Chronic Obstructive Pulmonary Disease (COPD)

1. Andriy Lepyavko, MD, PhD Department of Internal Medicine № 2 Chronic Obstructive Pulmonary Disease (COPD)

2. Plan of the lecture • Etiology, pathogenesis of COPD • Diagnostic criteria • Principles of treatment • Step-by-step treatment

3. COPD and Bronchial Asthma are the most common diseases of lungs • 4-10 % of adult people are ill with COPD • In Europe 7,4 % of people have COPD • Mortality of such patients is 10 %

6. According GOLD 2006 COPD – this is disease which is characterized by combination of clinical signs of chronic obstructive bronchitis (inflammation and narrowing of bronchi) and emphysema (changes of lung tissue structure).

7. Pathogenesis of COPD • Permanent hyperactivity of parasympathetic nervous system with hyperproduction of acetylcholine, bronchial spasm and hypersecretion of mucus • Insufficiency of adrenal receptors in bronchial walls as the result of deep morphological changes with bronchial hypersecretion, bronchial spasm and cough • Bronchial hyperreactivitywhich is characterized by immune inflammation of bronchioles walls All that lead to: • 1) narrowing of bronchioles; • 2) development of emphysema

8. Pathophysiology ofCOPD • 1.Hypersecretion of mucus • 2.Dysfunction of ciliary epithelium • 3.Decreasing of air flow in bronchi • 4.Hyperpneumatization of lungs • 5.Disturbances of gases-exchange • 6.Pulmonary hypertension • 7.cor pulmonale

17. Anamnesis • Severe smoking • Occupational diseases • Family anamnesis

18. Complaints • Chronic cough is the earliest sign of COPD and arise earlier then dyspnea • Sputum – as a rool in small amount, after cough • Dyspnea – persistent, progressive, becomes worse during physical activity and in severe cases – even if patient is calm

19. Physical signs • Central cyanosis, emphysematous chest, additional breathing muscles are necessary for breathing • Increasing of breathing rate, decreasing of its deepness, prolongation of expiration • Percussion: decreasing of heart dullness • Auscultation: wheezing, dry rales, heart tones are dull

20. Methods of investigation of patients with COPD according “GOLD” • Investigation of external breathing (spyrometry); • Bronchodilatation test; • Cytology of sputum; • Blood analysis; • X-ray; • ECG; • Blood gases;

21. Investigation of external breathing • FVC – max air volume which is expired during forced expiration after max inspiration; • FEV1 (<80 %) • FEV1/FVC (<70 %) • Peak flow (of expiration)

22. X-ray signs of COPD • Lungs are enlarged • Dyaphragm is located lower than normally • Narrow heart shadow • Sometimes – emphysematous bullas

23. X-ray of patient with COPD

26. Bronchodilatation test • Is necessary to find bronchial reversibility • Spyrometry has to be provided before and 15 min after inhalation of 400 mkg of Salbutamol (or 30-45 min – 80 mkg of Ipratropium) • Increasing of FEV1 more than 15 % tells us about reversibility

27. Classification of COPD

28. Principles of treatment of COPD • Increasing of intensivity of treatment in correlation with COPD severity; • Permanent basis therapy; • Individual sensitivity of patients to different medicines leads to necessarity of permanent control; • Inhaled medicines are useful.

32. Inhaled cholynolytics • Short action – (Ipratropium bromid, Berodual Н) has more slowly beginning but longer action than β2-agonists • Prolonged action – (Thyotropium bromid,Spiriva ) is active for 24 hours

34. Inhaled broncholytics • agonists of short action(Salbutamol, Fenoterol) – fast beginning of action, but duration – 4-6 hours • 2-agonists of prolonged action (Salmeterol, Formoterol ) are active for 12 hours.

35. Methylxantines • Theophyllines of prolonged action are useful – Teopec, Teotard.

36. Glucocorticosteroids • Are useful for permanent basis therapy for patients with COPD III-IV st. • Inhaled GCS areused. • Prednisone may be used only during exacerbation and is not recommended for basis therapy

37. Inhaled GCS (Beclomethasone, Budesonid, Fluticasone). • Seretid (GCS+Salmeterol) is used in patients with III-IV st. of COPD and oftern exacerbations in anamnesis.

47. Thanks for your attention!