Chronic Obstructive Pulmonary Disease (COPD)

  •  COPD (Chronic Obstructive Pulmonary Disease) 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 cough and ex ectoration.
    • Small airway disease is a condition in which small broncioles are narrowed.
Chronic Obstructive Pulmonary Disease (COPD) 3

Chronic Obstructive Pulmonary Disease (COPD) Clinical features Symptoms Diagnosis

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) 1

Chronic Obstructive Pulmonary Disease (COPD) Clinical features 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 1st 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 spirometry
    • 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 failure

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 hypertension, and cor pulmonale.

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 heart failure may develop
  • There IS hypoxaemia and later on hypercapnia. In some patients. The JVP 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- signs 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 acute 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 auscultation, 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


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