COPD

(Chronic Obstructive Pulmonary Disease)

 A common lung disease.
Having COPD makes it hard to breathe.

2 types of COPD
1. Chronic Bronchitis- involves a long-term cough with mucus.
2.  Emphysema - involves damage to the lungs over time.

CHRONIC BRONCHITIS
 The inflamed bronchial tubes produce a lot of mucus. This leads to
coughing and difficulty breathing. Cigarette smoking is the most common
cause. Breathing in air pollution, fumes, or dust over a long period of time
may also cause it.
 Defined as a cough that occurs every day with sputum production that
lasts for at least 3 months, two years in a row. 
 Many of the bronchi develop chronic inflammation with swelling and
excess mucus production. The inflammation causes a change in the lining
cells of the airways to varying degrees.
  The fixed airway obstruction, airway inflammation, and retained secretions
can result in a mismatch of blood flow and airflow in the lungs. This can
impair oxygenation of the blood as well as removal of the waste product,
carbon dioxide.
 Majority of people diagnosed with the disease are 45 years of age or older.

The major signs and symptoms of chronic bronchitis are:

1. Cough and sputum production 
 usually last for at least 3 months and occur daily.
 The intensity of coughing and the amount and frequency of sputum
production vary from patient to patient.
 Sputum may be clear, yellowish, greenish, or occasionally, blood-
tinged.
2. Shortness of breath (dyspnea)
 people with chronic bronchitis get short of breath with activity and begin
coughing
 dyspnea at rest usually signals that COPD or emphysema has
developed.
3. Wheezing 
 (a coarse whistling sound produced when airways are partially
obstructed)

Other signs and symptoms that may accompany chronic bronchitis

include:
 Fatigue
 Sore throat
 Muscle aches
 Nasal congestions
 Headcahes
Signs and symptoms of exacerbation of chronic bronchitis include:
*Exacerbation of chronic bronchitis occurs when symptoms worsen or
become more frequent. These exacerbations often require antibiotics, and
may need steroid medication and an increase in respiratory inhaled
medications.

 Severe coughing that causes chest discomfort or chest pain.

 Cyanosis (bluish/grayish skin coloration) may develop in people with
advanced COPD.
 Fever may indicate a secondary viral or bacterial lung infection.
What are the causes of chronic bronchitis?

 Many other inhaled irritants (for example, smog, industrial pollutants, and
solvents) can also result in chronic bronchitis.)
 Viral and bacterial infections that result in acute bronchitis may lead to
chronic bronchitis if people have repeated bouts with infectious agents
  main cause is cigarette smoke. 
  major risk factor for individuals to develop chronic bronchitis is tobacco
smoking and second-hand tobacco smoke exposure.

When should you see a doctor for chronic bronchitis?

 Ideally, a person should seek medical care before chronic bronchitis

develops. It is reasonable for people to seek care for tobacco addiction
and the occasional chronic cough (occurring less than daily for 3 months)
and to get medical help to potentially avoid developing chronic bronchitis.
However, any daily cough that lasts for at least 3 months in a person
should be investigated by a physician.
 If a person develops chronic (3 months or longer) cough,
difficulty breathing, sputum production, and other symptoms, it may
represent the first bout of chronic bronchitis. Thus, seeking medical care
may help slow or prevent the usual progression of the disease.

If a person with diagnosed chronic bronchitis (or COPD or emphysema) develops

severe problems with breathing, cyanosis , fever, they should seek emergency
medical care immediately.
How is chronic bronchitis diagnosed?

 person's medical history

 physical exam

 diagnostic tests

 chest x-rays

 CT scan of chest

What is the treatment for chronic bronchitis?

 stop smoking cigarettes

 avoid second-hand tobacco smoke

Two major classes of medications are used to treat chronic bronchitis:

1. Bronchodilators (for example, albuterol [Vent Olin, Proventil,

AccuNeb, Vospire, ProAir], metaproterenol [Alupent], formoterol

[Foradil],salmeterol [Serevent]) work by relaxing the smooth muscles that
encircle the bronchi, which allows the inner airways to expand.
Anticholinergic drugs also can act as bronchodilators, including tiotropium
(Spiriva) and ipratropium (Atrovent).
2. Steroids (for example, prednisone, methylprednisolone [Medrol, Depo-

Medrol]) reduce the inflammatory reaction and thus decrease the bronchial
swelling and secretions that in turn allows better airflow because of
reduced airway obstruction. Often inhaled steroids are administered since
they have fewer side effects than systemic (oral) steroids. Examples
include budesonide (Pulmicort), fluticasone (Flovent), beclomethasone
(Qvar), and mometasone (Asmanex). Combination therapy with both
steroids and bronchodilators is often utilized. These include
 fluticasone/salmeterol (Advair), budesonide/formoterol (Symbicort), and
mometasone/formoterol (Dulera).

What medications treat chronic bronchitis? What are other medical

treatments?

 PDE4 inhibitors are a class of anti-inflammatory agents for certain

exacerbations of COPD. 

