 CHRONIC OBSTRUCTIVE PULMONARY DISEASE

 Chronic Obstructive Pulmonary Disease(COPD) can be defined as characterized

by progressive airflow limitation that is not fully reversible.
 The airflow limitation is both usually progressive and associated with an abnormal
inflammatory response of lungs to noxious particles or gases.
 People with COPD are at increased risk of developing heart disease, lung cancer and a
variety of other conditions.
 Although COPD is a progressive disease that gets worse over time, COPD is
treatable.
 With proper management, most people with COPD can achieve good symptom
control and quality of life, as well as reduced risk of other associated conditions.

 TYPES OF COPD
 The main types of chronic obstructive pulmonary disease (COPD) are emphysema
and chronic bronchitis. They differ in the kind of damage they do to the airways and
lungs. However, the causes, symptoms, and treatment of the two conditions are almost
completely identical.

 There are four stages of COPD that range from mild to very severe. A person with
mild COPD may not know that they have the condition, while someone with very
severe COPD will experience life threatening symptoms.
  EMPHYSEMA
 Emphysema is a condition that involves damage to the walls of the air sacs (alveoli) of
the lung. Alveoli are small, thin-walled, very fragile air sacs located in clusters at the end
of the bronchial tubes deep inside the lungs.
 There are about 300 million alveoli in normal lungs. As you breathe in air, the alveoli
stretch, drawing oxygen in and transporting it to the blood. When you exhale, the alveoli
shrink, forcing carbon dioxide out of the body.
 When emphysema develops, the alveoli and lung tissue are destroyed. With this damage,
the alveoli cannot support the bronchial tubes. The tubes collapse and cause an
“obstruction” (a blockage), which traps air inside the lungs. Too much air trapped in the
lungs can give some patients a barrel-chested appearance. Also, because there are fewer
alveoli, less oxygen will be able to move into the bloodstream.

 CHRONIC BRONCHITIS
 Chronic bronchitis is long-term inflammation of the bronchi. It is common among
smokers. People with chronic bronchitis tend to get lung infections more easily. They also
have episodes of acute bronchitis, when symptoms are worse.
 Chronic bronchitis is not caused by a virus or bacteria. Most experts agree that the main
cause of chronic bronchitis is cigarette smoking. Air pollution and your work
environment may also play a role.
 People with chronic bronchitis often have a cough and make mucus for many years before
they have shortness of breath.
 EPIDEMIOLOGY OF COPD

 Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of

morbidity and mortality in the industrialized and the developing countries. During 1997,
COPD has been estimated to be the number four cause of death after cardiovascular
diseases, tumors and cerebrovascular diseases in the United States. In 2020 COPD will
probably become the third leading cause of death all over the world, following the trend
of increasing prevalence of lung cancer.
 In the United States direct and indirect costs of COPD were estimated at about USD24
billion in 1993. Data collected in a general population sample (living in Italy) showed a
progressive increase of the prevalence of chronic bronchitis and emphysema with age,
both in males and in females.
 COPD is determined by the action of a number of various risk factors either singly or
interacting among themselves in a synergistic way. Among these, the most important is
cigarette smoking, ranking at the first level for developing chronic bronchitis and
emphysema. Also air pollution and some occupational exposures represent risks for
developing COPD. Many epidemiological studies have indicated an association between
the prevalence of chronic bronchitis and a low socioeconomic status.

 ETIOLOGY OF COPD
a. Cigarette smoking
b. Infection
 c. Occupation dust and chemical
d. Air pollution
e. Ageing
f. Hereditary
 STAGES OF COPD
 The following stages come from the Global Initiative for Chronic
Obstructive Lung Disease (GOLD) guidelines, which derive from a
specific breathing test called spirometry grading.
Stage 1: Mild COPD: People have mild limitations to their airflow, and some may also have
an ongoing cough. They may cough up sputum, a mixture of mucus and saliva. Someone in
this stage may not be aware that their lung function is abnormal.
Stage 2: Moderate COPD: In Stage 2, airflow limitation worsens, and people tend to
experience shortness of breath during exercise. This is the stage where people usually seek
medical attention.
Stage 3: Severe COPD: In stage 3, a person experiences an even greater restriction to their
airflow, as well as increased shortness of breath. This accompanies a decrease in exercise
tolerance. The recurring episodes of worsening symptoms reduce quality of life.
Stage 4: Very severe COPD: In stage 4, people have severe airflow limitations and greatly
reduced quality of life, while episodes of worsening symptoms may become life threatening.

