Obstructive Airways

Disease

:Prepared by
.Fruto, Engelbert T

:Definition
Asthma: It's a chronic respiratory condition that
causes the airways to constrict become inflamed
and collect mucus. It can be triggered by natural
allergens, cigarette smoke, pets, exercise or
.emotional stress
COPD: is characterized by air flow obstruction.
The airflow obstruction is usually progressive, not
fully reversible and doesn't change markedly over
several months. The disease is predominantly
.caused by smoking

COPD

Chronic Obstructive Pulmonary Disease

?What is COPD
Definition:

It is a disease state characterized by the

presence of air flow obstruction due to
chronic bronchitis or emphysema.
The air flow limitation is generally
progressive.

COPD
Chronic bronchitis

Clinically diagnosed

Emphysema

Pathologically
diagnosed

Chronic bronchitis
Chronic

productive cough on most days

of 3 consecutive months
in 2 consecutive years.
Providing other causes have been
excluded.
>85% of COPD.

Emphysema
Abnormal and permanent dilation of air spaces
associated with destruction of their walls.

Etimology
Smoking

the primary risk factor

Long-term smoking is responsible for 80-90 % of cases.
Prolonged exposures to harmful particles and
gases from:

passive smoke,
Industrial smoke,
Chemical gases, vapors, mists & fumes
Dusts from grains, minerals & other materials

Alpha 1-antitrypsin deficiency >>> emphysema

Pathophysiology
Exposure to inhaled noxious particles & gases
inflammation
imbalance of
proteinases and anti-proteinases

Dilatation & destruction

mucus secretion+

Clinical features
Hx:
Smoker
Productive cough
Constant
Chest tightness in the morning
Sputum>>>>>> mucoid
If purulent>>>> infection

SOB>>>> on exertion

Aggravated by infection, heavy smoking.

On Examination:

Inspection:
Pt looks dyspnic
Use of accessory muscles
Burrel shaped chest

Palpation

Decrease chest expansion

Percussion
hyper-resonant
Loss of normal area for cardiac & liver dullness

Auscultation:

Decreased breath sounds

Normal vesicular breathing but prolonged
expiration
Coarse crepitatons>> on both phases

Investigations
Baseline

ABG:

important for assessing patients with severe COPD.

Annual monitoring test
Detect acute & chronic hypercapnia
Respiratory acidosis

Investigations
Chest

X-Ray:

Not sensitive for Dx

To exclude other diseases
Hyper-inflation signs

Investigations
Pulmonary

function testing (spirometry):

Main method for diagnosing COPD.

low FEV1/FVC (< 70%)
Used for classification of COPD severity.

PFT

Obstructive pattern
FEV1>>>>>>>reduced (<80%)
FEV1/FVC>>>reduced (<70%)
PEF>>>>>>>>reduced
TLC>>>>>>>>increased

Classification of severity of COPD

Mild
FEV1

60-79%
Smoker , cough

Moderate
FEV1 40-59%
SOB, wheeze, cough +/- sputum

Severe
FEV1

< 40%
SOB, wheeze, cough ,RD, swollen legs

Other Investigations
Sputum

C/S >> in acute

ECG
Echo

>> assess pulmonary artery pressure

Alpha 1-anti-trypsin

Treatment of COPD
Cessation

of Smoking (most important)

Oxygen Therapy
Ongoing assessment & monitoring
Education
Rx of Acute exacerbations.

Management
of COPD

Increase survival

Improve quality
of life

stop smoking
Supplemental O2

Bronchodilators
steroids+

Oxygen Therapy
(LTOT)

Home oxygen in low dose

Given at least 15 hrs @ flow rate 1-3L/min
If PaO2 <60%
If SaO2 < 88%

 Inhaled

bronchodilators

Beta-agonists
Short

acting>>> 2-4 puffs bid-qid & PRN

e.g: salbutamol
Long acting >>> twise daily
e.g: salmetrol, formoterol
Side efferct: Tachycardia, tremors, hypokalemia

Anti-cholinergic
Ipratropium

bromide (Atrovent) 2-4 puffs PRN

 Steroids

Inhaled:
e.g

: fluticasone
Withdrawal may cause exacerbation

Systemic :
Only

for severe cases.

Vaccinations

Influenza
Pneumococcal

No role for antibiotics

except in acute exacerbations

Acute exacerbation of COPD

Increased

SOB

Wheezing
Causes

Infections
pollutions

Infections

Streptococcus
Moraxella
pneumoniae 19.2% 17.2%catarrhalis
30.3% 33.3%
Other pathogens
include:
Haemophilus
H parainfluenzae,
influenzae
Staphylococcus
aureus2

 Oxygen
BiPAP
Mechanical

ventilation

Indication for ICU admission

Severe

dyspnea not medical Rx

Mental status changes
Persistent hypoxemia, hypercapnia or Resp.
acidosis despite medical Rx