COPD

Dr. C.P. Acharya

COPD
 Definition
• Chronic obstructive pulmonary disease (COPD) is a preventable and treatable
disease state characterized by airflow limitation that is not fully reversible.

• The airflow limitation is usually progressive and is associated with an abnormal

inflammatory response of the lungs to noxious particles or gases, primarily
caused by cigarette smoking.

• Although COPD affects the lungs, it also produces significant systemic

consequences.
 COPD: General facts

• Major cause of death and disability

• 4th leading cause of death

• COPD is the only chronic disease that is showing progressive

upward trend in both mortality and morbidity.

• It is expected to be the third leading cause of death by 2020.

• Emphysema

- Emphysema is pathologically defined as an abnormal permanent

enlargement of air spaces distal to the terminal bronchioles,
accompanied by destruction of alveolar walls .
• Chronic Bronchitis

- Chronic Bronchitis which is defined clinically as cough with sputum

expectoration for at least 3 month a year during a period of 2 consecutive years.
It is associated with hypertrophy of mucus producing gland in the mucosa of
large cartilaginous airway.
 Risk factors for COPD
• Tobacco smoking 90% (most common cause), 15% of smoker develop
• Smoke from home cooking and heating fuel
• Occupational dust and chemicals
• Gender: More common in men. M:F ratio is 5%:2.7% (in India) and12.4%:5.4% (in
China)
• Increasing age(FEV1 Start to decline at the age of 30-35yrs), nearly 30ml per year
• ★ Others:

• Infection, nutrition, socioeconomic status and deficiency of alpha1

antitrypsin(Genetic)
 Symptoms

• Cough and mucoid sputum

• Dyspnea-slowly progressive
• Wheeze
• Edema (If corpulmonale)
• Winter exacerbations
• Extra pulmonary manifestations, Cardiac, Musculoskeletal, Neuro
 Key indicators for COPD diagnosis
Chronic cough Present intermittently or every day often present
throughout the day; seldom only nocturnal
Chronic sputum production Present for many years, worst in winters. Initially
mucous sputum
becomes purulent with exacerbation
Dyspnea that is Progressive (worsens over time)
Persistent (present every day)
Worse on exercise
Worse during respiratory infections

Acute bronchitis Repeated episodes

History of exposure to risk factors Tobacco smoke
occupational dusts and chemical smoke from home
cooking and heating fuel
Diagnosis

I. History

II. LAB

a) CBC

b) CXR

c) Sputum

d) CECT Chest

III. Gold Standard:- Spirometry

 Pulmonary function testing
Spirometry
• Diagnosis
• Assessing severity
• Assessing prognosis
• Monitoring progression
• FEV1 – Forced expired volume in the first second

• FVC – Total volume of air that can be exhaled from maximal inhalation to
maximal exhalation

• FEV1/FVC% – The ratio of FEV1 to FVC, expressed as a percentage.

 4 COPD classification based on Spirometry
Severity Post bronchodilator Post bronchodilator FEV1%
FEV1/FVC % predicted

At risk (0 stage) >70 >80

Mild (1 stage) <70 >80
Moderate < 70 50-80
(2 stage)
Severe (3 stage) < 70 30-50

Very severe < 70 <30

(4 stage)

SPIROMETRY is not to substitute for clinical judgment in the evaluation of the

severity of disease in individual patients.
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
 Smoking cessation

• Stops accelerated decline in FEV1

• Improves possibility of oxygen therapy benefits

• 3-6 months after quitting: end of cough/phlegm production

• 1 year: lung function increased 30mls

• 1 year: risk of Small Cell Lung Cancer halved

 Contd….

• 5 years: risk of any lung cancer halved

• No progression of COPD
• Sporting performance enhanced

• Methods of smoking cessation

• Counseling; Nicotine replacement; Behavior modification
© 2020 Global Initiative for Chronic Obstructive Lung Disease
Pulmonary Rehabilitation
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
THANK YOU