West Visayas State

University
COLLEGE OF
NURSING
La Paz, Iloilo City

NOTES ON CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Prepared by: MARNI LIEZA G. TICAO

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

 also known as chronic obstructive lung disease
 a disease of the lungs characterized by chronic obstruction of the flow of air through the
airways and out of the lungs, and the obstruction generally is permanent and progressive over
time
 the most common chronic lung disease and one of the leading causes of morbidity and
mortality worldwide
 encompasses two types of airway disease:
a. Chronic Bronchitis
- airway obstruction that is caused by inflammation of the major and small airways
- excessive mucus production with productive cough for at least 3 months per year for 2
consecutive years
- “blue bloaters”
b. Emphysema
- characterized by a loss of lung elasticity and abnormal enlargement of the air spaces distal to
the terminal bronchioles, with destruction of the alveolar walls and capillary beds
- “pink puffers”

ETIOLOGIC FACTORS
 cigarette smoking – leading cause of COPD; most common cause of chronic bronchitis
 passive smoking/exposure to second-hand smoke
 air pollution (indoor & outdoor)
 prolonged and intense exposure to occupational dusts and chemicals
 recurrent or chronic respiratory tract infections
 hereditary deficiency in alpha1 antitrypsin – most common cause of emphysema

PATHOPHYSIOLOGY (Schematic Diagram)

Hyperplasia (inc. in #) & hypertrophy (inc. in size) of the goblet cells and mucous glands of the airway

Increased mucous production Infiltration of the airway

cells with
inflammatory cells

Reduced ciliary function

Scarring & remodelling that thickens the
vessel wall

Narrowing of the airways

Plugging of airway by mucous

Abnormal change in the tissue lining the inside of the airway

Further thickening & scarring of the airway wall (fibrosis)

Limitation of airflow

CHRONIC BRONCHITIS

******************************************************************************************************
Imbalances of proteinases & antiproteinases in the lung

Loss of elastic lung fibers

Reduction of lung elasticity

Enlargement of air spaces distal to the Reduction of surface area for the
terminal bronchioles exchange of O2 & CO2 during
breathing
 Destruction of alveolar walls &
capillary beds

Loss of support for the airways that are

embedded in the lung

Limitation of airflow

EMPHYSEMA

CLINICAL MANIFESTATIONS

3 Primary Symptoms
 Cough
 Sputum production
 Dyspnea on exertion, and later on, even at rest
Chronic Bronchitis
 Productive cough
 Exertional dyspnea
 Copious sputum (gray, white, yellow)
 Weight gain due to edema
 Cyanosis
 Tachypnea
 Wheezing
 Prolonged expiratory time
 Use of accessory muscles for breathing
 Crackles upon auscultation
Emphysema
 Dyspnea
 Chronic cough
 Anorexia
 Weight loss
 Malaise
 Barrel chest
 Use of accessory muscles for breathing
 Prolonged expiratory period with grunting
 Pursed-lip breathing
 Tachypnea
 Peripheral cyanosis

DIAGNOSTIC PROCEDURES

a. Physical examination
b. Chest x-ray
Chronic bronchitis
• May show hyperinflation and increased bronchovascular markings
Emphysema
• In advanced disease, flattened diaphragm, reduced vascular markings at lung periphery,
overaeration of lungs, vertical heart, enlarged anteroposterior chest diameter, and large
retrosternal air space
c. Pulmonary function tests
- measure how much air your lungs can hold and the flow of air in and out of your lungs; also
measure the amount of gases exchanged across the membrane between your alveolar wall and
capillary membrane
Chronic bronchitis
• Increased residual volume, decreased vital capacity and forced expiratory volumes, and normal
static compliance and diffusing capacity
Emphysema
• Increased residual volume, total lung capacity, and compliance; decreased vital capacity, diffusing
capacity, and expiratory volumes
d. Arterial Blood Gas
- measures how well your lungs transfer oxygen to your bloodstream and how effectively they
remove carbon dioxide
Chronic bronchitis
• Decreased PaO2,normal or increased PaCO2
Emphysema
• Decreased PaO2,with normal PaCO2
e. Sputum examination
- analysis of cells in sputum to determine the cause of some lung problems
COMPLICATIONS
 Respiratory insufficiency and failure
 Pneumonia
- an inflammation of the lung parenchyma that is caused by a microbial agent
 Atelectasis
- refers to closure or collapse of alveoli
 Pneumothorax
- partial or complete collapse of the lung due to positive pressure in the pleural space
 Cor pulmonale
- a condition in which the right ventricle of the heart enlarges