O slideshow foi denunciado.
Utilizamos seu perfil e dados de atividades no LinkedIn para personalizar e exibir anúncios mais relevantes. Altere suas preferências de anúncios quando desejar.

Chronic obstructive pulmonary disease(copd)

1.238 visualizações

Publicada em

Chronic obstructive pulmonary disease(copd)

Publicada em: Saúde e medicina
  • Entre para ver os comentários

Chronic obstructive pulmonary disease(copd)

  1. 1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE(COPD) Rana Shankor Roy
  2. 2. DEFINITION  Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation that is usually progressive, and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.
  3. 3. IT INCLUDES------------  chronic bronchitis (cough and sputum on most days for at least 3 months, in each of 2 consecutive years)  Emphysema (abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis).
  4. 4. CLINICALLY TWO TYPES--------  Blue bloaters: --Patients having predominantly bronchitis. --Cyanosis present(Blue) --Edematous(bloaters) -- ↑PCO2 & ↓PO2 --Cor-pulmonale common.  Pink puffer: --Patients having predominantly emphysema. --Pursed-lip breathing(puffer) --Absence of cyanosis i.e. pink --lean & thin body. -- PCO2 & PO2 normal.
  5. 5. WHAT ARE THE OBSTRUCTIVE PULMONARY DISEASE?  COPD  Asthma
  6. 6. RISK FACTORS FOR COPD  Environmental • Tobacco smoking • Indoor air pollution; cooking with biomass fuels • Occupational exposures, such as coal dust, silica • Infections: recurrent infection persistence of adenovirus in lung tissue. HIV infection • Low socioeconomic status  Host factors • α1-antiproteinase deficiency; other COPD • Airway hyper-reactivity
  7. 7. SYMPTOMS  Cough(Productive, frothy, persist throughout the day)  Sputum production  Breathlessness( Exertional breathlessness)  Hemoptysis  Morning headache(indication of hypercapnia)  Features of complications
  8. 8. SIGNS  Increased respiratory rate  Pursed lip breathing  Intercostal recession  Bilaterally reduced chest expansion  Edema, if heart failure develop
  9. 9. WHAT YOU EXPECT IN PHYSICAL EXAMINATION?  Inspection: --RR increased. --Intercostal recession  Palpation: --Bilaterally reduced chest expansion.  Percussion: --Hyperresonant.  Auscultation: --Breath sound is vesicular with prolonged expiration --Ronchi may found.
  10. 10. IMPORTANT NEGATIVE HISTORY:  No history of nocturnal dyspnea/ orthopnoea.  No family history of same type of disease.  No dust/cold allergy.  Any skin disease
  11. 11. INVESTIGATIONS  General: i)CBC— Hb% : polycythemia (If anemia, then any associated disease such as TB, carcinoma) ii) Electrolyte: Hypokalemia iii) Blood glucose iv) Serum creatinine
  12. 12.  Specific: i) Chest X-ray: X-ray is essential to identify alternative diagnoses, such as cardiac failure, other complications of smoking such as lung cancer, and the presence of bullae. In emphysema----- --Hyper translucent lung fields due to trapping of air. --Low flat diaphragm. --Long tubular heart shadow. --widening of rib space --Emphysematous bulla.
  13. 13. ii) Spirometry: --Post bronchodilator FEV1<80% of predictive value. --FEV1/FVC<70% iii) In younger patients with predominantly basal emphysema,α1-antiproteinase should be assayed.
  14. 14. SPIROMETRIC CLASSIFICATION OF COPD SEVERITY BASED ON POST-BRONCHODILATOR FEV1 Stage Severity FEV1 I Mild FEV1/FVC < 0.70 FEV1 ≥ 80% predicted II Moderate FEV1/FVC < 0.70 FEV1 50–79% predicted III Severe FEV1/FVC < 0.70 FEV1 30–49% predicted IV Very severe FEV1/FVC < 0.70 FEV1 < 30% predicted or FEV1 < 50% predicted if respiratory failure present
  15. 15. D/D  Chronic asthma  Tuberculosis  Bronchiectasis  Congestive cardiac failure.(Orthopnea present)  In COPD patients can lie but in Heart failure patients cant lie.
  16. 16. CORPULMONALE  It is defined as Pulmonary HTN with right ventricular hypertrophy with or without HF due to COPD or any respiratory cause.
  17. 17. MANAGEMENT  Reducing exposure to noxious particles and gases: Smoking should be stopped  Bronchodilators: ---Short-acting bronchodilators, such as the β2- agonists salbutamol and terbutaline, or the anticholinergic ipratropium bromide, may be used for patients with mild disease, --Longer acting bronchodilators, such as the β2- agonists salmeterol, formoterol and indacaterol, or the anticholinergic tiotropium bromide, are more appropriate for patients with moderate to severe disease. --Thioxanthene derivatives such as Theophylline.
  18. 18.  Corticosteroids: both for maintenance & acute attack. -- Oral prednisolone 30 mg for 10 days. Or --Inj. Hydrocortisone. --Inhaler Fluticasone, Beclomethasone  Leukotriene antagonist( No role but given) --Montelukast.  Oxygen therapy: Long-term domiciliary oxygen therapy (LTOT) has been shown to be of significant benefit in selected patients  Non-invasive ventilation.  Surgery: --Bullectomy or --lung volume reduction surgery (LVRS) to improve symptoms.
  19. 19. HOW WILL YOU MANAGE A ACUTE CASE?  Propped up position.  Oxygen inhalation: 1-2 L/min Low flow oxygen at 24% or 28% should be used with the aim of maintaining a PaO2 above 8 kPa (60 mmHg).(In patients with an exacerbation of severe COPD, high concentrations of oxygen may cause respiratory depression and worsening acidosis)
  20. 20.  Nebulization: Nebulized short-acting β2- agonists, combined with an anticholinergic agent (e.g. salbutamol and ipratropium),should be administered. 3ml solution -----1ml normal solution+1ml ipratropium+1ml Salbutamol in adults -----1.5ml normal solution+1ml ipratropium +0.5ml Salbutamol in children Given for 10 minutes.
  21. 21.  Oral prednisolone 30 mg for 10 days  Antibiotic: Amino penicillin or macrolides.  If, despite the above measures, the patient remains tachypnoeic, hypercapnic and acidotic (PaCO2 > 6 kPa, H+ ≥ 45 (pH < 7.35)), then NIV(Non-invasive ventilation) should be commenced
  22. 22. PRESCRIPTION OF LONG-TERM OXYGEN THERAPY IN COPD  Arterial blood gases measured in clinically stable patients on optimal medical therapy on at least two occasions 3 weeks apart: • PaO2 < 7.3 kPa (55 mmHg) irrespective of PaCO2 and FEV1< 1.5 L • PaO2 7.3–8 kPa (55–60 mmHg) plus pulmonary hypertension, peripheral oedema or nocturnal hypoxaemia • the patient has stopped smoking. Use at least 15 hrs/day at 2–4 L/min to achieve a PaO2 > 8 kPa (60 mmHg) without unacceptable rise in PaCO2.
  23. 23. DIFFERENCE BETWEEN ASTHMA & COPD Traits Bronchial asthma COPD Age incidence Child & younger Old age(>50 years) Main symptom Respiratory distress Cough & sputum Diurnal variation Occurs Not occurs History of allergy Present Usually Absent Smoking history Not so important Important Chest X-ray Usually normal Abnormal Eosinophil count Increase Normal IgE level Raised Normal

×