COPD is a type of obstructive lung disease and related conditions. it is very helpful presentation to you about information of COPD. It includes all things that is definition, causes, symptoms, pathophysiology, diagnostic evaluation, types, treatment and role of nurses for COPD patient.

2. CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
BY-
PREETI SHARMA
MSC. NSG. 1st YR.

3. INTRODUCTION
 Chronic obstructive pulmonary disease (COPD) is
comprised primarily of three related conditions - chronic
bronchitis, chronic asthma, and emphysema. In each
condition there is chronic obstruction of the flow of air
through the airways and out of the lungs, and the
obstruction generally is permanent and may be
progressive over time. COPD is also known as chronic
obstructive lung disease (COLD), chronic obstructive
airway disease (COAD), chronic airflow limitation (CAL)
and chronic obstructive respiratory disease (CORD).

4. DEFINITION
 Acc. to WHO- “Chronic obstructive pulmonary disease is a
lung disease characterized by chronic obstruction of lung
airflow that interferes with the normal breathing and its
compulsory reversible.”
OR
“Chronic obstructive pulmonary disease (COPD) is a type of
obstructive lung disease characterized by long term
breathing problems and poor airflow.”

5. ANATOMY & PHYSIOLOGY

6. CLASSIFICATION
COPD
CHRONIC
BRONCHITIS EMPHYSEMA

7. CONT…
 Emphysema- It is a type of COPD involving damage to
the air sacs (alveoli) in the lungs. As a result, your body
does not get the oxygen it needs. It makes it hard to
catch your breath. You may also have a chronic cough
and have trouble breathing.
 Chronic Bronchitis- It is defined as the presence of
cough and sputum production for at least 3 months.

8. RISK FACTORS
 Cigarette & Smoke
 Occupational dust & chemicals
 Environmental tobacco smoke
 Nutrition
 Socio-economic status
 Infection
 Indoor & outdoor air pollution

9. ETIOLOGY
 Cigarette, smoke- This is the most common
reason people get COPD.
 Secondhand smoke- Even if you aren’t a
smoker, you can get COPD from living with
one.
 Pollution and fumes- you can get COPD from
air pollution. Breathing in chemical fumes, dust
or toxic substances at work can also cause it.
 Age- Most people are 40 or older when their
symptoms start up.

10. CONT…
 Genes- In rare cases, people with COPD have a
defect in their DNA, the code that tells your body
how to work properly. This defect is called “alpha-
1 antitrypsin deficiency”. When you have this,
your lungs don’t have enough of a protein needed
to protect them from damage. This can lead to
severe COPD.
 Infections- If you had lots of respiratory infections
in childhood, you have a greater chance of COPD
in adulthood.

11. PATHOPHYSIOLOGY
Abnormal inflammatory response of the lungs due to toxic
gases
Response occurs in the airways, parenchyma
Narrowing of the airway takes place
Destruction of parenchyma leads to emphysema
Destruction of lung parenchyma leads to an imbalance of
proteinases/ antiproteinases

12. CONT…
Pulmonary vascular changes
 Thickening of vessels
 Collagen deposit
 Destruction of capillary
Mucus hyper secretion (cilia dysfunction, airflow
limitation, corpulmonale (RVF))
Chronic cough and sputum production

13. SIGN & SYMPTOMS
 Coughing up lots of mucus
 Shortness of breath, especially when you’re physically
active
 Wheezing when you are breathe
 Tightness in the chest
 Frequent colds or flu
 Blue fingernails
 Low energy
 Losing weight
 Swollen ankles, feet or legs
 Respiratory infections

14. DIAGNOSTIC EVALUATION
1. History - medical history
 Whether you've recently had a cold or the flu
 Whether you smoke or spend time around others who
smoke
 Whether you've been exposed to dust, fumes, vapors,
or air pollution
2. Spirometry- It is the most common test. You’ll
breathe into a large, flexible tube that’s connected to
a machine called a spirometer. It’ll measure how
much air your lungs can hold and how fast you can
blow air out of them.

15. CONT…
 Chest X-ray- It can help out emphysema, other
lung problems, or heart failure.
 CT Scan- This uses several X-rays to create a
detailed picture of your lungs and can tell the
doctor if you need surgery.
 Arterial blood gas test- It measures how well
your lungs are bringing in oxygen and taking out
carbon dioxide.

16. MANAGEMENT
There is no cure for COPD. However, there are many things
you can do to relieve symptoms and keep the disease from
getting worse.
 The goals of COPD treatment include:
 Relieving your symptoms
 Slowing the progress of the disease
 Improving your exercise tolerance (your ability to stay
active)
 Preventing and treating complications
 Improving your overall health

17. MEDICAL MANAGEMENT
Persons with COPD MUST stop smoking. This is
the best way to slow down the lung damage.
 Treatment
The appropriate medications for COPD depend on
its stage of severity as determined by symptoms.
The Global Initiative for Chronic Obstructive
Lung Disease (GOLD) has proposed a strategy
that is widely accepted. GOLD categorizes COPD
severity as follows:

18. CONT…
 Stage I: Smoker's cough, little or no shortness
of breath, no clinical signs of COPD, FEV1
greater than 80% of predicted.
 Stage II: Shortness of breath on exertion,
sputum-producing cough, some clinical signs
of COPD, FEV1 50 - 80% of predicted.
 Stage III: Shortness of breath on mild exertion,
FEV1 30 - 50% of predicted.
 Stage IV: Shortness of breath on mild exertion,
right heart failure, cyanosis, FEV1 less than
30% of predicted.

