Dr. M Abdur Rahim M.D.

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Asst. Professor of Medicine

COPD
‡ Defined as Preventable & treatable Lung Disease with some significant Extrapulmonary effects. ‡ Pulmonary component is characterised by airflow limitation that is not fully reversible

‡ Air flow limitation is usually progressive & associated with an abnormal inflammatory response of the lung to noxious particles or gases ‡ Related Diagnosis are 1. Chronic Bronchitis 2. Emphysema

.CHRONIC BRONCHITIS : ‡ Cough & Sputum on most days for atleast 3 consecutive months for atleast 2 successive years.

.EMPHYSEMA : ‡ Abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompnied by destruction of their walls & without obvious fibrosis.

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Extra Pulmonary Manifestations .

EPIDEMOILOGY : ‡ Tobacco smoking & Biomass fuels ‡ 80 million people .

AETIOLOGY .

during exercise as the time available for expiration shortens. .PATHOPHISIOLOGY ‡ Changes in Pulmonary & chest wall compliance mean that collapse of Intrathoracic airways during expiration is exacerbated. results in dynamic hyperinflation.

‡ Increased V/Q mismatch. increases the dead space & wasted ventilation. ‡ Flattening of the diaphragmatic muscles and an increasingly horiziontal alignment of IC muscles place the respiratory muscles at a mechanical disadvantage. .

. as disease advances at rest too.‡ Work of breathing is therefore markedly increased first on exercise.

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‡ Emphysema is classified by the pattern of the enlarged airspaces Centriacinar Panacinar Periacinar .

‡ Cough and associated sputum production are usually the first symptoms.Clinical features : ‡ COPD is suspected in patients > 40 yrs who have symptoms of Chronic Bronchitis and or Breathlessness.Smoker s Cough .

‡ Haemoptysis may complicate exacerbations of COPD. ‡ Breathelessness-first presentation.

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‡ Presence of oedema (first during exacerbation). ‡ Morning headache(hypercapnia)

Physical Signs .

Classical Phnotypes : Pink Puffers Thin & Breathless Blue bloaters Hypercapnia Oedema & Secondary polycythaemia .

INVESTIGATIONS ‡ CXR ‡ Full Blood Count ‡ Alpha 1.antiproteinase assay ‡ Air flow obstruction by Spirometry & Postbronchodilator FEV1 (< 80%) .

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‡ Helium dilution Technique ‡ Body Plethysmography ‡ Pulse Oximetry ‡ HRCT .

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MANAGEMENT ‡ Smoking Cessation ‡ BronchodilatorsBeta2 agonist & Anticholenergic Inhaled Oral ‡ Corticosteroids ‡ Pulmonary Rehabilitation .

.‡ O2 Therapy ‡ Surgical Invtervention Bullectomy LVRS Lung Transplantation ‡ Annual Influenza vaccination. Pneumococcal Vaccination.

Prognosis : BODE Index .

Acute Exacerbation of COPD ‡ Characterised by an increase in symptoms and deterioration in lung function and health status. ‡ Common as the disease progresses & caused by Bacteria Viruses or Change in Air quality .

BRONCHIECTASIS ‡ Abnormal dilatation of the Bronchi Chronic suppurative airway infecion with sputum production Progressive scarring and lung damage .

Aetiology .

Clinical Features .

SIGNS : Coarse Crackle s Bronchial Breathing .

INVESTIGATIONS : ‡ Bacteriological & Mycological examination of sputum ‡ Radiological ExaminationCystic Bronchiectasis spaces ‡ Assessment of Ciliary Function .

Management : ‡ Inhaled Bronchodilators & Corticosteroids ‡ Physiotherapy ‡ Antibiotic Therpy ‡ Surgical Treatment Excision .

Prevention : ‡ ‡ ‡ Measles Wooping Cough Primary TB .

or a cavity lined by chronic inflammatory tissue. from which pus has escaped by rupture into a bronchus .LUNG ABSCESS ‡ Lesions in which there is a large localised collection of pus.

‡ Often develop after the inhalation of septic material during operations on the nose. particulary if oral hygiene is poor. mouth or throat under general anasthesia or vomitus during anaesthesia or coma. .

‡ Complicate local bronchial obstruction from a neoplasm or foreign body ‡ Infections are a mixture of anaerobes & aerobes. ‡ Bacterial infection of a pulmonary infarct or a collapsed lobe may also produce Lung Abcess ‡ Lemierre s Syndrome .

Lemierre s Syndrome ‡ Rare cause of Lung Abscesses ‡ Caused by anaerobe Fusobacterium Necrophorum ‡ Presents as sore throat painful swollen neck. rigor. haemoptysis and dyspnoea ‡ Spread into the Jugular Veins leads to Thrombosis . fever.

Clinical Features : .

INVESTIGATIONS : ‡ CXR.Cavitation & Fluid level ‡ Sputum and Blood Culture .

TREATMENT : ‡ Amoxycillin 6th Hrly ‡ Clindamycin. Tetracyclines and Linezolid ‡ 4-6 weeks ‡ Physiotherapy .

TUMOURS OF THE BRONCHUS & LUNG ‡ ‡ ‡ ‡ ‡ ‡ Lung Cancer common 1.4 million deaths Tobacco use 18% of all Cancer deaths 30 % at 1st year 6-8 % at 5 Year .

PRIMARY TUMOURS OF LUNG AETIOLOGY : Cigarette Smoking 90 % of lung carcinoma Naturally occuring radon Atmospheric Pollution(Urban>Rural) .

BRONCHIAL CARCINOMA ‡ Arise from Bronchial epithelium or Mucous glands .

Common Cell types in Bronchial Carcinoma Cell Type Squamous Adenocarcinoma Small cell Large Cell % 35 30 20 15 .

. results in delayed diagnosis.‡ Tumours occuring in large bronchus causes symptoms early ‡ Peripheral bronchus tumours grow very large without producing symptoms.

‡ Peripheral Squamous tumours undergo central necrosis & cavitation resemble a Lung abscess on CXR .

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adrenals & skin. bone.‡ May involve pleura either directly or by Lymphatic spread ‡ Chest Wall extension by invading intercostal nerves or the Brachial Plexus causing Pain ‡ Blood borne metastases occur commonly in liver. brain. .

CLINICAL FEATURES : ‡ ‡ ‡ ‡ Cough Haemoptysis Pleural Pain Bronchial Obstruction .

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Confirm Diagnosis .Extent of the disease Imaging : CXR CT .Establish Histological Cell type .INVESTIGATIONS .

Radiologic presentation .

HISTOLOGICAL CHARACTERISATION ‡ ‡ ‡ ‡ ‡ Flexible bronchoscope Percutaneous Needle biopsy 3 Sputum Samples Pleural Effusion Aspiration & Biopsy Thoracoscopy .

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Needle Aspiration/Biopsy.LN.Skin lesions .

Management : Surgical treatment Radiotherapy Chemotherapy .

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