Chronic Obstructive Pulmonary Disease (COPD) : Assistant Professor:Tong Jin

Chronic Obstructive
Pulmonary Disease (COPD)
Assistant Professor :Tong Jin

()
Respiratory department of the second
affiliated hospital of Chongqing medical
university
What is COPD
COPD, a common preventable and treatable
disease, is characterized by persistent airflow
limitation that is usually progressive and associated
with an enhanced chronic inflammatory response in
the airways and the lung to noxious particles or
gases.
chronic inflammatory response in the airways
preventable and treatable
airflow limitation is persistent and progressive
What is COPD
COPD is a general term used for several lung
diseases
Chronic asthma may also be included in this group.
While some patients with COPD have only chronic
bronchitis or emphysema,most patients have a
combination of both. COPD worsens gradually,
causing limited airflow in and out of the lungs.
Emphysema
Burden of COPD
COPD is a leading cause of morbidity and
mortality worldwide.
The burden of COPD is projected to increase

in coming decades due to continued
exposure to COPD risk factors and the aging
of the worlds population.
COPD is associated with significant economic

burden.
Prevalence
There are approximately 16 millions adult
Americans with COPD. This number includes
about 14 million with chronic bronchitis and 2
million with emphysema (figure 1). In china ,
the number is 300 millions. Many more may
have COPD but not know it because the
disease has not yet become symptomatic.
Pathology
Risk Factors for COPD
Genes
Infections
Socio-economic
status
Aging Populations
Clinical feature
Symptoms
Patients with COPD present in the fifth or sixth
decade of life.
Cough
Sputum production
Shortness of breath-- Dyspnea
A feeling of "tightness" in the chest
Wheezing
Cough
"wet," cough that produces mucus.
Excess mucus makes it difficult to breathe
properly.
A side effect of mucus-caused dyspnea is

wheezing: the infected person makes a thin,
whistling noise when they breathe out.
Sputum production
Without infection --- mucoid sputum--the mucus is
often thick and discolored
With infective exacerbation ,especially during the
winter months,associated with
purulent(green/yellow)sputum
Accumulating mucus also makes it necessary for
people to frequently clear their throats
Sputum production
Dyspnea
Dyspnea is the medical term for shortness of breath.
Excess mucus makes it difficult to breathe properly,
so dyspnea is a common bronchitis symptom.
Dyspnea is noted initially only on heavy exertion,but
as the condition progresses it occurs with mild
activity.
In severe disease,dyspnea occurs at rest.
Symptoms
Symptoms have often been present for 2 years
or more.
Symptoms are worsened by
Cold weather
Pollution (Poor air quality)
Fog
Frequent exacerbations of illness are common
and result in absence from work and eventual
disability.
signs
Inspection-- The Thorax Barrel
Palpation-- Tactile fremitus decreased
Percussion-- Hyperresonance
Auscultation-- Decreased breath sounds,

crackles or rhonchi
Laboratory finding
Blood routine examination

Sputum
Chest radiograph
Lung function tests
Sputum
Volume, color
Culture
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Chest radiograph
Hyperinflation
Flattened diaphragms
Increased anterior-posterior diameter and intercostal
space
Lung function tests
Diagnosis and Assessment
A clinical diagnosis of COPD should be considered
in any patient who has dyspnea, chronic cough or
sputum production, and a history of exposure to
risk factors for the disease.(symptoms)
Spirometry is required to make the diagnosis;
the presence of a post-bronchodilator FEV1/FVC
< 0.70 confirms the presence of persistent
airflow limitation and thus of COPD. By FEV1/pre,
we could diagnose the degree of COPD.
2013 Global Initiative for Chronic Obstructive Lung Disease

Degrees of COPD
Patient is now in one of
four categories:
A: Less symptoms, low
risk
B: More symptoms, low

risk
C: Less symptoms, high

risk
D: More symptoms, high

risk
Differential Diagnosis
COPD ASTHMA
Onset in mid-life Onset early in life (often childhood)
Symptoms slowly Symptoms vary from day to day
progressive Symptoms worse at night/early
Long smoking history morning
Allergy, rhinitis, and/or eczema also
present
Family history of asthma
2013 Global Initiative for Chronic Obstructive Lung Disease

