COAD

Path
ology

Gas trapping - Hyperinflation

Airflow limitation
 DEFINITION
• A common, preventable and treatable
disease that is characterized by persistent
respiratory symptoms and airflow
(COP
limitation that is due to airway and/or
alveolar abnormalities usuallyD)caused by
significant exposure to noxious particles
or gases.
 Hypoxic vasoconstriction

Pulmonary hypertension.

Pathology
pulmonary
Vasculatu
re Right ventricular hypertrophy

Right-side cardiac failure.

 HOST
genetic, congenital,
developmental
abnormality, LBW,
childhood infection
POLLUTION
TOBACCO SMOKE : occupational dusts,
cigar/ cigarettes vapors, fumes,
gases, chemicals

COPD SYMPTOMS
dyspnea,
chronic cough, chronic
sputum production,
recurrent LRTI
 COPD
Diagnosi
s
PERFORMING SPIROMETRY

BRONCHODIALATION

Post SABA 10-15 min or,

post SAAC or SABA/SAAC 30-45min

PERFORMANCE

Maximal patient effort

Trained personale
Take the largest sum of FVC and FEV1 from 3 test

EVALUATION

Compare with reference values base on age, height, sex, and race.
FEV1/FVC < 0.70 = comfirm airflow limitation

© 2019 Global Initiative for Chronic Obstru

ctive Lung Disease
 COPD
classification
© 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
 Differential diagnosis
Asthma

Congestive heart failure

Bronchiectasis

Tuberculosis

Obliterative bronchitis

Diffuse panbronchitis
 Avoid RISK
PREVENTION FACTORS
 SMOKING
CEASSATION

INHALALOR
TECHNIQUE

Maintainace
therapy

VACCINATION

PULMONARY
REHABILITATION
 OXYGEN
THERAPY

Maintainace NON INVASIVE

therapy VENTILATION

SURGICAL
INTERVENTIONS
Inhalation drugs INDIVIDUALLY TAILORED

PROPER
TECHNIQUE

Adherence
 ATROVENT
SEEBRI BREEZHALER
SPIRIVA
RESPIMART
BERODUAL

COMBIVENT/
DUOLIN

SIMBICORT TURBUHALER
SERETIDE ACCUHALER
 Beta 2 SAMA :
agonists MDI SALBUTAMOL
S/E :
1. SINUS TACHYCARDIA
2. TREMORS
 SAMA:
Ipratropium bromide
(ATROVENT)

LAMA :
SEEBRI BREEZHALER (gb)
SPIRIVA RESPIMART (t)
ANTI
MUSCARINIC M3 muscarinic receptors
in airway smooth muscle.
S/E :
1. dryness of mouth
2. Urinary retention
SAMA/SABA
SABA OR
SAMA
 METHYL
XANTHINES
TOXICITY
• Due to narrow theraputic
level.
• Excess cathecolamine can
cause serious S/E such as
arrhythmias, seizures,
rhabdomyolisis, and
hyperglycemia.
ANTI-INFLAMMATORY THERAPY IN STABLE COPD
INHALED ICS
• LABA/ICS more effective than monotherapy in moderate to severe
copd
• BUT regular ICS increase risk of pneumonia
• LABA/LAMA/ICS is superior than LABA/ICS, LABA/LAMA

ORAL ICS
• No benefit in long term use oral ICS
PDE4 INHIBITORS-roflumilast
• Use in copd with chronic bronchitis, severe to very severe copd and
exacerbations.

ANTIBIOTICS
• Long term azithromycin and erythromycin rimprove exacerbations but
increased bacterial resistance
MUCOREGULATORS AND ANTIOXIDANT AGENTS
• Can reduce risk of exacerbation

© 2020 Global Initiative for Chronic Obstructive Lung Disease

© 2020 Global Initiative for Chronic Obstructive Lung Disease
Mucolytics

ANTITUSSIVE ARE NOT RECOMMENDED

© 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
EXACERBATION
of COAD
 PNEUMONIA

PULMONARY PNEUMOTHO
OEDEMA RAX

DIFFERENTIAL
DIAGNOSIS
CARDIAC PLEURAL
ARRITMIAS EFFUSION

PULMONARY
EMBOLISM
© 2019 Global Initiative for Chronic Obstru
ctive Lung Disease
© 2019 Global Initiative for Chronic Obstru
ctive Lung Disease
© 2019 Global Initiative for Chronic Obstru
ctive Lung Disease