1. COPD
Michelle Taylor
Lecturer Faculty of Health & Social Science

2. Aims & Objectives
 Definition of COPD?
 Diagnostic labels of COPD
 What is Airflow Obstruction?
 Factors to be considered
 Pathophysiology of contributing factors
 Signs & symptoms of COPD
 Diagnosis of COPD
 Treatment & Management

3. Definition
COPD is – Chronic Obstructive Pulmonary Disease
 General term used to describe certain conditions
where people have difficulty breathing with long-term
affects, that may not be fully reversible and can
cause permanent damage to the lungs.
 In COPD air sacs lose their elasticity and they
collapse or don’t inflate properly
 In COPD the breathing tubes are blocked with
mucous and become swollen so air cannot move in
and out
British Lung Foundation (2011)

4. Diagnostic labels
 Chronic Bronchitis –
irritation, inflammation
& swelling of the
bronchi
 Emphysema – affects
the bronchi & builds up
mucous in the alveoli
 Chronic Asthma

5. Emphysema
 Find a diagram of a diseased lung

6. Airflow Obstruction
 Find a picture of airflow obstruction

7. What is airflow
obstruction?
 Airflow obstruction is defined as a reduced FEV1
(forced expiratory volume in 1 second)
 Forced expiratory volume is the amount of air which
can be forcibly exhaled from the lungs in the 1st
second of a forced exhalation
 Forced Vital Capacity (FVC) is the maximum amount
of air you can expel when breathing out
 Measured by spirometers

8.  Calculation depends upon gender, age, height, if you
are a smoker & level of fitness
 Different classifications
- FEV1% is between 50 – 80% MILD COPD
- FEV1% is between 30 – 49% MODERATE COPD
- FEV1% is below 30% SEVERE COPD
NICE (2004)

9. Factors to consider
 Significant airflow obstruction may be present before
the individual is aware of it
 30,000 people in the UK die of COPD every year
 COPD produces symptoms, disability and impaired
quality of life
 COPD is now the term used for conditions with
airflow obstruction once diagnosed as chronic
bronchitis and emphysema

10. Pathophysiology –
contributing factors
 Recurrent or chronic respiratory problems including
wheezing, coughing, infection & the production of
phlegm
 Allergens – dust & air pollution
 Hereditary factors - genetic
 Smoking – pipe, cigar or cigarette
 Occupational exposure – chemicals & toxic fumes

11. Smoking
Smoking is the most important factor in COPD. It
impairs cilliary action, causing inflammation in the
airway, increased mucous production, alveolar
destruction and bronchiolar fibrosis

12. Signs & Symptoms
 Wheezing
 Coughing
 Sputum production
 Shortness of breath/Dyspnoea
 Chest tightness
 Barrel chest (lung over-distension)
 Prolonged expiration - because accessory muscles
are used for inspiration and abdominal muscles are
used to force air out of lungs
 Decreased breath sounds

13. Diagnosis
Spirometry Chest X-ray

14. Ask your patients about
the presence of the
following factors
 Weight loss
 Effort intolerance
 Waking at night
 Ankle swelling
 Fatigue
 Occupational hazards
 Chest pain
 Haemoptysis

15. Assessment of severity
 This is important as it has indications for treatment
and relates to prognosis
 True assessment includes the degree of airflow
obstruction and disability, frequency of exacerbations
and the following prognostic factors
 Exercise capacity
 BMI
 Partial pressure of O2 in arterial blood

16. Treatment
 Eliminate exposure to
things that cause COPD
 Quit smoking
 Exercise and pulmonary
rehabilitation
 Inhaled medications to
open the breathing tubes
or decrease the
inflammation
 Oxygen
 Pneumococcal and flu
vaccines

17. Meter dose inhaler (MDI)
 Choose appropriate device
 Educate patients
 Best evidence for bronchodilators = MDI + SPACER
 Regular assessment of ability to use device should be
taken
 Ensures delivery of the medication to the lungs
 NB. Spacers MUST be compatible with MDI
 Rinse mouth after use if using a steroid inhaler

18. Meter dose inhaler

19. Management
 Inhaled bronchodilator therapy
Short acting B2 agonist – initial treatment for relief
of breathlessness and exercise limitation (example
‘salbutamol’)
Effectiveness should be assessed by improvement in
symptoms, i.e. Activities of Living, exercise capacity and
rapidity of symptom relief

20. Nebulisers
 Consider if symptoms distressing or disabling despite
maximal therapy using inhalers. But DISCONTINUE
after
 Reduction in symptoms
 Increase in patients ability to undertake Activities of
Living
 Increase in exercise capacity
 Improvement in lung function
 NB. Monitor ability to use and consider application
i.e. mask, mouthpiece?

21. Still a problem?
Patients who remain symptomatic should be given
 Long acting bronchodilators (LAB) once daily
(e.g. salmeterol)
 LAB should be used if > 2 exacerbations/yr
 Consider – patient response, side effects, patients
preference, cost

22. Oxygen (LTOT)
 NB – can cause respiratory depression if given
inappropriately
 Indicated when patients have PaO2 < 7.3 when
stable
 To benefit, breathe supplemental O2 for at least
15hrs/day

23. Pulmonary rehabilitation
 An MDT programme of care for patients with chronic
respiratory impairment that is individually tailored
and designed to optimise the individual’s physical and
social performance and autonomy
 Not for immobile, unstable angina, recent MI
 Includes physical training, disease education,
nutritional, psychological and behavioural
intervention

24. MDT management
 Via assessment - spirometry, O2 needs and aids
 Managing - pulmonary rehab, hospital at home/early
discharge (ACTRITE, IMPACT) including palliative
care, identification of anxiety/depression, dietary,
exercise, benefits, travel advice
 Self management
 Education

25. Which Lung would YOU
prefer??

26. Summary
 Discussed the definition of COPD
 Discussed the diagnostic labels of COPD
 Described what Airflow Obstruction is
 Discussed the factors to be considered
 Described the pathophysiology of contributing factors
 Discussed the signs & symptoms of COPD
 Discussed the diagnosis of COPD
 Described the treatment & Management