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Respiratory system. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD). DEFINITION.
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DEFINITION • COPDIs Defined As A Chronic Slowly Progressive Disorder of Airways Characterized By Air Flow Obstruction [Reduced Forced Expiratory Volume In 1 Sec (Fev1)<80% and Fev1; Forced Vital Capacity (fvc) <70% ] , which Doesn’t Change Markedly Over Several Months • Its pulmonary component is characterized by airflow limitation that is not fully reversible.
PATHOPYSIOLOGY • The basic pathophysiologic process in COPD consists of: • increased resistance to airflow • loss of elastic recoil • decreased expiratory flow rate
The inflammatory process is a driving aspect in the pathophysiology of COPD and the inflammatory response results in a number of effects: • an arrival of inflammatory cells (macrophages, neutrophils and lymphocytes). • Thickened airways and structural changes such as increased smooth muscle and fibrosis • COPD is a subset of obstructive lung diseases that includes cystic fibrosis, bronchiectasis and asthma. Degeneration and destruction of the lung and supporting tissue are characteristic of COPD • Smoking and noxious particles results in narrowing and hyperactivity of airways
ASTHMA & COPD • Onset in mid-life. • Symptoms slowly progressive. • Long smoking history. • Dyspnea during exercise. • Largely irreversible airflow limitation. COPD Asthma COPD • 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. Asthma
COPD is basically a combination of two other respiratory diseases- emphysema and bronchitis.
EMPHYSEMA Emphysema is a lung disease involving damage to the air sacs (alveoli). There is progressive destruction of alveoli and the surrounding tissue that supports the alveoli. With more advanced disease, large air cysts develop where normal lung tissue used to be. Air is trapped in the lungs due to lack of supportive tissue which decreases oxygenation
CHRONIC BRONCHITIS Defined as the production of cough and sputum for at least 3 months in each of 2 consecutive years, is not necessarily associated with airflow limitation
BARREL CHEST PURSED-LIP BREATHING SIGNS
PRODUCTIVE COUGH CYANOSIS
SYMPTOMS • Shortness of Breath (dyspnea) Dyspnea, the most common symptom of COPD, comes on gradually and is first noticed during physical exertion or during acute exacerbations. It is closely associated with lung function decline and is not always associated with low oxygen in the blood. • Chronic Cough Chronic cough typically begins as a morning cough and slowly progresses to an all-day cough. The cough usually produces small amounts of sputum (less than 60 mL/day) and is clear or whitish but may be discolored. Sputum production decreases when one quits smoking.
CAUSES / RISK FACTORS • Smoking • Allergies and ASTHMA • Nutrition • Periodontal Disease • Low Birth Weight • Age, Gender, Ethnic Background • Environmental pollution • Occupation • Congenital • Recurrent Bronchopulmonary Infections
Indicators for Considering a COPD Diagnosis Chronic cough Present intermittently or every day. Often present throughout the day; seldom only nocturnal. Chronic sputum production Any pattern of chronic sputum production may indicate COPD. Acute bronchitis Repeated episodes. Dyspnea Progressive (worsens over time). Persistent (present every day). Worse on exercise.Worse during respiratory infections. History of exposure to risk factors Tobacco smoke Occupational dusts and chemicals.Smoke from home cooking and heating fuel. Diagnosis Of COPD
Diagnosis Of COPD,cont The diagnosis should be confirmed bySpirometry • When performing spirometry, measure: • Forced Vital Capacity (FVC) and • Forced Expiratory Volume inone • second (FEV1). • Calculate the FEV1/FVC ratio. • Patients with COPD typically show : • a decrease in both FEV1 and FEV1/FVC • With limited reversibilityafter • bronchodilators
CLASSIFICATION OF COPD SEVERITY BY SPIROMETRY STAGE I: MILD FEV1/FVC < 70% FEV1≥ 80% predicted STAGE II: MODERATE FEV1/FVC < 70% 50% ≤ FEV1 < 80% predicted STAGE III: SEVERE FEV1/FVC < 70% 30% ≤ FEV1 < 50% predicted STAGE IV: VERY SEVEREFEV1/FVC < 70% FEV1 < 30% predicted OR FEV1 < 50% predicted PLUS CHRONIC RESPIRATORY FAILURE
TREATMENT • COPD can't be cured, but it can be treated. Proper COPD treatment includes these steps: • Quit smoking • Take COPD medications • Make changes to your lifestyle • Join a respiratory rehabilitation program • Prevent and control your COPD flare-ups • Work with your healthcare team