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    Chronic Obstructive Pulmonary Disease: Saja Quzmar

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    kolakav107
    Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation caused by exposure to noxious particles or gases. The two major manifestations are chronic bronchitis and emphysema. Cigarette smoking is the leading cause. Diagnosis involves pulmonary function tests showing airflow limitation. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, antibiotics for exacerbations, and oxygen therapy for hypoxemia.

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    Chronic Obstructive Pulmonary Disease: Saja Quzmar

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    kolakav107
    26 views28 pages
    Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation caused by exposure to noxious particles or gases. The two major manifestations are chronic bronchitis and emphysema. Cigarette smoking is the leading cause. Diagnosis involves pulmonary function tests showing airflow limitation. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, antibiotics for exacerbations, and oxygen therapy for hypoxemia.

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    Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation caused by exposure to noxious particles or gases. The two major manifestations are chronic bronchitis and emphysema. Cigarette smoking is the leading cause. Diagnosis involves pulmonary function tests showing airflow limitation. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, antibiotics for exacerbations, and oxygen therapy for hypoxemia.

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    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd
    Download as key, pdf, or txt
    26 views28 pages

    Chronic Obstructive Pulmonary Disease: Saja Quzmar

    Uploaded by

    kolakav107
    Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation caused by exposure to noxious particles or gases. The two major manifestations are chronic bronchitis and emphysema. Cigarette smoking is the leading cause. Diagnosis involves pulmonary function tests showing airflow limitation. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, antibiotics for exacerbations, and oxygen therapy for hypoxemia.

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    COPD

    Chronic Obstructive Pulmonary Disease


    Saja Quzmar
    Obstructive lung disease
    Definition

    Characterized by an increase in resistance to airflow due to diffuse


    airway disease, which may affect any level of the respiratory tract.
    These diseases are distinguished from Restrictive Lung Diseases
    through pulmonary function tests FEV1/FVC < 0.7
    Examples of obstructive lung diseases include: COPD, Asthma,
    Bronchiectasis.
    COPD
    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 caused by exposure to noxious particles or
    gases.
    COPD has two major clinicopathologic manifestations: Chronic
    Bronchitis & Emphysema.
    Causes

    Tobacco (90%)
    Environmental pollutants
    Alpha-1 anti-trypsin deficiency (specific to emphysema)
    Patients can have both chronic bronchitis and emphysema
    Pathophysiology
    Chronic Bronchitis

    Definition: productive cough >


    3 months for ≥ 2 years.
    Emphysema

    Definition: irreversible
    enlargement of the airspaces
    distal to the terminal
    bronchiole, accompanied by
    destruction of their walls
    Centrilobular Emphysema
    A. Acini within the upper lobes/apices of the lungs
    B. Caused by smoking
    Panacinar Emphysema
    1. Acini in the lower lobes/bases of the lungs
    2. alpha-1 anti-trypsin deficiency
    Complications of chronic bronchitis :

    Polycythemia
    pneumonia
    core pulmonal.

    Complications of emphysema:

    Pneumothorax
    COPD
    Diagnosis

    Best initial: CXR.


    Pulmonary function Test
    Pulmonary Function Testing Flow Volume Loops
    DLCO
    Diffusing capacity of carbon monoxide
    Measures ability of lungs to transfer gas
    Patient inhales small amount (not dangerous) CO
    Machine measures CO exhaled
    Normal = 75 – 140 % predicted
    Severe disease < 40% predicted
    Decreased in many forms of restrictive lung disease
    Decreased in emphysema but not chronic bronchitis
    ABGs
    chronic respiratory acidosis
    GOLD classification
    chronic respiratory acidosis
    COPD
    Treatment

    Smoking cessation ↓mortality


    Bronchodilator
    Corticosteroids
    Antibiotic
    Oxygen therapy ↓mortality
    Bronchodilation
    β 2 receptor agonists will help
    ↑bronchodilation while M3 receptor
    antagonists will help
    ↓bronchoconstriction
    Both of these are most effective in
    COPD as inhaled products
    Usually, a SABA and SAMA
    combination is used in acute COPD
    exacerbations = duo neb: Albuterol +
    Ipratropium
    In chronic treatment, the usual first
    line is a LAMAlike tiotropium
    Antibiotics

    Azithromycin, Macrolides (Atypical Pneumonia)

    Has been shown to prevent further exacerbations and pneumonia


    Indicated to those patients with frequent (>3) exacerbations
    Oxygen Therapy

    Patient population qualified for oxygen therapy:


    SpO 2 < 88% or PaO 2 < 55 mmHg during rest or exercise
    SpO2 < 90% or PaO2 < 60 mmHg in patients with RHF d/t
    cor pulmonale or polycythemia, These patients have an
    increased risk of hypoxemia, which is why we’re treating
    them earlier
    Corticosteroids

    Inhaled Corticosteroids : Examples: budesonide, fluticasone Used


    with a LABA or LAMA

    IV or PO Corticosteroids: Used in acute COPD exacerbation,


    Examples: Methylprednisolone (IV), prednisone (PO)
    Other drugs

    Palliative pharmacotherapy for dyspnea (e.g., opiates): may be considered


    for all patients
    Methylxanthines (e.g., theophylline)
    Nonselectively antagonize adenosine receptors and inhibit
    phosphodiesterase
    May be trialed if other bronchodilators are not available
    Unproven benefit
    Mucolytics (e.g., N-acetylcysteine, erdosteine)
    Ventilation Support

    For acute COPD exacerbation


    Putting on positive pressure
    ventilation such as BIPAP
    Failing on BIPAP → ET tube
    intubation
    Surgical Treatment

    Advanced “end-staged” COPD


    Lung volume reduction surgery/bullectomy, Remove diseased lung tissue,
    Allow healthy lung tissue more room to expand
    Lung transplantation
    Multifocal Atrial Tachycardia
    Common during COPD exacerbations

    Irregular rhythm
    Multiple p wave morphologies
    Treat underlying condition

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