CHRONIC OBSTRUCTIVE

PULMUNARY DISEASE
What is COPD?
 A LUNG disease characterized by airflow limitation
that is not fully reversible.
 Sometimes referred to as chronic airway obstruction
or chronic obstructive disease.
 The airflow limitation is usually progressive and
associated with an abnormal inflammatory response
of the lung to noxious particles or gases, resulting in
narrowing of airways, hypersecretion of mucus, and
changes in the pulmonary vasculature.
• Ranks as the seventh top cause
of death in the Philippines.
• The Global Burden of Disease
Study reports a prevalence of
251 million cases of COPD
globally in 2016.
Globally, it is estimated that 3.17
million deaths were caused by the
disease in 2015 (that is, 5% of all deaths
globally in that year).

• More than 90% of COPD deaths occur

in low­and middle­income countries
• 2020-COPD is estimated to be the 3rd
leading cause of of death and 5th
leading cause of disability.
(Sin,Mclister,Man,et al 2003)
 CAUSES OF COPD
 smoking pipes, cigars, and other types of
tobacco
 second-hand smoke
 Prolonged and intense exposure to occupational
dusts and chemicals,
indoor air pollution, and outdoor air
pollution
Genetic abnormalities, including a
deficiency of alpha1-
antitrypsin, an enzyme inhibitor that
normally counteracts the destruction of
lung tissue by certain other enzymes
Signs and Symptoms
• Shortness of breath, especially during
physical activities
• Wheezing
• Chest tightness
• Having to clear your throat first thing in the
morning, due to excess mucus in your lungs
• A chronic cough that may produce mucus
(sputum) that may be clear, white, yellow or
greenish
• Blueness of the lips or fingernail beds (cyanosis)
• Frequent respiratory infections
• Lack of energy
• Unintended weight loss (in later stages)
CONDITIONS IN COPD
Chronic bronchitis
a disease of the airways, is defined
as the presence of cough and
sputum production for at least 3
months in each of 2 consecutive
years.
normal chronic bronchitis
Emphysema
 -impaired oxygen and carbon dioxide exchange results from destruction
of the walls of overdistended alveoli.
 Emphysema is a pathologic term that describes an abnormal
distention of the airspaces beyond the terminal bronchioles and
destruction of the walls of the alveoli (GOLD, 2008).
 This is the end stage of a process that progresses slowly for many years.
As the walls of the alveoli are destroyed (a process accelerated by
recurrent infections), the alveolar surface area in direct contact with
the pulmonary capillaries continually decreases.
 This causes an increase in dead space (lung area where no gas exchange
can occur) and impaired oxygen diffusion, which leads to hypoxemia.
1. panlobular (panacinar)
type of emphysema, there is destruction of the
respiratory bronchiole, alveolar duct, and alveolus.
2. centrilobular emphysema
the pathologic changes occur in the lobule,
whereas the peripheral portions of the acinus are
preserved
Panlobular
emphysema
(PLE)

normal
Centrilobular
emphysema (CLE)
Barrel chest
chronic hyperinflation leads to the
“barrel
chest” thorax configuration. This
configuration results from a
more fixed position of the ribs in the
inspiratory position (due
to hyperinflation) and from loss of
lung elasticity
PATHOPHYSIOLOGY
 airflow limitation is both progressive and associated with an
abnormal inflammatory response of the lungs to noxious
particles or gases. Inflammatory response occurs throughout
the proximal and peripheral airways, lung parenchyma, and
pulmonary vasculature (GOLD, 2008)

 Because of the chronic inflammation and the body’s attempts

to repair it, changes and narrowing occur in the airways. In
the proximal airways (trachea and bronchi greater than 2 mm
in diameter), changes include increased numbers of goblet
cells and enlarged submucosal glands, both of which lead to
hypersecretion of mucus.
 .
 In the peripheral airways , inflammation causes thickening of the
airway wall, peribronchial fibrosis, exudate in the airway, and
overall airway narrowing (obstructive bronchiolitis).

 Over time, this ongoing injury-and-repair process causes scar

tissue formation and narrowing of the airway lumen (GOLD,
2008).

