definition of copd copd is a preventable and treatable disease with some significant extrapulmonary...
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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 COPDInflammation in COPDINFLAMMATION IN COPD
Small airway diseaseAirway inflammationAirway remodeling
Parenchymal destructionLoss of alveolar attachments
Decrease of elastic recoil
AIRFLOW LIMITATION
Noxious particles
and gases
Lung inflammation
Host factors
COPD pathology
ProteinasesOxidative stress
Anti -proteinasesAnti -oxidants
Repair mechanisms
Pathogenesis of COPDPathogenesis of COPD
Diagnosis of COPD
SYMPTOMS
coughsputumdyspnea
EXPOSURE TO RISKFACTORS
tobaccooccupation
indoor/outdoor pollution
SPIROMETRY
Spirometry: Normal and Patients with COPD
Spirometry GuideSpirometry Quick GuideSpirometry Teaching Slide Set
To help health care professionals understand how to perform & evaluate spirometry.
All resources available at www.goldcopd.org.
Spirometry “How-To” Resources from GOLD
Classification of COPD Severity by Spirometry
Stage I: Mild FEV1/FVC < 0.70 FEV1 > 80% predicted
Stage II: Moderate FEV1/FVC < 0.70 50% < FEV1 < 80% predicted
Stage III: Severe FEV1/FVC < 0.70 30% < FEV1 < 50% predicted
Stage IV: Very Severe FEV1/FVC < 0.70 FEV1 < 30% predicted or
FEV1 < 50% predicted plus chronic respiratory failure
IV: Very Severe III: Severe II: Moderate I: Mild
Therapy at Each Stage of COPDTherapy at Each Stage of COPD
• FEV1/FVC < 70%
• FEV1 > 80% predicted
• FEV1/FVC < 70%
• 50% < FEV1 < 80% predicted
• FEV1/FVC < 70%
• 30% < FEV1 < 50% predicted
• FEV1/FVC < 70%
• FEV1 < 30% predictedor FEV1 < 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 vaccinationAdd short-acting bronchodilator (when needed)
Add long term oxygen if chronic respiratory failure. Consider surgical treatments
Differential Diagnosis: Differential Diagnosis: COPD and AsthmaCOPD 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 ConditionsCOPD 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 ExacerbationsPreventing 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.
• ADVISE Strongly urge all tobacco users to quit.
• ASSESS Determine willingness to make a quit attempt.
• ASSIST Aid the patient in quitting.
• ARRANGE Schedule follow-up contact.
Anatomy of the Anatomy of the Lower Respiratory SystemLower Respiratory System
Trachea
LeftRight
Main bronchi
Bronchus
Bronchioles
Acinus
Alveolus
Acinus
Alveolus
Capillaries
rigid because ofC-shapedcartilage rings
Capillary
Alveolarspace
Attenuatedepithelium
Anatomy of the AirwaysAnatomy of the Airways
Trachea and major bronchi Bronchioles
MucusCiliaSecretory cells
Ciliated cells
Basal membrane
Submucosa
Smooth muscle
Connective tissue
Cartilage
Mucous membrane
Epithelium
Airway mucous membrane