COPD Presentation – By Dr. Ankita Bali 1

•“A disease state characterized by airflow limitation that is not fully reversible” By, Global Initiative for Chronic Obstructive Lung Disease (GOLD)

•“ COPD is defined as a preventable and treatable lung disease with some significant extrapulmonary effects that may contribute to the severity in individual patient .” Davidson’s Principles and Practice of Medicine

COPD Presentation – By Dr. Ankita Bali 2

-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

-Small airways disease- a condition in which small bronchioles are narrowed.

(Asthma and Bronchiactsis is included in this category ) COPD is present only if chronic airflow obstruction occurs; Chronic bronchitis without chronic airflow obstruction is not included within COPD

(Classification from – Harrison’s Principles of Internal Medicine.)

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COPD Presentation – By Dr. Ankita Bali 4

80- 90 % COPD’s Death are caused by Smoking.

•Cigarette Smoking •Airway Hyper-responsiveness •Recurrent Respiratory Infections •Occupational Exposures to Pollutants. •Ambient Air Pollution •Passive or second hand smoking experience •Genetic Considerations (Severe antitrypsin (AT) deficiency is a proven genetic risk factor for COPD; there is increasing evidence that other genetic determinants also exist.)

(From– Harrison’s Principle of Internal Medicine)

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(Pathophysiology from – www.antidotecme.com)

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Gold Stage

Severity Symptoms Spirometry

0 At Risk Chronic cough, sputum production

Normal

I Mild With or without chronic cough or sputum production

FEV1/FVC <0.7 and FEV1 80% predicted

IIA Moderate With or without chronic cough or sputum production

FEV1/FVC <0.7 and 50% FEV1 <80% predicted

III Severe With or without chronic cough or sputum production

FEV1/FVC <0.7 and 30% FEV1 <50% predicted

IV Very Severe With or without chronic cough or sputum production

FEV1/FVC <0.7 and FEV1 <30% predicted or FEV1 <50% predicted with respiratory failure or signs of right heart failure

(From– Harrison’s Principle of Internal Medicine)

COPD Presentation - By Dr. Ankita Bali 8

COPD Presentation - By Dr. Ankita Bali 9

History -The three most common symptoms in COPD : -Cough, -Sputum production, and -Exertional dyspnea. (Many patients have such symptoms for months or years before seeking medical attention.) -ONSET Gradual (commonly )or acute . -The development of Exertional dyspnea ( As the dieases progresses dyspnoea even on rest. - Resting hypoxemia in later stages which wil require institution of supplemental oxygen

(From– Harrison’s Principle of Internal Medicine)

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Defination - Chronic Bronchitis is defined as a disease characterised by cough and sputum for at least 3 consecutive months in a year for more than 2 successive years. (Ref. – API Textbook of Medicine )

Clinical Features •Repeated attack of productive cough. •Shortness of breath. •Respiration Rate hurried •Raised temperature •Central Cynosis maybe present

Investigations – •Blood count – Polycythemia in long standing cases •Pulmonary Function Test •E.C.G – May show right ventricular hypertrophy, • supraventricular and ventricular arrhythmia •Bacterial Culture of sputum

(From – API Textbook of Medicine)

COPD Presentation - By Dr. Ankita Bali 11

Defination – It is a condition of abnormal permanent enlargement of air spaces distal to Terminal bronchioles with destruction of their wall without obvious fibrosis. “Emphysema may be defined by the pattern of the enlarged spaces: Centriacinar , Panacinar and periacinar.” – Principles and Practice of Medicine by Davidson

Clinical Features •Usually above 40 years •Males>Females •Breathlessness and hurried respiration •Wheezing sound •Gradual weakness and loss of weight •Clubbing of finger and central cynosis •Barrel shaped chest •Vocal fermitus diminished ;liver , spleen and cardiac dullness ; Breath sounds diminished. Investigations -X- ray of chest -Lung Function Test

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(Reference from – www.pinterest.com )

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COPD Presentation - By Dr. Ankita Bali 14

(From- www.medcomic.com)

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(From- www.clinicalresearchcentre.com and www.patients.thoracic.org )

Emphysema Chronic Bronchitis Bronchial Asthma

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•Smoking cessation •Improve quality of life •Inhalers (Bronchodilators) •Oxygen therapy •Homoepathic Treatment

Image from – www.chestnet.org

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Emphsema – Amm. Carb Ant. Ars. Lobel. Chronic Bronchitis - Ammonniac Ars. Seneg Sulph Antim jod Bronchial Asthma - Ipec. Ars. Eucalypt Adrenalin Natrum Sulph

(From– Pocket Manual and Homoeopathic Materia Medica and Repertory by William Boericke)

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•Content- Harrison’s Principle of Internal Medicine Davidson’s Principles and Practice of Medicine www.antidotecme.com •Homoeopathic Therapeutics Pocket Manual and Homoeopathic Materia Medica and Repertory by William Boericke •Images – www.hickesvilleschools.org www.sphweb.bumc.bu.edu www.clinicalresearchcentre.com www.medcomic.com www.patients.thoracic.org www.chestnet.org www.pinterest.com