Chronic Obstructive Pulmonary Disease (COPD) Clinical features Symptoms Diagnosis

Chronic Obstructive Pulmonary Disease (COPD)

•  COPD (ChronicChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » Obstructive Pulmonary DiseasePalpation of Precordium and Percussion of the Heart. Read more ... ») is a disease state characterized by airflow limi­tation that is not fully.reversible.
• The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious (toxic) particles or gases.
• The Global initiative for Chronic Obstructive Lung Dis­ease (GOLD) defines COPD as a limitation of air flow which is not reversible.
• This includes emphysema, chronic bronchitis, and small airway disease. In all these, chronic airflow 05­struction occurs.
  •  Emphysema is the destruction and enlargement of
  • alveoli.
  • Chronic bronchitis is a condition with chronic coughInfluenza SARS and Whooping Cough Signs and Symptoms with Diagnosis and Treatment. Read more ... » and ex ectoration.
  • Small airway disease is a condition in which small broncioles are narrowed.

Chronic Obstructive Pulmonary Disease (COPD) ClinicalPalpation of Precordium and Percussion of the Heart. Read more ... » features SymptomsPalpation of Precordium and Percussion of the Heart. Read more ... » DiagnosisPalpation of Precordium and Percussion of the Heart. Read more ... »

Risk factors of COPD

• Cigarette smoking
• Tendency for bronchoconstriction – allergic, environmental, genetic factors
• Respiratory infection
• Occupational exposures
• Air pollution
• Passive smoker.
• Smoking
• Passive smoking, especially adults whose parents smoked
• Severe viral pneumonia early in life
• Aging
• Alcohol consumption
• Airway hyperactivity

Chronic Obstructive Pulmonary Disease (COPD) Clinical featuresPulmonary Thromboembolism Pathophysiology Clinical Features with Treatment. Read more ... » Symptoms Diagnosis

Stages of COPD GOLD staging by spirometric assessment –

• Measure the maximal volume of air forcibly exhaled from the point of maximum inhalation (FVC _ forced vital capacity).
• Measure volume of air exhaled during 1^st second of the maneuver (forced expiratory volume in one sec­ond) - FEV1
• Calculate ratio of FEV₁ / FVC.
• Post bronchodilator FEV₁ <80% of predicted value and FEV₁ / FVC <70% is an airflow limitation which is not fully reversible.
• Old
  • 0 – At risk
  • I – Mild
  • II – Moderate
  • III – Severe
• New:
  • 0 -
    • At risk
    • Chronic symptoms
    • Exposure to risk factors
    • Normal spirometryComplete Management of COPD. Read more ... »
  • I -
    • Mild
    • FEV₁/ FVC <70%
    • FEV₁ ~80 %
    • With or without symptoms
  • II -
    • Moderate
    • FEV₁/ FVC <70%
    • 50%.$. FEV₁ <80%
    • With or without symptoms
  • III -
    • Severe
    • FEV₁/ FVC <70%
    • 30%.$. FEV₁ <50%
    • With or without symptoms
  • IV -
    • Very severe
    • FEV₁/ FVC <70%
  • FEV₁ <30% or FEV₁ <50% predicted plus chronic respiratory failureRespiratory Failure Causes Clinical Features with Management. Read more ... »

Pathophysiology COPD

• Impaired gas (CO₂ and O₂) exchange
• Airway obstruction by mucus in chronic bronchitis
• Destruction of lung parenchyma in emphysema
• There is mucus hypersecretion ciliar dysfunction, airflow limitation, pulmonary hyperinflation, gas ex­shange abnormalities, pulmonary hypertensionGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... », and cor pulmonaleCor pulmonale Causes of Cor pulmonale Symptoms of COR PULMONALE and Treatment. Read more ... ».

COPD Pathological Findings

• Chronic bronchitis

  • Bronchial mucous gland enlargement
  • Increased number of secretory cells in surface epithelium
  • Thickened small airways from edema and inflammation
  • Smooth muscle hyperplasia
  • Mucus plugging
  • Bacterial colonization of airways

• Emphysema

  • Entire lung affected
  • Bronchi usually clear of secretions
  • Anthracotic pigment
  • Alveoli enlarged with loss of septa
  • Cartilage atrophy
  • Bullae

In advanced COPD

• QLPU momnale I.e. right heartPalpation of Precordium and Percussion of the Heart. Read more ... » failure may develop
• There IS hypoxaemia and later on hypercapnia. In some patients. The JVPExamination of arterial pressure pulse with Jugular Venous Pulse (JVP). Read more ... » will be raised, there will be
• Pulmonary hyperte~sion, which develops late in the edema, congested liver, right ventricular 53 ascites
• course of COPO is the ma)or cardiovascular compli- signsPalpation of Precordium and Percussion of the Heart. Read more ... » of pulmonary hypertension. ‘ ,
• cation of CO PO and is associated with the develop- Clubbing is not a feature of COPD.
• ment of cor pulmonale and a poor prognosis.

Host Factors

• if Hereditary deficiency of alpha 1 antitrypsin Airway hyper-responsiveness
•   Lung growth

Clinical features Symptoms COPD

• Cough with expectoration
• Exertional dyspnoea and dyspnoea at rest.
• Patient uses accessory muscles of respiration there­fore any activity where the arms are to be raised above shoulder level cause discomfort or are even impos­sible.
• There may be acutePalpation of Precordium and Percussion of the Heart. Read more ... » exacerbations off and on need­ing hospitalizption.

COPD Physical findings

• There may be nothing particular in the physical ex­amination.
• Evidence of smoking like nicotine stains on finger tips and lips may be seen.
• There is barrel-shaped chest.
• Accessory muscles of respiration are seen to work like in the neck and abdomen.
• There is cyanosis in the lips and nails.
• On auscultationHow to take good medical history & examination. Read more ... », the expiration is prolonged and there is wheezing.
• If there is predominent emphysema and no cyanosis­the patient is referred to as pink puffers.
• Pink puffers have diminished” breath sounds.
• In cigarette smokers there is centriacinar emphysema and in alphal AT deficiency there is panacinar em­physema.
• Patient with chronic bronchitis are called blue bloat­ers because of edema and cyanosis on face.
• There is weight loss.
• There is paradoxical inward movement of rib cage with inspiration called Hoover’s sign.

Diagnostic Tests & Interpretation

Lab Initial Lab Tests

• Chronic bronchitis:

  • Arterial blood gases (ABGs) may show hypercapnia and hypoxia.
  • Hemoglobin may be increased.

• Emphysema:

  • Normal serum hemoglobin or polycythemia
  • Normal PaCO₂ on ABGs

Lab diagnosis

• Spirometry-FEV₁, FEV/FVC Arterial blood gases-pH, PC02 X-Ray Chest for lungs
• Chronic bronchitis chest x-ray (CXR): Increased bronchovascular markings and cardiomegaly
• Emphysema CXR: Small heart, hyperinflation, flat diaphragms, and possibly bullous changes
• CT scan
• Serum alphal anntitrypsin