CHRONIC OBSTRUCTIVE PULMONARY DISEASE

1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE

2. CHRONIC OBSTRUCTIVE LUNG DISEASES ASTHMA REVERSIBILITY OF AIR WAY OBSTRUTION CHRONIC BRONCHITIS EMPHYSEMA FULL NONE COPD ASTHMA Dr.Sarma@works

3. PREVALENCE of MORTALITY (2000) • In 2000, the WHO estimated 2.74 million COPD deaths worldwide. • In 1990, COPD was ranked 12thleading cause of death. • It is expected to be the third leading cause of death by 2020. • 10 lacsIndians die in a year due to smoking related diseases. • In India, 4,00,000 premature deaths annually due to use of biomass fuels, like cow dung cakes, open fires *The Indian J Chest Dis & Allied Sciences 2009; 43:139-47

4. PREVALENCE of MORBIDITY • Cigarette smoking is the primary cause. • WHO estimates 1.1 Billion smokers in world. • In India 1,49,00,000 chronic cases of COPD in the age group of 30 ?

5. 4000 chemicals (more than 60 carcinogens) are inhaled in cigarette smoke

6. Currently there are 94 million smokers in India COLLEGE STUDENTS ( 2%) TENDER AGE GROUPS Every day 55000 Indian youth start tobacco use THE NUMBER OF WOMEN SMOKERS& PASSIVE SMOKERS IS ON RISE Dr.Sarma@works

7. Risk Factors for COPD Nutrition Infections Socio-economic status • Genes (alpha1- anti-trypsin↓) Aging Populations

8. TYPES OF COPD

9. Simple concept…….

10. CHRONICBRONCHITIS COPD • Mucus gland hypertrophy • Smooth muscle hypertrophy • Goblet cell hyperplasia • Inflammatory infiltrate • Excessive mucus • Squamousmetaplasia Normal bronchial architecture Dr.Sarma@works

14. PULMONARY VASCULAR CHANGES IN COPD • THICK VESSEL WALL • INFALMMATORY CELLS INFILTRATE • COLLAGEN DEPOSIT • DESTRUCTION OF CAPILLARY BED Normal Pulmonary Artery 4 3 Dr.Sarma@works

15. COPDPathophysiology Fig. 29-7

16. Did you know? • The King of Pop suffered from Alpha-1 antitrypsin deficiency,

17. Centrilobular (central part of lobule) • Dilation and destruction of respiratory bronchioles and pulmonary capillary bed • Prominent in upper lobes • Panlobular (destruction of whole lobule) • Affects respiratory bronchioles, alveolar ducts, and alveolar sacs. • Prominent in lower lobes

18. Clinical Manifestations • Develops slowly around 50 yrs of age after 20 pack years of cigarette smoking • Diagnosis is considered with • Cough • Sputum production • Dyspnea • Exposure to risk factors * Packets per day x Years of smoking = Pack Years

19. Clinical Manifestations • Intermittent Cough with expectoration • Progressive Dyspnea Described by the patient as an “increased effort to breathe,” “heaviness,” “air hunger,” or “gasping.”

20. Clinical Manifestations • chest breathing • Use of accessory such as those in the neck and intercostal muscles • Decreased abdominal breathing –flattened diaphragm from over distended lungs. • Purse lip breathing on expiration. It helps to prevent airway collapse by increasing pressure .

21. Clinical Manifestations • Barrel Chest- • Air gets trapped causing increase in antero posterior dimensions of the chest • Characteristically underweight with adequate caloric intake • Chronic fatigue

22. COPD Clinical Manifestations • Tripod position • Patient may sit upright with arms supported on a fixed Surface .This optimises the function of pectoral muscles to expand thoracic cavity. • Bluish-red color of skin • Polycythemia and cyanosis • Hemoptysis

23. Poor ventilation and perfusion; unable to compensate leading to hypoxia and cyanosis • Clubbing

24. Over ventilate to maintain relatively normal ABG’s • Red face

25. DIAGNOSTIC EVALUATION • *Percussion : • Hyperresonant • depressed diaphragm, • *Auscultation: • Prolonged expiration ； • reduced breath sounds; • The presence of wheezing during quiet breathing Crackle can be heard if infection exist. • The heart sounds are best heard over the xiphoid area.

26. Para clinical examination • CT: highlighting the pulmonary emphysema and emphysema bubbles. • Blood examination In excerbation or acute infection in airway, leucocytosis may be detected. • Screening for alpha 1 antitrypsin deficiency • Sputum examination streptococcus pneumonia Haemophilusinfluenzae klebsiella pneumonia

27. 6-Minute walk test to determine O2 desaturation in the blood with exercise • ECG can show signs of right ventricular failure • ABG typical findings • Low PaO2 • ↑ PaCO2 • ↓ pH • ↑ Bicarbonate level found in late stages COPD

28. Spirometry • FEV1– Forced expired volume in the first second • FVC – Total volume of air that can be exhaled from maximal inhalation to maximal exhalation • FEV1/FVC% - The ratio of FEV1 to FVC, expressed as a percentage.

29. SPIROMETRY NORMAL AND COPD Dr.Sarma@works

30. CHEST SKIAGRAMS OF EMPHYSEMA Dr.Sarma@works

31. V- P MISMATCH NUCLEOTIDE IMAGING Dr.Sarma@works

32. HRCT – NORMAL CHEST Dr.Sarma@works

33. HRCT – EMPHYSEMA Dr.Sarma@works

36. Management based on GOLD Post-bronchodilatorFEV1(% predicted)

37. NO TOMORROW! IF ONE QUITS SMOKING • Assess and monitor disease • Reduce risk factors • Manage stable COPD • Education • Pharmacologic • Non-pharmacologic • Manage exacerbations • Studies have shown that with smoking cessation • The rate of decline in lung function slows • There will be definite clinical improvement in symptoms

38. REHABILITATION For the lungs to get more air PURSED-LIP BREATHING(like breathing out slowly into a straw) INHALE EXHALE Dr.Sarma@works

39. REHABILITATION For the lungs to get more air DIAPHRAGMATIC BREATHING Put one hand on your abdomen. Now inhale slowly through your nose. (Push your abdomen out while you breathe in) Then push in your abdominal muscles and breathe out using the pursed-lip technique Sit comfortably and relax your shoulders Dr.Sarma@works

41. Positions for Postural Drainage

42. Cupped-Hand Position

43. Flutter Mucus Clearance Device

44. Methods of Oxygen Administration C. Venturi Mask D. Tracheostomy Mask E. Face Tent F. Standard Nasal Cannulas Fig. 29-11 C-F

45. Plastic Face Mask with Reservoir Bag for Oxygen Administration Simple Face Mask for Oxygen Administration Fig. 29-11 A

46. You administer high flow supplemental oxygen to a patient with COPD and the patient stops breathing. What Happened to your patient?

47. The single most important driver of ventilation is CO2 But can be deadly for the COPD Patient Microsoft clipart CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2 CO2

49. You removed his drive to breathe!

50. DIET PLAN Calories -1300 to 1800 Kcal/day Protein - 1 gm/kg/body weight Fat - 50 gm Fibers - 30 to 35 gms Potassium rich diet Salt 10 gm/day Hydration 3 litre /day