Presentation on theme: "Definition of COPD COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual."— Presentation transcript:
Definition of COPD COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.
Inflammation in COPD
Pathogenesis of COPD
Diagnosis of COPD SYMPTOMS cough sputum dyspnea EXPOSURE TO RISK FACTORS tobacco occupation indoor/outdoor pollution SPIROMETRY
Spirometry: Normal and Patients with COPD
Spirometry Guide Spirometry Quick Guide Spirometry Teaching Slide Set To help health care professionals understand how to perform & evaluate spirometry. All resources available at Spirometry How-To Resources from GOLD
IV: Very Severe III: Severe II: Moderate I: Mild Therapy at Each Stage of COPD FEV 1 /FVC < 70% FEV 1 > 80% predicted FEV 1 /FVC < 70% 50% < FEV 1 < 80% predicted FEV 1 /FVC < 70% 30% < FEV 1 < 50% predicted FEV 1 /FVC < 70% FEV 1 < 30% predicted or FEV 1 < 50% predicted plus chronic respiratory failure Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation Add inhaled glucocorticosteroids if repeated exacerbations Active reduction of risk factor(s); influenza vaccination Add short-acting bronchodilator (when needed) Add long term oxygen if chronic respiratory failure. Consider surgical treatments
Differential Diagnosis: COPD and Asthma COPD ASTHMA Onset in mid-life Symptoms slowly progressive Long smoking history Dyspnea during exercise Largely irreversible airflow limitation Onset early in life (often childhood) Symptoms vary from day to day Symptoms at night/early morning Allergy, rhinitis, and/or eczema also present Family history of asthma Largely reversible airflow limitation
COPD and Co-morbid Conditions Common co-morbid conditions in COPD patients: Cardiovascular disease Lung cancer Osteoporosis Musculoskeletal disorders Depression/anxiety Obesity/type II diabetes Physicians should identify and treat co-morbid conditions that impact on the clinical course of COPD. Smoking prevention and cessation, weight control, exercise, and rehabilitation have the potential to beneficially affect COPD and co-morbid conditions.
Preventing COPD Exacerbations Prevent respiratory infections: pneumococcal vaccine, annual influenza vaccine. Avoid air pollution: remain indoors and close windows on bad air pollution days. Quit smoking and avoid exposure to secondhand smoke. Understand medication regimen and proper inhaler use. Patients with severe COPD and repeated exacerbations (3 or more in a year): use inhaled glucocorticosteroids. Recognize and respond to early signs of exacerbations to minimize impact when exacerbations do occur.
Risk Factors for COPD Oxidative stress Gender Age Respiratory infections Socioeconomic status Nutrition Comorbidities Genes Exposure to particles Tobacco smoke Occupational dusts, organic and inorganic Indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings Outdoor air pollution Lung growth and development
Brief Strategies to Help the Patient Willing to Quit Smoking ASK Systematically identify all tobacco users at every visit. ADVISEStrongly urge all tobacco users to quit. ASSESS Determine willingness to make a quit attempt. ASSIST Aid the patient in quitting. ARRANGESchedule follow-up contact.
Anatomy of the Lower Respiratory System Trachea Left Right Main bronchi Bronchus Bronchioles Acinus Alveolus Acinus Alveolus Capillaries rigid because of C-shaped cartilage rings Capillary Alveolar space Attenuated epithelium
Anatomy of the Airways Trachea and major bronchiBronchioles Mucus Cilia Secretory cells Ciliated cells Basal membrane Submucosa Smooth muscle Connective tissue Cartilage Mucous membrane Epithelium Airway mucous membrane