 Inflammatory and structural changes also occur in the lung

parenchyma (respiratory bronchioles and alveoli). Alveolar wall
destruction leads to loss of alveolar attachments and a decrease
in elastic recoil.
Finally, the chronic inflammatory process affects the
pulmonary vasculature and causes thickening of the lining
of the vessel and hypertrophy of smooth muscle, which
may lead to pulmonary hypertension.
Processes related to imbalances of substances (proteinases and
antiproteinases) in the lung may also contribute to airflow
limitation. When activated by chronic inflammation, proteinases
and other substances may be released, damaging the
parenchyma of the lung. These parenchymal changes may also
occur as a consequence of inflammation or environmental or
genetic factors (eg, alpha1-antitrypsin deficiency).
 COMPLICATIONS
Respiratory Failure- condition in which your blood
doesn't have enough oxygen or has too much carbon
dioxide.
Acute respiratory distress syndrome (ARDS)
ARDS is a life-threatening condition in which severe
inflammation of the lungs causes fluid to leak into the
blood vessels in the airways
 3.Heart failure- is when the heart muscle cannot pump
blood efficiently through the body. It is a progressive
condition that can occur on the right or left side of the heart
or on both sides. Heart failure that occurs in people with
COPD is commonly right-sided.
4.Pneumonia -is an infection that causes inflammation of
the lungs. It can result from a viral, bacterial, or fungal
infection. People with lung diseases, such as COPD, are
more likely to develop pneumonia and other lung
infections.
DIAGNOSTIC TEST
• Spirometry is used to evaluate airflow obstruction, which is determined by
the ratio of FEV1 to forced vital capacity (FVC).
A lung function test to measure breathing capacity and how well you breathe. You
will breathe into a device called a spirometer.
• Arterial blood gas measurements-Measurements of blood pH and of arterial
oxygen and carbon dioxide tensions are obtained when managing patients with
respiratory problems and in adjusting oxygen therapy as needed. The arterial
oxygen tension (PaO2) indicates the degree of oxygenation of the blood, and the
arterial carbon dioxide tension (PaCO2) indicates the adequacy of alveolar
ventilation
• chest x-ray-Your doctor may do a chest X-ray to rule out any other diseases
that may be causing similar symptoms.
MEDICAL MANAGEMENT
• Smoking cessation-is the single most cost-effective interventionto
reduce the risk of developing COPD and to stop its progression.
• Bronchodilators-relieve bronchospasm by altering smooth
muscle tone and reduce airway obstruction by allowing increased
oxygen distribution throughout the lungs and improving alveolar
ventilation. METERED-DOSE INHALERS
• Corticosteroids- suppress inflammation
• antibiotic agents mucolytic agents
antitussive agents vasodilators,

• oxygen therapy
• Bullectomy-A bullectomy is a surgical option for select patients with
bullous emphysema
• Lung Volume Reduction Surgery-removal of a portion of the
diseased lung parenchyma
• Lung Transplantation
• Lung transplantation- is a viable option for definitive surgical
treatment of end-stage emphysema. It has been shown to improve
quality of life and functional capacity in a selected group of patients
with COPD
Nursing Management
• Assessing the Patient
Assessment involves obtaining information about current
Symptoms as well as previous disease manifestations.
• Achieving Airway Clearance
the nurse must administer the
medications properly and be alert for potential side
effects
• Improving Activity Tolerance
strengthen the muscles of the upper and lower
extremities and to improve exercise tolerance
and endurance. Use of walking aids may be
recommended to improve activity levels and
ambulation
• Monitoring and Managing Potential Complications
The nurse must assess for various complications of COPD,
such as life-threatening respiratory insufficiency and failure,
as well as respiratory infection and chronic atelectasis,which
may increase the risk of respiratory failure. The
nurse monitors for cognitive changes (personality and
behavioralchanges, memory impairment), increasing
dyspnea,tachypnea, and tachycardia, which may indicate
increasing hypoxemia and impending respiratory failure.
O2 SAT
• Promoting Home and Community-Based Care.
Teaching Patients Self-Care
When providing instructions about self-management, it is
important for the nurse to assess the knowledge of patients
and family members about self-care and the therapeutic
regimen
  THANK YOU  