SIGNS AND SYMPTOMS OF COPD

 Chronic cough with sputum
 Cyanosis of mucosal membrane
 Barrel chest
 Increased resting respiration rate
 Use of accessory respiratory muscles
 Shallow breathing
 Pursing of lips during expiration
 Worsening dyspnea
 Chest tightness
 Malaysia
  PATHOPHYSIOLOGY OF
COPD
 Pathophysiology is the evolution of adverse functional
changes associated with a disease. For people with COPD,
this starts with damage to the airways and tiny air sacs in
the lungs. Symptoms progress from a cough with mucus to
difficulty breathing.
 The damage done by COPD can’t be undone. However,
there are some preventive measures you can take to lower
your risk of developing COPD.
 To understand COPD’s pathophysiology, it’s important to
understand the structure of the lungs.
 When you inhale, air moves down your trachea and then
through two tubes called bronchi. The bronchi branch out
into smaller tubes called bronchioles. At the ends of the
bronchioles are little air sacs called alveoli. At the end of
the alveoli are capillaries, which are tiny blood vessels.
 Oxygen moves from the lungs to the bloodstream through
these capillaries. In exchange, carbon dioxide moves from
the blood into the capillaries and then into the lungs before
it’s exhaled.
 Emphysema is a disease of the alveoli. The fibers that make
up the walls of the alveoli become damaged. The damage
makes them less elastic and unable to recoil when you
exhale, making it hard to exhale carbon dioxide out of the
lungs.
 If the lung airways become inflamed, this results in
bronchitis with subsequent mucus production. If the
bronchitis persists, you can develop chronic bronchitis. You
also can have temporary bouts of acute bronchitis, but these
episodes aren’t considered to be the same as COPD.
  COPD Tests and Diagnosis
 A diagnosis of chronic obstructive pulmonary disease (COPD) is
based on your signs and symptoms, history of exposure to lung
irritants (such as smoking), and family history. Your doctor will
need to do a complete physical examination before determining a
diagnosis.
 COPD symptoms can be slow to develop, and many of its
symptoms are somewhat common.
 Your doctor will use a stethoscope to listen to both heart and lung
sounds and may order some or all of the following tests:
Spirometry:
 The most effective and common method for diagnosing COPD is
spirometry. It’s also known as a pulmonary function test or PFT.
This easy, painless test measures lung function and capacity.
Bronchodilator reversibility test:
 This test combines spirometry with the use of a bronchodilator,
which is medicine to help open up your airways.
Blood tests:
 Blood tests can help your doctor determine whether your
symptoms are being caused by an infection or some other medical
condition.
Genetic testing:
 While smoking and exposure to harmful substances in the
environment are the main causes of COPD, there’s also a
hereditary risk factor for this condition. A family history of
premature COPD may signal that you have the condition.
 Chest X-ray or CT scan: A CT scan is a type of X-ray that creates
a more detailed image than a standard X-ray. Any type of X-ray
 that your doctor chooses will give a picture of the structures inside
your chest, including your heart, lungs, and blood vessels.
Sputum examination:
 Your doctor may order a sputum examination, especially if you
have a productive cough. Sputum is the mucus you cough up.
 Analyzing your sputum can help identify the cause of your
breathing difficulties and may help detect some lung cancers. If
you have a bacterial infection, it can also be identified and treated.
Electrocardiogram (ECG or EKG):
 Your doctor might request an electrocardiogram (ECG or
EKG) to determine if your shortness of breath is being
caused by a heart condition as opposed to a lung problem.
 Over time, though, the breathing difficulties associated with
COPD can lead to cardiac complications including
abnormal heart rhythms, heart failure, and heart attack.

 MANAGEMENT OF COPD
PRECAUTIONS FOR
COPD
Pulmonary rehabilitation
 Pulmonary rehabilitation is a program that can help you
learn how to breathe easier and improve your quality of
life. It includes breathing retraining, exercise training,
education, and counseling.
 Regular exercise has many benefits. Exercise, especially
aerobic exercise, can:
 Improve your circulation and help the body better use
oxygen
 Improve your COPD symptoms
 Build energy levels so you can do more activities without
becoming tired or short of breath
 Strengthen your heart and cardiovascular system
 Increase endurance
 Lower blood pressure
 Improve muscle tone and strength; improve balance and
joint flexibility
 Strengthen bones
 Help reduce body fat and help you reach a healthy
weight
 Help reduce stress, tension, anxiety, and depression
 Boost self-image and self-esteem; make you look fit and
feel healthy
 Improve sleep
 Make you feel more relaxed and rested