Complications
Pulmonary Hypertension
Pulmonary heart disease
Chronic respiratory failure
Pneumothorax
Hemoptysis
Pulmonary hypertension
Pulmonary hypertension results from a

combination of pulmonary vasconstriction
(induced by hypoxia/ hypercapnia)
and increased blood viscosity (due to
polycythemia induced by chronic hypoxia)
Leads to damage to branches of the
pulmonary artery with intimal and medial
hypertrophy narrowing the lumen and
further aggravating the problem
Pulmonary heart disease
Cardiac damages occurs over the long
term secondary to pulmonary hypertension
The heart develops right ventricular
hypertrophy and dilation secondary to
chronic straining against the increased
pulmonary artery pressure
Treatment (Catabasis)
Smoking cessation
Long-term oxygen therapy(LTOT)
Bronchodilators
Maintaining a healthy diet
Following a structured exercise program
Preventing respiratory infections
There is no evidence to support the use of
prophylactic antibiotics
Domiciliary oxygen
The benefits include survival, longer
reduced hospitalization needs, and better
quality of life.
Patients with COPD treated with
supplemental oxygen therapy is directly
proportionate to the number of hours per
day oxygen is administered.
Domiciliary oxygen
May be supplied by liquid oxygen
systems (LOC),compressed cylinders, gas
or oxygen concentrators.
Oxygen by nasal prongs must be given
at least 15 hours per day unless therapy
is intended only for exercise or sleep.
A flow rate of 1-3 L/min achieves a PaO2
greater than 55 mm Hg.
L--- liter, mm Hg ---millimeter
hydrargyrum
Bronchodilator
2- adrenergic agonist
Short-acting
long acting
Anticholinergics
Theophylline
Theophyllines principal value in COPD may
relate to improving respiratory muscle
performance
Anticholinergics
Its include:Ipratropium bromide and Tiotropium
Anticholinergics is superior to 2- adrenergic
agonist aerosols in achieving bronchodilation in
patients with moderate to severe COPD.
Anticholinergics has a slower onset but a longer
duration of action than 2- adrenergic agonist
agents
In combination with other bronchodilators ,it
enhances and prolongs bronchodilation.
Corticosteroids
Inhaled, oral,and vein
oral corticosteroids are prescribed
with asthmatic bronchitis or frequent exacerbations
fail to respond to conventional therapy with
anticholinergics, 2- adrenergic agonist agents,
and with theophylline
Inhaled corticosteroids may be of value for
corticosteroids-responsive patients
Therapy (Exacerbations)
Acute worsening of COPD that fails to
respond to measures for ambulatory patients.
Smoking cessation
Oxygen therapy
Bronchodilators
Antibiotics
Other measures
Therapy(exacerbations)
Smoking cessation
Oxygen therapy
Bronchodilators
Antibiotics
Other measures
Antibiotics therapy
Treat an acute episode of bronchitis
treat COPD exacerbations
Broad-spectrum antibiotics
Experimental treatment and sputum
culture
Other measures
To deal with sputum,cough
Cough suppressants and sedatives should
be avoided as routine measures.
Postural drainage
Chest percussion or vibration (sometimes)
Cor pulmonale
Cor pulmonale usually responds to
measures that reduce pulmonary artery
pressure:
----- Supplement oxygen

----- correction of acidemia
----- bed rest
----- salt restriction
----- diuretics
Respiratory failure
Progressive respiratory failure ensues:
Tracheal intubation and Mechanical

ventilation are necessary.
Surgery
Lung transplantation
Limited life expectancy without transplantation
Adequate function of other organ systems
Good social support system
Lung volume reduction surgery
This is an experimental surgical approach to
relief of dyspnea and improvement in exercise
tolerance in patients with advance diffuse
emphysema and lung hyperinflation
Prognosis
The outlook for patients with clinically significant

COPD is poor.
But it could be preventable and treatable
Earlier diagnosis, earlier treatment and earlier
prevention
Smoking cessation, oxygen and proper exercise.

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What are the main symptoms of COPD?

What are the main symptoms of COPD?

What factors increase the risk of developing COPD?

What factors increase the risk of developing COPD?

Chronic Obstructive

Pulmonary Disease (COPD)

Assistant Professor :Tong Jin

The burden of COPD is projected to increase

COPD is associated with significant economic

A side effect of mucus-caused dyspnea is

Auscultation-- Decreased breath sounds,

Blood routine examination

2013 Global Initiative for Chronic Obstructive Lung Disease

B: More symptoms, low

C: Less symptoms, high

D: More symptoms, high

2013 Global Initiative for Chronic Obstructive Lung Disease

Pulmonary hypertension results from a

----- Supplement oxygen

Tracheal intubation and Mechanical

The outlook for patients with clinically significant

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