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الرحمن الله بسمالرحیم

سالم با

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Chronic Obstructive Pulmonary Disease

Dr A. Asadian

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Occupational Respiratory Diseases

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تعریف

COPD is defined as a disease state characterized by the presence of airflow obstruction due to chronic

bronchitis or emphysema.

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airflow limitation that is not fully reversible Accessed September 19, 2008, at http://www.goldcopd.com/.)

N Engl J Med Volume 359:1616-1618 October 9, 2008

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Key Indicators for COPD DiagnosisChronic cough Present intermittently or every

day often present throughout the day; seldom only nocturnal

Chronic sputum production Present for many years, worst in winters. Initially mucoid – becomes purulent with exacerbation

Dyspnoea that is Progressive (worsens over time)Persistent (present every day)Worse on exerciseWorse during respiratory infections

Acute bronchitis Repeated episodes

History of exposure to risk factors

Tobacco smoke occupational dusts and chemical smoke from home cooking and heating fuel

Disease Trajectory of a Patients with COPD

Symptoms

Exacerbations

Exacerbations

ExacerbationsDeterioration

End of Life

Physical signs

Large barrel shaped chest (hyperinflation)

Prominent accessory respiratory muscles in

neck and use of accessory muscle in

respirationLow, flat diaphragmDiminished breath

sound

Emphysema

Normal versus Diseased Bronchi

COPD classification based on spirometry GOLD 2003

.

Severity Postbronchodilator FEV1/FVC

Postbronchodilator FEV1% predicted

At risk >0.7 >80

Mild COPD <0.7 >80

Moderate COPD

<0.7 50-80

Severe COPD <0.7 30-50

Very severe COPD

<0.7 <30

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Cardiac Disease in Chronic Obstructive Pulmonary Disease

The cardiac manifestations of chronic obstructive pulmonary disease (COPD)

are numerous. right ventricular

dysfunction and pulmonary vascular disease are well known to complicate

the clinical course of COPD and correlate inversely with survival.

Spirometry

Diagnosis

Assessing

severity

Assessing

prognosis

Monitoring

progression

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Spirometry

FEV1 – Forced expired volume in the first second

FVC – Total volume of air that can be exhaled from maximal inhalation

to maximal exhalationFEV1/FVC% - The ratio of FEV1 to

FVC, expressed as a percentage .

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COPD   :

Beyond FEV1

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Systemic Effects

weight loss

,

Circulating concentrations of interleukin-6

acute-phase proteins, such CRP

levels of leptin

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CXY in COPDCXY in COPDDIAGNOSIS OF A R F IN COAD …

1} X-RAY CHEST

• Hyper - inflation• Flattened diaphragm• Less lung markings• Increased hilum / pulm.Art.Size• RA / RV dilated • Existing pathology

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DIAGNOSIS OF A R F IN COAD ….

2} E C G

- NORMAL- RT AXIS DEVIATION- RAH ( ‘P’ PULMONALE)- RVH WITH RV – STRAIN- RBBB

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comorbidities of COPDThe most common that are possibly related

to the systemic effects of smoking are CHF, arrhythmias, hypertension, peripheral and

coronary artery diseases, diabetes and metabolic syndrome, osteoporosis, cancer

(particularly lung cancer), pulmonary vascular abnormalities, psychiatric

disorders, cachexia, skeletal muscle abnormalities, and infections

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Airflow Limitation in Smokers Is Associated with Subclinical Atherosclerosis

Conclusions: Smokers with airflow limitation had exaggerated subclinical atherosclerosis.. American Journal of Respiratory

and Critical Care Medicine Vol 179. pp. 35-40, 2009

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Copyright restrictions may apply.

Lynch, J. InnovAiT 2008 1:222-232; doi:10.1093/innovait/inn019

(a) Normal and (b) barrel chest

Post-bronchodilator

FEV1(% predicted)

Management based on GOLD

What medications are used to prevent complications?

Annual flu vaccine Reduces risk of flu and its complications

Pneumonia vaccineReduces risk of common cause of

pneumonia

Algorithm for the management of COPD

Short acting bronchodilator – as required

Tiotropium

Tiotropium+LABA

Long acting beta agonist

LABA + tiotropium

Add-Inhaled steroids-Theophylline

Mild

Severe

asse

ss w

ith s

ympt

oms

and

spiro

met

ry

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Chicken or egg: physical activity in COPD

Eur Respir J 2009; 33:227-229Copyright ©ERS Journals Ltd 2009

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نباشید خسته

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QUESTIONS?