Medicine 1

Gold follow up pharmacological treatment:

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3rd Year 2nd Semester Medicine 1

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BFOM 38 Team
3rd Year 2nd Semester Medicine 1

Mechanical Ventilatory Support:

*The initiation of noninvasive positive-pressure
ventilation (NIPPV) in patients with respiratory
failure, defined as Paco2 >45 mmHg, results in
a significant reduction in mortality rate, need
for intubation, complications of therapy, and
hospital length of stay.
*Contraindications to NIPPV include
cardiovascular instability, impaired mental status,
inability to cooperate, copious secretions or the
inability to clear secretions, craniofacial abnormalities
or trauma precluding effective fitting of mask,
extreme obesity, or significant burns.
*Invasive (conventional) mechanical ventilation via
an endotracheal tube is indicated for patients with
severe respiratory distress despite initial therapy,
life-threatening hypoxemia, severe hypercarbia
and/or acidosis, markedly impaired mental status, resp. arrest, hemodynamic instability, or
other complications.
*The mechanical ventilation is to correct the aforementioned Factors to consider during
mechanical ventilatory support include the need to provide sufficient expiratory time in patients
with severe airflow obstruction and the presence of auto-PEEP (positive end-expiratory
pressure), which can result in patients having to generate significant respiratory effort to trigger
a breath during a demand mode of ventilation.
*The mortality rate of patients requiring mechanical ventilatory support is 17-30% for that
particular hospitalization.
*For patients aged >65 admitted to the intensive care unit for treatment, the mortality rate
doubles over the next year to 60P/o, regardless of whether mechanical ventilation was required.
Following a hospitalization for COPD, about 20% of patients are re-hospitalized in the
subsequent 30 days and 45% are hospitalized in the next year.
*Mortality following hospital discharge is about 20% in the following year.

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