19. CONT…
Treatment calls for:
 Patients with GOLD stage I - IV: Treatment with an
inhaled anticholinergic or inhaled short-acting beta2-
agonist.
 Patients with GOLD stages II - IV: Addition of an
inhaled long-acting bronchodilator in place of a
short-acting beta2-agonist. A combination of
bronchodilators may be used. In patients who do not
respond to bronchodilators, slow-release
theophylline may be used.

20. CONT…
 Patients with GOLD stages III - IV: Regular use of
inhaled corticosteroids for those with repeated
exacerbations. Systemic corticosteroids for severe
exacerbations.
 Patients with GOLD stage IV: Long-term oxygen
therapy, consideration of surgical options.

21. PHARMACOLOGY
MANAGEMENT
Medications used to treat COPD include:
 Inhalers (bronchodilators) to open the airways, such
as ipratropium (Atrovent), tiotropium (Spiriva),
salmeterol (Serevent), formoterol (Foradil), or
albuterol
 Inhaled steroids to reduce lung inflammation
 Anti-inflammatory medications such as montelukast
(Singulair) and roflimulast are sometimes used
 Oxygen administered.

22. SURGICAL MANAGEMENT
When a patient no longer responds to medications, surgery
becomes a possible option. In rare cases, surgery may
benefit some people who have COPD. Surgery usually is a
last resort for people who have severe symptoms that have
not improved from taking medicines.
Surgery may be used, but only a few patients benefit from
these surgical treatments:
 Surgery to remove parts of the diseased lung can help
other areas (not as diseased) work better in some patients
with emphysema
 Lung transplant for severe cases.

23. CONT….
Surgeries for people who have COPD that's
mainly related to emphysema include bullectomy
and lung volume reduction surgery (LVRS). A
lung transplant may be done for people who have
very severe COPD.
 Bullectomy
 Lung transplantation
 Lung volume reduction surgery (LVRS)

24. Cont…
 Bullectomy
When the walls of the air sacs are destroyed, larger air
spaces called bullae form. These air spaces can
become so large that they interfere with breathing. In
a bullectomy, doctors remove one or more very large
bullae from the lungs.
 Lung Volume Reduction Surgery
In LVRS, surgeons remove damaged tissue from the
lungs. This helps the lungs work better. In carefully
selected patients, LVRS can improve breathing and
quality of life.

25. CONT…
 Lung Transplant
A lung transplant may benefit some people
who have very severe COPD. During a lung
transplant, your damaged lung is removed and
replaced with a healthy lung from a deceased
donor.

26. COMPLICATIONS
 Respiratory infections- COPD can boost your chance of
getting colds, flu and pneumonia. It makes harder you to
breathe and could cause more lung damage.
 Heart problem- COPD can raise your risk of heart
disease, including heart attack.
 Lung cancer- People with COPD are more likely to get
lung cancer.
 Pulmonary hypertension- COPD may rise blood
pressure in the arteries that bring blood to your lungs.
 Depression- Trouble breathing can stop you from doing
things you like, and living with a chronic illness can lead
to depression.

27. NURSING DIAGNOSIS
1. Ineffective breathing pattern related to accumulation of
the secretion to the region evidenced by breathlessness,
restlessness and shortness of breath.
2. Impaired body temperature related to chest infection as
evidenced by chest pain and elevated temperature
3. Impaired nutrition less than body requirement related
to loss of appetite.
4. Ineffective coping related to anxiety prolonged
hospitalization as evidence by reduce socialization,
depression.

28. HEALTH EDUCATION
 Advices the patient to walk slowly and small distance
slowly increase how far you walk.
 Try not to talk when you walk if you get short of
breath.
 Use pursed lip breathing when breathing out (to
empty your lungs before the next breath).
 Avoiding very cold air
 Making sure no one smokes in your home
 Eat a healthy diet with fish, poultry, or lean meat, as
well as fruits and vegetables. If it is hard to keep your
weight up, talk to a dietitian about eating foods with
more calories.

29. CONCLUSION
 Chronic Obstructive Pulmonary Disease (COPD)
makes it hard for you to breathe. Coughing up mucus
is often the first sign of COPD. Chronic bronchitis and
emphysema are common COPDs.
 Cigarette smoking is the most common cause of
COPD. Breathing in other kinds of irritants, like
pollution, dust or chemicals, may also cause or
contribute to COPD. Quitting smoking is the best way
to avoid developing COPD.