1. Formal Template Student: Abdulrahman M. AlOmair | Group: 4 | Tutor: Dr.Ayub Ali Case 1.1: Shortness of breath during exertion ( COPD )

2. LEARNING OBJECTIVES  Meaning of Abbreviations  What the changes of dynamic and static lung volumes indicate?  Reason for change in SaO2?  What is shortness of breath (on exertion) ?  Overview of obstructive and restrictive pulmonary diseases.  Definition of chronic obstructive pulmonary diseases(COPD).  Types of chronic obstructive pulmonary diseases(COPD).  Causes and risk factors.  Signs & symptoms  Pathophysiology  Investigations  Complications  Treatment

3. CASE SUMMARY A 67-years old man suffering from shortness of breath during effort and recently while sitting still Complaining from a productive cough with green sputum and his temperature is raised He used to smoke two packs of cigarette a day, but stopped six years ago Breathing rate is 32 min -1 and auscultation indicates reduced breath sound and wheezing His BP is 132/78 mmHg and HR is 94 min-1, and arterial O 2 saturation (SaO 2 ) is 91% His FVC & FEV1 are decreased. TLC, FRC and RV are increased.

4. NORMAL VALUES Normal value in our case Breathing rate Blood pressure Heart rate SaO 2 32 min -1 12 – 20 min -1 120/80 mmHg132/78 mmHg 60 – 100 min -1 94 min -1 97%91% (BR) (BP) (HR) (arterial O 2 saturation)

5. Abbreviations FVC: Forced vital capacity, is the amount of air which can be forcibly exhaled from the lungs after taking the deepest breath possible. FEV1: Forced expiratory volume for 1 second, The volume of air that can be forced out in one second after taking a deep breath TLC: total lung capacity, the volume of air contained in the lungs at the end of a maximal inspiration; also equals vital capacity plus residual volume. FRC: functional Residual Capacity, is the volume of air present in the lungs at the end of passive expiration. RV: the volume of air still remaining in the lungs after the most forcible expiration possible  FVC and FEV1 are called dynamic lung volumes.  TLC, FRC, RV are called static lung volumes.

6. Dynamic & Static volumes Static lung volume: volumes not affected by respiratory rate. Dynamic lung volume: volumes depend on the rate of air that flow out from the lungs  In healthy lungs, dynamic & static volumes are almost equal.  A consistent change in the level of compliance indicates the presence of disease.

7. Change in SaO 2  Normal blood oxygen levels in humans are considered 95-100 percent. If the level is below 90 percent, it is considered low resulting in hypoxemia.  Complication of COPD are frequently associated with abnormality of gas exchange and associated hypoxemia.  hypoxemia in COPD patients is ventilation/perfusion (V/Q) mismatch resulting from progressive airflow limitation and emphysematous destruction of the pulmonary capillary bed of alveoli.  So, the saturation of O 2 in the arteries is decreased because of the abnormal gas exchange.

8. Shortness of breath o known medically as dyspnea — is often described as an intense tightening in the chest, air hunger or a feeling of suffocation. Causes: o extreme temperatures o massive obesity o high altitude all can cause shortness of breath in a healthy person. o Outside of these examples, shortness of breath is likely indicate a sign of a medical problem (lung, heart, etc.)

9. In our case  The man feels shortness of breath on exertion and recently while sitting still.  Shortness of breath on exertion is a difficulty breathing when engaged in a simple activity like walking up stairs or going to short distance places, known as; breathlessness on exertion, exertional dyspnea, dyspnea on effort.  The cause can be: chronic obstructive pulmonary disease – asthma – anemia - pneumonia

10. General Anatomy of Respiratory system

11. Obstructive & restrictive lung diseases  Exhaled air comes out slowly than normal.  At end of expiration, amount of air stays in the lungs.  Result from condition causing stiffness in the lung.  Stiffness of chest wall, weak muscle, damaged nerves. Asthma – Cystic fibrosis - chronic obstructive pulmonary disease (COPD) includes emphysema and chronic bronchitis. Obesity - Sarcoidosis, an autoimmune disease - Interstitial lung disease, such as idiopathic pulmonary fibrosis. Obstructive lung diseases Restrictive lung diseases  Shortness of breath  Characterized by airway obstruction.  Lung cannot be fully filled with air  characterized by reduced lung volumes.

12. Quiz Q1: Cystic fibrosis considered as: A)Obstructive lung disease B)Restrictive lung disease C)Heart disease Q2: Sensations to not be able to get enough air, medically known as: A)Eupnea B)Hyperpnea C)Dyspnea

13. Chronic Obstructive Pulmonary Lung disease (COPD)  is a progressive disease that makes it hard to breathe.  serious condition that restricts airflow in the lungs  The disease cannot be cured, only be managed.  most common in people at least 40 years of age who have a history of smoking.

14. Types of ( COPD ) Emphysem a Chronic bronchitis progressive disease of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli Causes: Cigarette smoking, bronchial tube damage, inherited. Symptoms: Difficulty breathing – shortness of breath – wheezing – coughing – fatigue. It occurs if the lining of the bronchial tubes is constantly irritated and inflamed, causing a long-term cough with mucus. that lasts for at least 3 months, 2 years in a row. Causes: The major cause of chronic bronchitis is cigarette smoking, other like dust, fumes, vapors, and air pollution. Symptoms: productive cough – shortness of breath – chest discomfort – fatigue.

15. Risk factors of COPD Risk factors for COPD include:  Exposure to tobacco smoke. The most significant risk factor for COPD is long- term cigarette smoking.  indoor and outdoor air pollutants can cause the condition when exposure is intense or prolonged.  genetic factors (inherited emphysema) : The genetic disorder results in a lack of the protein alpha 1 (α 1) - antitrypsin (AAT) Its primary function is to protect the lungs from neutrophil elastase..

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17. Investigations Your doctor may order several tests to diagnose your condition, Tests may include:  Lung (pulmonary) function tests: measure the amount of air you can inhale and exhale e.g. Spirometry.  Chest X-ray: can show emphysema.  CT Scan: can help detect emphysema and help determine if you might benefit from surgery for COPD.  Arterial blood gas analysis: measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide.  Laboratory tests: used to determine the cause of your symptoms e.g. genetics, dust, etc.

18. Quiz What is the machine we use to measure amount of air you can inhale or exhale for diagnostic purpose? A)Ultrasound B)Spirometry C)ECG recording

19. Complication COPD gradually gets worse over time. If you are diagnosed later, you may have already lost much of your lung function.  Heart failure  Depression  Lung Cancer  Your disease makes it harder to fight off lung infections so pneumonia may occur. are possible complications of COPD.

20. Treatment Even for more advanced stages of disease, effective therapy is available, it includes:  Smoking cessation: most important step.  Medications: e.g. Bronchodilators - Inhaled steroids – Antibiotics.  Oxygen therapy  Surgery: for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone. E.g. Lung transplant

22. References Chapter 37 p,465 Chapter 39 p.485