COPD

Dr Josephine Ojoo
MBChB FRCP CCST(Resp) Dip HIV Med
Senior Lecturer
Maseno University
 COPD
• Definition
• Epidemiology
• Pathophysiology
• Diagnosis
• Management
 Definition
Chronic Obstructive Pulmonary Disease
• chronic ariflow obstruction that results from exposure to
noxious substances resulting inflammation of the airways
and the lung parenchyma

– Chronic bronchitis

– Emphysema
 Definition

COPD

Chronic bronchitis Emphysema

• hypersecretory disorder
• productive cough most days for at
least 3 months of 2 successive years
• other causes excluded
 Epidemiology
• Mainly smoking related

• Prevalence and mortality reflect the smoking

history of the population

• Worldwide 3 million deaths each year

 Aetiology
• Chronic exposure to cigarette • Genetic factors:
smoke – A1-antitrypsin deficiency
– 90% of COPD
– 15% of smokers get COPD
• Childhood factors
• Indoor pollutants- burning of – Low birth weight
biomass fuels
– Charcoal, firewood, industries
– poorly ventilated rooms • Sex

• Occupational dusts (coal,

grain, cotton) and chemicals
 Pathophysiology

COPD

Chronic bronchitis Emphysema

• alveolar destruction
• Loss of elastic tissue
• Main cause of
airflow limitation
 Chronic bronchitis
Inflammation results in
• increased goblet cell
numbers
• mucous gland
hypertrophy
 Emphysema
Centrilobular • Loss of elastic tissue distal
to terminal bronchiole with
wall destruction.
• Loss of elastic recoil
• Airways obstruction
• Air trapping

panacinar
Emphysema
Effect of smoking
on lung function
Decline in lung function
 Diagnosis
History Examination
• 40yrs • Barrel chest
• Smoking >20py • Pursed lips
• Progressive breathlessness • Cyanosis
• Cough with sputum • Stigmata of smoking
• Wheeze • Use of accessory muscles
• Chest tightness • Rhonci
• Recurrent infections
 Diagnosis
Chronic bronchitis Emphysema
• Obstructive picture • Obstructive picture
– FEV1 and FVC < 80% • Parenchymal damage
– FEV1/FVC <70% – KCO, TLCO
– Reduced PEF – CXR
– CT scan
• A1 antitrypsin levels
 Severity
British Thoracic Society • Other factors
• FEV1 – DLCO
– 60-80% Mild – BMI
– 40-59% Moderate – Exercise capacity
– <40% Severe
 Management
• Minimise symptoms

• Preserve functional status

– Smoking cessation

• Prolong life
Smoking cessation
 Therapy
• Smoking cessation
• Medication
 Inhaled therapy
• Bronchodilators –
– Include both sympathomimetic and anticholinergics
– Short and long acting agents

• Cortocosteroids
– Anti-inflammatory FEV1 <50% predicted

• Combination therapy
– Reduced exacerbations, slowed decline in lung function
 Medication
• Bronchodilators- relievers
– Salbutamol, terbutaline, ipratropium

• LAAA slowed lung function decline

– Tiotropium

• Cortocosteroids/LABA
– Beclomethasone, budesonide, fluticasone
– Formoterol, salmeterol
 Medication
• Oral therapy

– Mucolytics

– Xanthines
 Therapy
• Smoking cessation
• Medication
• Pulmonary rehabilitation
 Pulmonary rehabilitation
• Improves functional capacity
• Reduces breathlessness

• Moderate COPD

• Educational
• Exercises
 Therapy
• Smoking cessation
• Medication
• Pulmonary rehabilitation
• Respiratory failure
Long term oxygen therapy (LTOT)
• Saturations <92%
(pO2 <8kPa)
• Keep pO2 >8kPa
• Reduced mortality
by half
Long term oxygen therapy (LTOT)
 Therapy
• Smoking cessation
• Medication
• Pulmonary rehabilitation
• Oxygen
• Treatment of infections early
 Exacerbations
• Increased
– cough
– Breathlessness
– Sputum amount, purulence
 Exacerbations
• Breathlessness
– SABA, anticholinergics- inhalers/ nebuliser

• Oral corticosteroids
– Shorten duration of illness

• Antibiotics
– Amoxicillin, tetracycline
– Co-amoxiclav
– Quinolones
– Pseudomonas: ceftazidime/gentamicin/ carbapenems
 Exacerbations
• Increased
– cough
– Breathlessness
– Sputum amount, purulence
 Exacerbations
• Breathlessness
– SABA, anticholinergics- inhalers/ nebuliser

• Oral corticosteroids
– Shorten duration of illness

• Antibiotics
– Amoxicillin, tetracycline
– Co-amoxiclav
– Quinolones
– Pseudomonas: ceftazidime/gentamicin/ carbapenems
 Therapy
• Smoking cessation
• Medication
• Oxygen
• Treatment of infections early
• Prevention of exacerbations
– Pneumococcal vaccination
– Influenza vaccination
 Therapy
• Smoking cessation
• Medication
• Pulmonary rehabilitation
• Oxygen
• Treatment of infections early
• Prevention of exacerbations
• Surgery
Bullectomy
Patient selection
 Surgery
• Bullectomy
• LVRS
– Reduce breathlessness
– Improves FEV1
– Improves survival
 Therapy
• Smoking cessation
• Medication
• Pulmonary rehabilitation
• Oxygen
• Treatment of infections early
• Prevention of exacerbations
• Surgery
• Lung transplantation
Lung transplantation
Lung transplantation
 COPD
• Definition
• Epidemiology
• Pathophysiology
• Diagnosis
• Management
 References
• Country statistics and global health estimates by WHO and UN partners. Last
updated: January 2015

• Int J Chron Obstruct Pulmon Dis. 2012; 7: 95–99. Published online 2012 Feb 9. doi:
10.2147/COPD.S27480