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Chronic Obstructive Pulmonary Disease: Copd: Dr. Tjatur Winarsanto SPPD
Chronic Obstructive Pulmonary Disease: Copd: Dr. Tjatur Winarsanto SPPD
Disease of airflow
obstruction that is not
totally reversible
Chronic
Bronchitis
Emphysema
COPD: Etiology
Cigarette smoking #1
Recurrent respiratory infection
Alpha 1-antitrypsin deficiency
Aging
Def: Chronic Bronchitis
Excessive tracheobronchial mucus
production sufficient to cause cough with
expectoration for most days of at least 3
months of the year for 2 consecutive years.
Classification:
1. Simple chronic bronchitis
2. Chronic mucopurulent bronchitis
3. Chronic bronchitis with obstruction
4. Chronic bronchitis with obstruction and
airway hyperreactivity.
Chronic Bronchitis
Recurrent or chronic productive
cough for a minimum of 3 months
for 2 consecutive years.
Risk factors
Cigarette smoke
Air pollution
Chronic Bronchitis
Pathophysiology
Chronic
inflammation
Hypertrophy &
hyperplasia of
bronchial glands
that secrete mucus
Increase number of
goblet cells
Cilia are destroyed
Chronic Bronchitis
Pathophysiology
Narrowing of
airway
Starting w/ bronchi
smaller airways
airflow resistance
work of breathing
Hypoventilation &
CO2 retention
hypoxemia &
hypercapnea
Chronic Bronchitis
Pathophysiology
Bronchospasm often occurs
End result
Hypoxemia
Hypercapnea
Polycythemia (increase RBCs)
Cyanosis
Cor pulmonale (enlargement of right side of
heart)
Chronic Bronchitis:
Clinical Manifestations
In early stages
Clients may not recognize early symptoms
Symptoms progress slowly
May not be diagnosed until severe episode
with a cold or flu
Productive cough
Especially in the morning
Typically referred to as cigarette cough
Bronchospasm
Frequent respiratory infections
Chronic Bronchitis:
Clinical Manifestations
Advanced stages
Dyspnea on exertion Dyspnea at rest
Hypoxemia & hypercapnea
Polycythemia
Cyanosis
Underweight
FEV1/FVC <70%
30% <FEV1 <50% predicted
With or without chronic
symptoms (cough, sputum
production)
Stage IV Very Severe
COPD
FEV1/FVC <70%
FEV1 <30% predicted or FEV1
<50% predicted plus chronic
respiratory failure
Goals of Treatment:
Emphysema & Chronic
Bronchitis
Improved ventilation
Remove secretions
Prevent complications
Slow progression of signs &
symptoms
Promote patient comfort and
participation in treatment
Collaborative Care:
Emphysema & Chronic
Bronchitis
Treat respiratory infection
Monitor spirometry and PEFR
Nutritional support
Fluid intake 3 lit/day
O2 as indicated
Collaborative Care:
Medications
Anti-inflammatory
Corticosteroids
Bronchodilators
Beta-adrenergic agonist: Proventil
Methylxanthines: Theophylline
Anticholinergics: Atrovent
Mucolytics:
Expectorants:
Antihistamines:
Collaborative Care:
Emphysema & Chronic
Bronchitis
Client teaching
Support to stop smoking
Conservation of energy
Breathing exercises
Pursed lip breathing
Diaphragm breathing
Chest physiotherapy
Percussion, vibration
Postural drainage
Self-manage medications
Inhaler & oxygen equipment
Therapy by Stage- Pretty
Simple
Bronchodilators
Beta2-agonists
Short-acting
Fenoterol
Salbutamol (albuterol)
Terbutaline
Long-acting
Formoterol
Salmeterol
Bronchodilators
Anticholinergics
Mode of Action
Cholinergic tone is only reversible component
of COPD
Normal airway have small degree of vagal
cholinergic tone
Short-acting
Ipratropium bromide
Oxitropium bromide
Long-acting
Tiotropium
Combos and
Methylxanthines
Methylxanthines
Aminophylline (slow release preparations)
Theophylline (slow release preparations)
RARELY OF SIGNIFICNAT BENEFIT
LEVEL 8-12 mcg/ml