COPD

D R A B D U L G H A N I WA S E E M
D efinition
⚫ A disease state characterized by the
presence o f airflow obstruction d u e to
ch ro nic bronchitis or e m p hy s e m a ; the
airflow obstruction is generally
progressive, m a y be a c c o m p a n i e d by
airflow hyperactivity, a n d m a y be viewed
as partially reversible.

⚫ Includes e m p h y s e m a a n d c hro nic

bronchitis
Types of C O P D

⚫ C h r o n i c Bronchitis
⚫ Presence o f a c o u g h productive o f s p u t u m
o n m o s t days for at least 3 m o n t h s over 2
consecutive years

⚫ Emphysema
⚫ Per m a n en t a n d destructive enla rg ement o f
airspaces distal to the terminal bronchioles without
obvious fibrosis a n d with loss o f n o r m a l
architecture.
Pathogenesis of C O P D
⚫ Increased n u m b e r o f activated
p o ly m o r p h o n u c l e a r cells a n d
ma cro p h a ge s p ro du c e elastases (such as
h u m a n leukocyte elastase), resulting in
lung destruction.

⚫ Increased oxidative stress caused by free

radicals in cigarette smoke , the oxidants
released by phagocytes, a n d
p o ly m o r p h o n u c l e a r leukocytes all m a y
lead to apoptosis or necrosis o f
exp osed cells
COPD
Risk Factors
⚫ SMOKING

⚫ O c c u p a t i o n a l Exposures
⚫ Dusts, gases, f u m e s

⚫ Alpha1-antitrypsin d efic ienc y

⚫ Alpha1-antitrypsin is an important
protease inhibitor that usually
presents elastases f r o m causing l ung
destruction
C L I N I C A L F E AT U R E S
⚫ Dyspnea
⚫ C o u g h (usually worse in m o r n i n g , s p u t u m
production)
⚫ Wheezing
⚫ Cyano sis
⚫ We igh t loss, anorexia
⚫ R igh t heart failure
Physical Exam

⚫ General:
⚫ Barrel-chest, accessory m u s c l e use
⚫ Resp:
⚫ Decreased breath sounds, wheezing,
rh o nc h i, crackles
Diagnosis of C O P D
⚫ L o o k for secondary po lyc yth em ia:
⚫ H c t >52% in males, Hct>47% in females.

⚫ Measure alpha1-antitrypsin levels in all

patients 40 years or younger, or in those
with f a m i ly history.

⚫ H y p e r in flati o n seen o n chest x-ray.

⚫ Bullae seen o n C h e s t x-ray or C T scan

I N V ES T I G AT I O N S
⚫ CBC: ↑
H gb /H c t .

⚫ ABG: ↓pH,
↑pCO2 .

⚫ C h e m i s tr y : ↑ H C O 3
X R AY C H E S T
Treatment of C O P D
⚫ S M O K I N G C E S S AT I O N .

⚫ Short-acti ng bronchodilators
⚫ S alb u t amo l , albuterol

⚫ L o n g - a c t i n g bronchodilator
⚫ Salmeterol

⚫ C o m b i n a t i o n o f anti-cholinergic a n d β-agonist bronchodilator

⚫ Ipratropi u m + albuterol (combivent)
Treatment of C O P D
⚫ Met hyl xa nt hi ne s (Theophylline)
⚫ H a s an t i - i nfl a m m at o r y affect, a nd i mp roves respiratory mu sc le fu nc t i on,
stimulates the respiratory center, a nd p ro motes bronc hodi lation
⚫ Adverse effects i nc lude anxiety, tremors, i nsomni a, nausea, cardiac
arrhythmi a, an d seizures

⚫
⚫ In hal ed corticosteroids
⚫ Fluticasone (Flovent), b ud eso ni d e (Pulmicort)

⚫ C o m b i n a t i o n o f In hal ed corticosteroid a n d long-acting

β-agonist
⚫ Fluticasone + salmeterol (Advair)

⚫ O ra l Corticosteroids
Treatment of C O P D (cont.)
⚫ O x y g e n T h e ra py
⚫ C o n t i n o u s ox yg e n has be en shown to cut mortality in
half or decrease m o rb i d i t y w h e n c o m p a r e d with
n o n - c o n t i n o u s ox yg e n
C O P D Exacerbati on
⚫ Ty pical ly manifest as increased s p u t u m production, m o r e
purulent s p u t u m a n d worsening o f dyspnea.

⚫ A l t h o u gh infectious etiologies account for m o s t exacerbations,

exposure to allergens, pollutants or inhaled irritants m a y also
play a role.

⚫ Bacterial infection is a factor in 70 to 75 percent o f

exacerbations, with u p to 6 0 percent caused by
⚫ Streptococcus pneumoniae
⚫ Haemophilus influenzae
⚫ Moraxella catarrhalis
C O P D Exacerbati on
⚫ Antibiotic therapy has a small but important effect o n
clinical recovery a nd o u tc o m e .
⚫ Respiratory fl u o ro q u i n o l on e (Levofloxaci n, Mox ifloxac i n)
⚫ C eftri axone + azi t h romyc i n

⚫ Sh o r t courses o f systemic corticosteroids m a y provide

import an t benefits in patients with exacerbations o f C O P D .

⚫ O x y g e n therapy to keep saturation Between 90-93%

⚫ Non-i nvasive ventilation such as B i PA P can be helpful

in avoiding intubation/mechanical ventilation.
T hank you