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26-Jan-18

Definition

CHRONIC OBSTRUCTIVE
PULMONARY DISEASE

RELATED DIAGNOSIS

•CHRONIC BRONCHITIS: cough and
sputum production on most days for at
least 3 months in each of 2 consecutive
years
...


RISK FACTORS FOR COPD
ENVIRONMENTAL
• Tobacco smoke
• Indoor air pollution – cooking with biomass fuels
• Occupational exposures – coal dust, silica and
cadmium
• Lung growth: childhood infections or maternal
smoking may affect growth of lung during
childhood
• Low socioeconomic status
• Cannabis smoking

EPIDEMIOLOGY AND AETIOLOGY OF COPD

HOST FACTORS
•Airway hyperactivity
•Genetic factors; α - antiproteinase deficiency

• Prevalence of COPD is directly related to the prevalence of
tobacco smoking and in low and middle income countries,
the use of biomass fuels
• Current estimates suggest that 80 million people world
wide suffer from COPD
• In 2005, COPD contributed to 5% of the deaths that
occurred that year globally
• There is an anticipated rise in morbidity and mortality
from COPD in the Asia and African countries as a result of
increasing tobacco consumption

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EPIDEMIOLOGY cont
...

•Individual susceptibility factors are
important in the development of COPD
since not all smokers develop the
condition

PATHOPHYSIOLOGY
• COPD has both pulmonary and systemic components
...

• Loss of elastic tissue, inflammation and fibrosis in
airway wall result in premature airway closure, gas
trapping and dynamic hyperinflation leading to
changes in pulmonary and chest wall compliance

PATHOPHYSIOLOGY cont
...


•Pulmonary vascular remodelling and impaired
cardiac performance
•Unopposed action of proteases and oxidants
leading to destruction of alveoli and
appearance of emphysema
•Presence of airflow limitation combined with
premature airway closure leads to gas trapping
and hyperinflation; this reduces pulmonary
and chest wall compliance

•The work of breathing is therefore increased
markedly, first on exercise when the time for
expiration is further shortened
...

•Bullae may form in some individuals and this
results in impaired gas exchange and respiratory
failure

PATHOPHYSIOLOGY cont
...
Reducing exposure to noxious particles and
gases
•Complete ceasation of smoking is
accompanied by an improvement in lung
function
•Use of alternative fuels in places where
biomass fuels are constantly
...
Bronchodilators
•Inhaled bronchodilators – short acting β2
agonists – Salbutamol or terbutaline or the
anticholinergics (ipratropium bromide) for
mild disease

On examination:
•Pursed lip breathing, central cyanosis, prolonged
expiration
•Use of accessory muscles
•Hyper inflated ‘barrel chest’, inward movement of
lower ribs on inspiration
•Intercostal indrawing during inspiration
•Auscultation: reduced breath sounds – wheeze –
rhonchi
•Cardiac apex is not palpable; loss of cardiac
dullness on percussion
...


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26-Jan-18

• This may reflect improvement in lung emptying that
reduce dynamic hyperinflation and ease the work of
breathing
...
Corticosteroids
• Inhaled corticosteroids (ICS) reduce the frequency and

severity of exacerbations
...
Pulmonary rehabilitation
• Encourage exercises – reassure patients that breathlessness whilst
distressing is not dangerous

Physical
training

Reduce
symptoms

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Surgical interventions
•Resection of large bullae (bullectomy)
•Lung volume reduction surgery (LVRS)
•Both bullectomy and LVRS can be performed
thoracospically minimising morbidity

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