 Antibiotics: used to treat chronic bronchitis exacerbations caused by

bacterial infections.

A. Fluoroquinolones (levofloxacin [Levaquin])

B. Macrolides (clarithromycin [Biaxin], azithromycin [Zithromax, Zmax])

D. Sulfonamides (sulfamethoxazole and trimethoprim [Bactrim])

D. Tetracyclines (doxycycline [Vibramycin])

What are the complications of chronic bronchitis?

 difficulty breathing, sometimes severe

 respiratory failure
 pneumonia
 Enlargement and weakness of right heart ventricle of the heart caused by
lung disease
 pneumothorax (collection of air or gas in lung causing lung collapse)
 polycythemia (abnormally high concentration of red blood cells needed to
carry oxygen)
 chronic obstructive pulmonary disease (some NIH researchers consider
chronic bronchitis a type of COPD)
  emphysema
 chronic advancement of the disease
 high mortality (death) rate (COPD is the fourth leading cause of death in
the United States)

EMPHYSEMA

 a long-term, progressive disease of the lungs that primarily causes

shortness of breath due to over-inflation of the alveoli (air sacs in the lung)
 the lung tissue involved in exchange of gases (oxygen and carbon dioxide)
is impaired or destroyed.
 loss of elasticity and enlargement of the air sacs in the lung.
 The damage is permanent. The ability to breathe properly cannot be fully
recovered

SYMPTOMS ARE:

 shortness of breath
 chronic cough

In the later stages, the person may have:

 frequent lung infections

 a lot of mucus

 wheezing

 reduced appetite and weight loss

 fatigue

 blue-tinged lips or fingernail beds, or cyanosis, due to a lack of oxygen

 anxiety and depression

 sleep problems

 morning headaches due to a lack of oxygen, when breathing at night is

difficult

Treatment:
 Treatment of COPD and emphysema aims to stabilize the condition and
prevent complications through use of medication and supportive therapy.
 Supportive therapy includes oxygen therapy and help with smoking
cessation

DRUG THERAPIES:

 Inhaled bronchodilators

1. Beta-agonists, which relax bronchial smooth muscle and increase

mucociliary clearance
2. Anticholinergics, or antimuscarinics, which relax bronchial smooth
muscle

Oxygen therapy

 Oxygen therapy improves oxygen delivery to the lungs. Oxygen can be

supplemented by using a range of devices, some of them for home use.

 Oxygen therapy can be administered 24 hours a day or 12 hours at night.

 Patients will be monitored for oxygen saturation to prevent oxygen toxicity

Surgery

 People with severe emphysema sometimes undergo surgery to reduce

lung volume or carry out a lung transplantation.
 Lung volume reduction surgery removes small wedges of the damaged,
emphysematous, lung tissue
  Lung transplantation improves quality of life, but not life-expectancy, for
people with severe emphysema.

Pulmonary rehabilitation and lifestyle management

 Pulmonary rehabilitation is a program of care for people with emphysema.

 It aims to help people improve their lifestyle by quitting smoking, following
a healthful diet, and getting some exercise.
 Drinking plenty of water can help keep the airways clear by loosening the
mucus.
 Exercises that can help improve breathing include diaphragmatic
breathing, purse-lip breathing, and deep breathing.

Causes

 Cigarette smoking is responsible for at least 85 percent of cases of

emphysema and COPD.
  smoke from indoor cooking
 heating is the main cause.

Other contributory risk factors are:

 low body weight

 air pollution

 occupational dust, such as mineral dust or cotton dust

 inhaled chemicals, including coal, grains, isocyanates, cadmium

 childhood respiratory disorders, either a viral infection, or possibly asthma

Types

 paraseptal
 centrilobular, affecting mainly the upper lobes; this is most common in
smokers

 panlobular, affecting both paraseptal and centrilobular areas

Stages

 Very mild or Stage 1: FEV1 is about 80 percent of normal

 Moderate or Stage 2: FEV1 is between 50 and 80 percent of normal

 Severe or Stage 3: FEV1 is between 30 and 50 percent of normal

 Very severe or Stage 4: FEV1 is lower than in Stage 3, or the same as

Stage 3 but with low blood oxygen levels

*The stages help the condition, but they cannot predict how long a person is
likely to survive. Doctors can carry out tests to know more about how serious a
person's condition is.

Diagnosis:

  physical examination

 ask the patient about their symptoms and medical history.

 If the patient has never smoked, a test may be carried out to see if the
person has an α1-antitrypsin deficiency.

 imaging, such as a chest X-ray or CT scan of the lungs

 arterial blood gas analysis to assess oxygen exchange

Lung function tests:

  Lung function tests are used to confirm a diagnosis of emphysema, to
monitor disease progression, and to assess response to treatment.

 They measure the capacity of the lungs to exchange respiratory gases and
include spirometry.

 Spirometry assesses airflow obstruction. It takes measurements according

to the reduction in forced expiratory volume after bronchodilator treatment.

Prevention

Avoiding or quitting smoking is the best way to prevent emphysema or stop it

from getting worse.