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COPD

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Martina S., Selda S., Sarah A.G., Dina H., Sonia C.


UMFT Victor Babes`
1.PATIENT DATA

I.M., 47 years old, male


Risk Factors
male sex
age >40
smoker (until 2012: 40 cig./d, now: 5 cig./d)
mineworker for 18 years occupational dust (SiO2)
BMI: 30
Reasons for admission
dyspnea orthopnea
severe cough
Personal medical history
Silicosis (2012)
Symptomatology appeared gradually since 2012
Main Symptoms:
Orthopnea
severe dry cough syncope
fatigability
sweating
chest tightness
2.PATIENT EXAMINATION

Height 1,73m, weight 91kg, BMI 30,4


abdominal obesity gr. I
reddish skin colour
smoker (5 cig./d)
HR: 80bpm, saturation 97%, BP 110/80
auscultation:
Inspiratory wheezing
Basal crackles
3. PRESUMED DIAGNOSIS

Q1: Based on the patients symptoms (orthopnea,


dry cough, fatigue, sweating) and medical history
which of the following could be a possible diagnosis

a. Lung Embolism
b. Congestive Heart failure
c. COPD
d. Pneumonia
COPD

Chronic Obstructive Pulmonary Disease

A progressive nonreversible disease


that affects the lungs, making it
difficult to breathe
COPD: AN UMBRELLA TERM

Umbrella term used to describe progressive


lung diseases which include:

Emphysema
Chronic bronchitis
Refractory (irreversible) asthma
Severe bronchiectasis
COPD

Chronic obstructive pulmonary disease (COPD) is a


lung ailment that is characterized by a persistent
blockage of airflow from the lungs.

It is an under-diagnosed, life-threatening lung


disease that interferes with normal breathing and is
not fully reversible.
UNDERSTANDING COPD

Critical to first understand normal lung function

Image courtesy of The National Institute of health


LUNG STRUCTURE AND FUNCTION

Biological Science Freeman, 2010


LUNGS WITH COPD

Image courtesy of The National Institute of health


CAUSES

Most cases of COPD occur as a result of long-term


exposure to lung irritants that damage the lungs and
the airways

The most common irritant that causes COPD is


cigarette smoke

In rare cases, a genetic condition called alpha-1


antitrypsin deficiency may play a role in causing
COPD
WHO IS AT RISK?

People who smoke or are exposed to smoke

People who have a family history of COPD are more


likely to develop the disease if they smoke

Long-term exposure to other lung irritants also is a risk


factor for COPD

Almost 90% of COPD deaths occur in low- and middle-


income countries, where effective strategies for
prevention and control are not always implemented or
accessible.
SYMPTOMS

breathlessness
abnormal sputum (a mix of saliva and mucus in the
airway)
a chronic cough
daily activities can become very difficult as the
condition gradually worsens
5. DIFFERENTIAL DIAGNOSIS

Q2: Which of the following is a disease known to


have similar symptoms ?

a. Alpha1-antitrypsin deficiency
b. Congestive Heart failure
c. Gastroesophageal reflux disease
d. Acute Tonsilitis
6. TESTS & INVESTIGATIONS

Q3: Which of the following sets of test and


investigations would you order for differential
diagnosis?

a. X-ray
b. Spirometry
c. CT
d. Audiogram
DIAGNOSIS

A simple diagnostic test called


"spirometry measures how much air a person can
inhale and exhale, and how fast air can move into
and out of the lungs

Spirometry can detect


COPD long before its
Symptoms appear.
6. PATIENTS RESULTS

Hematology:
HCT
HB
RBC
polyglobulinemia
TG
Chol.
LDL
Dislipidemia
Spirometry
FVC: 58%
FEV1: 48%
Ratio: 67.7%
FEF 25-75%: 34
PEF: 28
mixed ventilatory dysfunction
Bronchodilator Test
FVC : 46 60
FEV1: 42 53

NEGATIVE (<15)
XRAY
regular micro reticulonodular bilateral masses (silicosis)
pulmonary fibrosis

ECG
Sinus rhythm
HR: 80
Axis: 65
Neg. P-wave in V1 + V2
P-pulmonale
MRC BREATHLESSNESS SCALE

Grade 4
CAT SCORE

28
7. POSITIVE DIAGNOSIS

COPD: chronic bronchitis


Silicosis
Buccal Candidosis (inhalator abuse)
Q3 Which the following medications is used as a
treatment for COPD?

a. short-acting beta-agonists
b. Beta-blocker
c. mucolytics
d. long-acting beta-agonists
TREATMENT

COPD has no cure

Quitting smoking is the most important step an


individual can take to treat COPD

Other treatments for COPD may include medicines,


vaccines, pulmonary rehabilitation (rehab), oxygen
therapy, and surgery
Inhaled long-acting beta-agonists
Inhaled corticosteroids
Inhaled anticholingerics
8.PATIENTS MEDICATION

1. Spiriva 18 ug 1-0-1
anticholinergic
2. Ventoline 100 ug when needed
Salbutamol
3. Symbicort 1- 0-0
bronchodilator
4. Teotard 220mg 1 puff until 5pm (S.E. palpitations)
bronchodilator
MANAGING COPD

COPD symptoms usually slowly worsen over time

A cold, the flu, or a lung infection may cause


symptoms to intensify

Prescription antibiotics may treat infections and


other medicines, such as bronchodilators and
inhaled steroids, can help facilitate breathing
MANAGING COPD

Avoid lung irritants

Get ongoing care

Manage the disease and its symptoms

Prepare for emergencies


PROGNOSIS (BODE INDEX)

a BODE score greater than 7 is associated with a 30


percent 2-year mortality
A score of 5 to 6 is associated with 15 percent 2-
year mortality
If score is less than 5 the 2-year mortality is less than
10 percent
7 points 18% 5 year survival
COPD: STATISTICS

The National Heart, Lung, and Blood Institute (NHLBI)


estimates that 12 million adults have COPD, and
another 12 million are undiagnosed or developing
COPD

Estimated that over 210 million people worldwide


have COPD
COPD: STATISTICS

A person with COPD dies every four minutes

COPD will be the third leading cause of death in


the U.S. by 2020
WHO RESPONSE

Raise awareness about the global epidemic of


chronic diseases
Create more healthy environments, especially for
poor and disadvantaged populations
Decrease common chronic disease risk factors, such
as tobacco use, unhealthy diet and physical
inactivity
Prevent premature deaths and avoidable disabilities
from major chronic diseases
SOURCES

The World Health Organization


http://www.who.int/mediacentre/factsheets/fs315/en/
The COPD Foundation
http://www.copdfoundation.org/
The US Department of Health and Human Services
http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Co
pd_WhatIs.html
National Heart Lung and Blood Institute
http://www.nhlbi.nih.gov/health/public/lung/other/copd
_breathe.htm
Center for Disease Control and Prevention
http://www.cdc.gov/