1. Chronic Obstructive Pulmonary Disease(COPD)
Prof. Dr. Abdul Hameed Al Qaseer

4. Chronic obstructive pulmonary disease (COPD) is defined as a disease state characterized by airflow limitation that is not fully reversible COPD includes emphysema, an anatomically defined condition characterized by destruction and enlargement of the lung alveoli; chronic bronchitis, a clinically defined condition with chronic cough and phlegm; and small airways disease, a condition in which small bronchioles are narrowed. COPD is present only if chronic airflow obstruction occurs; chronic bronchitis without chronic airflow obstruction is not included within COPD.

7. Global Strategy for Diagnosis, Management and Prevention of COPD
Global Strategy for Diagnosis, Management and Prevention of COPD. Updated 2011
Risk Factors for COPD
Genes
Exposure to particles
Tobacco smoke
Occupational dusts
Indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings
Outdoor air pollution
Lung growth and development
Gender
Age
Respiratory infections
Socioeconomic status
Asthma/Bronchial hyperreactivity
Chronic Bronchitis

8. Risk Factors in COPD

9. COPD – and why? FEV1 No smoker Stop 45 years Disability Stop 65 years
Current smoker
Disability
Dead
FEV1
YEARS
Fletcher, Peto 1977

11. Pathogenesis of Emphysema

13. Breathlessness is the cardinal manifestation of COPD
It is a slowly progressive .However , it can acute during exacerbation
The patient may presented with leg edema with or without right sided heart failure ( core pulmonale)
Physical examination : may be minimum
wheeze , rals ……

16. Clinical Spectrum of COPD ( pink puffers(A)& blue bloaters(B)

17. BLUE BLOATERS ( CHROIN BRONCHITIS)
PINK PUFFERS (EMPHESYMA)

18. Modified Medical Council Research Dyspnea

19. Investigation Chest X-ray Spirometry High resolution CT
Arterial Blood Gas
Bacteriologic , CBC ……

21. Diagnosis: Spirometry
Global Strategy for Diagnosis, Management and Prevention of COPD. Updated 2011
Diagnosis: Spirometry
Normal 5 4 3
Volume, liters
FEV1 = 1.8L
FVC = 3.2L
FEV1/FVC = 0.56 2
Obstructive 1 1 2 3 4 5 6
Time, seconds

22. Spirometric classification of COPD

23. In patients with FEV1/FVC < 0.70:
Classification of Severity of Airflow Limitation in COPD*
In patients with FEV1/FVC < 0.70:
GOLD 1: Mild FEV1 > 80% predicted
GOLD 2: Moderate % < FEV1 < 80% predicted
GOLD 3: Severe % < FEV1 < 50% predicted
GOLD 4: Very Severe FEV1 < 30% predicted
*Based on Post-Bronchodilator FEV1

24. CT of chest shows emphysema

25. Differential Diagnosis of COPD
Chronic Asthma
Bronchiectasis
Bronchial carcinoma
Heart failure
Pulmonary TB
ILD

26. What are the deference between asthma & COPD(ch.bronchitis)?
ONSET
Mainly childhood
mid-late adult life
smoking
Usually nonsmoker
almost invariably smoker
Chronic cough & sputum
Absent
Frequent
Dyspnea on effort
Variable & reversible
constant , poorly reversible
Nocturnal symptoms
Relatively common
Uncommon
Airflow limitation
Diurnal variability
Normal
Response to bronchodilator
Good
poor

27. Ancillary tests in the D. Dx. between stable asthma & COPD
Reversibility to bronchodilator & /or corticosteroids
Usually present
usually absent
TLV + RV
usually normal
Increase
DLco
normal
AHR
might be increase
allergy test
Often +
often -
CXR
usually normal
usually abnormal
sputum
eosinophilia
neutrophilia
Exhaled NO
increase

28. Management of COPD Stop smoking Vaccination Bronchodilators
Corticosteroids
Oxygen therapy
Rehabilitation
Others

29. Smoking cessation
Every attempt should be made to highlight the role of smoking in the development and progress of the disease and encourage, advise and assist the patient toward smoking cessation. On cessation, patients should be warned to expect an apparent worsening of chest symptoms and reassured that this is temporary. Cessation is difficult but highly rewarding and remains the only intervention proven to decelerate the decline in FEV1.

31. COPD Assessment Score ( CAT)

32. Smoking cessation

34. Pharmacological Management of COPD

38. In advanced disease Long – term oxygen therapy is necessary

39. COPD in Old age

41. Management of acute exacerbation of COPD
1. Oxygen therapy : 24%---28% ---
2. Inhaled bronchodilators : SABA , SAMA , LABA ,LAMA
3. Oral corticosteroid: prednisolone 30 mg/d for 10 days
4. Antimicrobial drugs

42. Prognosis : BODE index( B=BMI;O=airway obstruction= dyspnea; E =exercise capacity)

43. Prognosis: Calculation of BODE index

44. THANK YOU