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COPD
COPD
DR.K.K.SHYAMALA
ASSOCIATE PROFESSOR
DEPT OF PULMONARY MEDICINE
DR.B.R.AMC
22/04/2020
Contents
Introduction
Etiology/ Risk Factors
Pathophysiology
Pathology
Clinical features
Diagnosis
Management
Complication
Definition : GOLD (Global Initiative for
Chronic Obstructive Lung Disease)
respiratory symptoms and airflow limitation that is due to airway and /or alveolar
PATHOBIOLOGY
. Impaired lung growth
Accelerated decline
Lung injury
Lung and systemic inflammation
PATHOLOGY
Small airway abnormalities
Emphysema CLINICAL
AIRFLOW
Systemic effects MANIFESTATION
LIMITATION
Symptoms
Persistent airflow
Exacebration
limitation
Comorbidities
© 2020 Global Initiative for Chronic Obstructive Lung Disease
Risk factors
Age – ageing increases copd risk, usually occurs above 40yrs
Gender – Equal incidence
Genetic factors- alpha 1 antitrypsin deficiency
Lung growth and development – during gestation and childhood
Exposure to particles
Tobacco smoke exposure – cigarette smokers
- Environmental tobacco smoke
Contd
Occupational exposures (organic and inorganic dusts, chemical agents and fumes
Air Pollution – Indoor – Biomass gas, burning of wood, heating in poorly ventilated
- Outdoor - small effect
Socio economic status – poverty , low SE –( crowding, poor nutrition, infections,
indoor and outdoor pollutants)
Asthma and airway reactivity
Chronic Bronchitis
Infections- history of childhood infection – increased respiratory symptoms in
adulthood
Pathology, Pathogenesis and
Pathophysiology
Exposure results in Chronic inflammation.
Pathological changes occur in airways, lung parenchyma, and Pulmonary
vasculature
Systemic inflammation may be present
Pathogenesis: Mechanism:
◦ Inflammation is modification of normal inflammatory response of
respiratory tract.
◦ Oxidative stress
◦ Protease and antiprotease imbalance
◦ Inflammatory cells- activated neutrophils, increased lymphocytes and
sometimes eosinophils – release inflammatory mediators – chemotactic factors
and proinflammatory cytokines
Pathophysiology
Airflow limitation and gas trapping: extent of inflammation, fibrosis and luminal exudates in
small airways
Reduction of FEVI1 and FEV1/FVC ratio (characteristic of COPD)
Hyperinflation as a result of gas trapping
Gas exchange abnormalities- VA / Q mismatch
Hypoxemia and hypercapnia
Mucus hypaersecretion – increased number of goblet cells, enlarged submucosal glands
Pulmonary hypertension – late response- hypoxic vasoconstriction of small pulmonary arteries,
intimal hyperplasia, later smooth muscle hypertrophy/hyperplasia, endothelial cell dysfunction, loss
of capillary bed in emphysema - result in right ventricular hypertrophy and right heart failure
Exacebration
Systemic features – inflammatory mediators – skeletal muscle wasting and cachexia, IHD,
Osteoporosis, normocytic anaemia, diabetes, and metabolic syndrome
© 2020 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE
© 2020 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE
© 2020 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE
Physical Examination
Presence of comorbidities
© 2020 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE
© 2020 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE
© 2020 GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE
Assessment of Exacebration risk – An exacerbation of copd is
defined as an acute worsening of respiratory symptoms that
results in additional therapy.
Preventive Aspects
Identify and Reduce risk factor exposure
◦ Smoking cessation
◦ Vaccinations : Pneumococcal and Influenza
Drugs
Bronchodilators
◦ Beta agonist
- Short acting- (SABA) - Salbutamol, levosalbutamol, Terbutaline
- Long acting (LABA) -Formoterol, Aformeoterol, Salmeterol, Indacterol
Antibiotics
Methylxanthines not recommended
NIV – Preferred when no absolute contraindications
Summary
Chronic Obstructive Pulmonary Disease is a common, preventable and treatable
disease that is characterized by persistent respiratory symptoms and airflow
limitation that is due to airway and or /alveolar abnormalities usually caused by
significant exposure to noxious particles or gases.
The most common respiratory symptoms include dyspnea, cough and /or sputum
production. These symptoms may be underreported by patients.
The main risk factor for COPD is tobacco smoking but environmental exposures
biomass fuel exposure and air pollution, genetic abnormalities, abnormal lung
development and accelerated aging
Acute exacerbations
Associated comorbidities may increase morbidity and mortality
Any Questions ?
Thank you