Chronic Obstructive Pulmonary Disease (COPD) : Assistant Sukhonos N

Chronic obstructive
pulmonary disease
(COPD)
Assistant Sukhonos N.
Definition
COPD = chronic obstructive pulmonary disease

(J44) (Greek “chron-” – time, “obstruct” – decrease of
permeability, “pulmo-” – lung) – disease of bronchopulmonary
system characterized by irreversible airflow limitation
predominantly in peripheral bronchi
 Characterized by decline lung function with airfow obstruction.

Generally 2° to chronic bronchitis or emphysema, which are
distinguished as follows:
 ■ Chronic bronchitis: Productive cough for > 3 months per year for
two consecutive years.
 ■ Emphysema: Terminal airway destruction and dilation that may
be 2° to smoking (centrilobular) or to α1-antitrypsin deficiency
(panlobular).
Epidemiology
 COPD is the 4th cause of death worldwide and is increasing

 3rd most common cause of hospitalization
 Mortality of hospitalized is 5-14%
 10% prevalence in 55-85 yrs
 Prevalence highest in countries with most cigarette use
 Men > Women
 Prevalence in women doubled in the past few decades
▪ Increased female smoking
Etiology & risk factors
• Smoking
• 80-90% of those with COPD are smokers
• 15% of smokers develop clinically significant COPD
• Mortality increased
• Early starting age
• Total pack-years
• Current smoking status
• Other
• Respiratory infections
• Occupational exposures
• Ambient air pollution
• Passive smoke exposure
• α1-antitrypsin deficiency (1% of patients with COPD)
• Diet
Pathogenesis
Pathophysiology of COPD
 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
Clinical Findings of Chronic Compensated COPD
 Hallmark symptoms: exertional dyspnea and cough

 Chronic productive cough
 Minor hemoptysis frequent
 Clinical findings
 Tachypnea
 Accessory respiratory muscle use
 Pursed-lip exhalation
 Expiratory wheezing
Diagnosis of Chronic Compensated COPD
 Examination of:
 Investigation of external breathing (spirometry);
 Bronchodilatation test;
 Cytology of sputum;
 Blood analysis;
 X-ray;
 ECG;
 Blood gases;
 Most valuable tools for determining disease severity are PFTs

 Ratio of FEV1 to FVC (Tiffeneau index) used to diagnose mild COPD
▪ FEV1 < 80% predicted + FEV1/FVC <70%
▪ Once disease progresses, percentage of predicted FEV1 is better measure of
disease severity
FEV1 Volume that has been exhaled at the end of the first second of forced expiration
FVC Forced vital capacity: the determination of the vital capacity from a maximally
forced expiratory effort
Spirography
Classification of COPD
 Stage 0 At Risk
 Stage I Mild COPD
 Stage II Moderate COPD
 Stage III Severe COPD
 Stage IV Very Severe COPD
COPD  classification
Stage,
Signs (criteria)
severity
1st, mild -сhroniс cough (not always)
-FEV1/FVC < 70 %
-FEV1  80 %
2nd, -progression of cough + dyspnea (on exertion)

moderate -FEV1/FVC < 70 %
-50 %  FEV1  80 %
3rd, severe -progression of cough & dyspnea + decrease of QOL

-FEV1/FVC < 70 %
-30 %  FEV1  50 %
4th, very -progression of signs + chronic respiratory insufficiency

severe -FEV1/FVC < 70 %
-FEV1 < 30 %
Global Initiative for Obstructive Lung Disease (GOLD), 2013
Management
 1. Assess and Monitor Disease
 2.Reduce Risk Factors
 3.Manage Stable COPD
 3.1Education
 3.2Med management
 3.3Non med management
 4.Treat exacerbations(aggravation)
 5.Inhaled medicines are preferred.
 6. Increasing of intensivity of treatment in correlation with COPD
severity
 7. Permanent basis therapy
 8. Individual sensitivity to different medicines leads to necessarity
of permanent control
Treatment of Chronic Compensated COPD
 Healthy lifestyle
 Regular exercise
 Weight control
 Smoking cessation
▪ Only therapeutic intervention that can reduce the accelerated decline in
lung function
▪ Reduces COPD mortality along with long-term oxygen therapy
The long-term O2 with chronic respiratory failure

increases survival
Pharmacotherapy of Chronic Compensated COPD
 1.Inhaled bronchodilators used:
▪ for mild to moderately obstructed patients with intermittent symptoms
▪ On a regular basis to prevent or decrease symptoms
 2.β2-agonists
 Relax smooth muscle
 Stimulates β2 -adrenergic receptors
 Long-acting β2 –agonists
▪ Salmeterol or formoterol
▪ May improve overall symptoms and health status
 Short-acting β2 –agonists
▪ May improve exercise capacity
▪ Less convenient to use
 3. Anticholinergics
 Facilitate bronchodilation
▪ Block acetylcholine on muscarinic-3 receptors
 Ipratropium bromide
▪ Drug of choice:
▪ Patients with persistent symptoms
 Refractory to β2-adrenergic agents
 Bothered by side effects of β2-adrenergic agents
 Regular use of inhaled ipratropium has been shown to improve health status
Pharmacotherapy of Chronic Compensated
COPD
 Systemic corticosteroids
 Evidence lacking for long-term use for all patients with COPD
 20-30% of patients with COPD improve when given chronic oral
steroids
 Inhaled corticosteroids
 Indicated only if:
▪ Documented spirometric response to inhaled corticosteroids
▪ If FEV1 is <50%
▪ Those with predicted and recurrent exacerbations requiring
antibiotic treatment or systemic corticosteroids
Treatment
 Corticosteroids
 Oxygen
 Prevention (cigarette smoking cessation,
pneumococcal and influenza vaccines)
 Dilators (β2-agonists,anticholinergics)

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Chronic obstructive

COPD = chronic obstructive pulmonary disease

 Characterized by decline lung function with airfow obstruction.

 COPD is the 4th cause of death worldwide and is increasing

 Hallmark symptoms: exertional dyspnea and cough

 Most valuable tools for determining disease severity are PFTs

2nd, -progression of cough + dyspnea (on exertion)

3rd, severe -progression of cough & dyspnea + decrease of QOL

4th, very -progression of signs + chronic respiratory insufficiency

The long-term O2 with chronic respiratory failure

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