Chron|c Cbstruct|ve u|monary D|sease

refers Lo several dlsorders LhaL affecL Lhe movemenL of alr ln and ouL of Lhe lungs 1he mosL
lmporLanL of Lhese dlseases are Chronlc 8ronchlLls Lmphysema and asLhma lL can also occur as a
resulL of lncreased alrway reslsLance and decreased elasLlc recoll
k|sk Iactors
Age Smoklng Alr polluLlon famlllal/geneLlc facLors CccupaLlonal Lxposure
athophys|o|ogy
CCu ls characLerlzed by slowly progresslve obsLrucLlon of Lhe alrways Lhe dlsease ls one of
perlodlc exacerbaLlons ofLen relaLed Lo resplraLory lnfecLlon wlLh lncreased sympLoms of dyspnea and
spuLum producLlon unllke acuLe processes ln whlch lung Llssues recover alrways and lung parenchyma
do noL reLurn Lo normal followlng an exacerbaLlon lnsLead Lhey demonsLraLe progresslve desLrucLlve
changes
AlLhough one or Lhe oLher may predomlnaLe CCu Lyplcally lncludes componenLs of boLh
chronlc bronchlLls and emphysema Small alrways dlsease narrowlng of small bronchloles ls also a parL
of Lhe CCu complex 1hese processes cause alrways Lo narrow reslsLance Lo alrflow Lo lncrease and
explraLlon Lo become slow or dlfflculL 1he resulL ls a mlsmaLch beLween alveolar venLllaLlon and blood
flow perfuslon leadlng Lo lmpalred gas exchange

Asthma
ls a chronlc lnflammaLory dlsorder of Lhe alrways characLerlzed by recurrenL eplsodes wheezlng
breaLhlessness chesL LlghLness and coughlng

k|sk factors
allergens alr polluLlon occupaLlonal exposure envlronmenL genes resplraLory vlruses such as
rhlnovlrus and lnfluenza

Man|festat|ons
O ulllng ln of Lhe skln beLween Lhe rlbs when breaLhlng (lnLercosLal reLracLlons)
O ShorLness of breaLh LhaL geLs worse wlLh exerclse or acLlvlLy
O Jheezlng
O Comes ln eplsodes
O ,ay be worse aL nlghL or ln early mornlng
O ,ay go away on lLs own
O eLs beLLer when uslng drugs LhaL open Lhe alrways (bronchodllaLors)
O eLs worse when breaLhlng ln cold alr
O eLs worse wlLh exerclse
O eLs worse wlLh hearLburn (reflux)
O usually beglns suddenly
O Lmergency sympLoms
O 8lulsh color Lo Lhe llps and face
O uecreased level of alerLness such as severe drowslness or confuslon durlng an asLhma aLLack
O LxLreme dlfflculLy breaLhlng
O apld pulse
O Severe anxleLy due Lo shorLness of breaLh
O SweaLlng
AddlLlonal sympLoms LhaL may be assoclaLed wlLh Lhls dlsease
O Abnormal breaLhlng paLLern breaLhlng ouL Lakes more Lhan Lwlce as long as breaLhlng ln
O 8reaLhlng Lemporarlly sLops
O ChesL paln
O -asal flarlng
O 1lghLness ln Lhe chesL
@reatment
1he goal of LreaLmenL ls Lo avold Lhe subsLances LhaL Lrlgger your sympLoms and Lo conLrol alrway
lnflammaLlon 1here are Lwo baslc klnds of medlcaLlon for Lhe LreaLmenL of asLhma
LongacLlng medlcaLlons Lo prevenL aLLacks and Culckrellef medlcaLlons for use durlng aLLacks

LongLerm conLrol medlcaLlons are used on a regular basls Lo prevenL aLLacks noL Lo LreaL Lhem Such
medlclnes lnclude
O lnhaled corLlcosLerolds (such as AzmacorL vancerll Aero8ld llovenL) prevenL lnflammaLlon
O LeukoLrlene lnhlblLors (such as Slngulalr and AccolaLe)
O LongacLlng bronchodllaLors (such as SerevenL) help open alrways
O Cmlllzumab (xolalr) whlch blocks a paLhway LhaL Lhe lmmune sysLem uses Lo Lrlgger asLhma
sympLoms
O Cromolyn sodlum (lnLal) or nedocromll sodlum (1llade)
O Amlnophylllne or Lheophylllne (noL used as frequenLly as ln Lhe pasL)
O SomeLlmes a slngle medlcaLlon LhaL comblnes sLerolds and bronchodllaLors are used (Advalr
SymblcorL)
Culck rellef or rescue medlcaLlons are used Lo relleve sympLoms durlng an aLLack 1hese lnclude
O ShorLacLlng bronchodllaLors (lnhalers) such as rovenLll venLolln xopenex and oLhers
O CorLlcosLerolds such as meLhylprednlsolone may be glven dlrecLly lnLo a veln (lnLravenously)
durlng a severe aLLack along wlLh oLher lnhaled medlcaLlons
eople wlLh mlld asLhma (lnfrequenL aLLacks) may use qulck rellef medlcaLlon as needed 1hose wlLh
perslsLenL asLhma should Lake conLrol medlcaLlons on a regular basls Lo prevenL sympLoms A severe
asLhma aLLack requlres a check up by a docLor and posslbly a hosplLal sLay oxygen and medlcaLlons
Lhrough a veln (lv)
A peak flow meLer ls a slmple devlce Lo measure how qulckly you can move alr ouL of your lungs lL
can help you see lf an aLLack ls comlng someLlmes even before any sympLoms appear eak flow
measuremenLs can help show when medlcaLlon ls needed or oLher acLlon needs Lo be Laken eak flow
values of 3080 of a speclflc persons besL resulLs are a slgn of a moderaLe asLhma aLLack whlle values
below 30 are a slgn of a severe aLLack

Chron|c 8ronch|t|s
Chronlc bronch|t|s a dlsease of Lhe alrways ls deflned as Lhe presence of cough and spuLum
producLlon for aL leasL 3 monLhs ln each of 2 consecuLlve years ln many cases smoke or oLher
envlronmenLal polluLanLs lrrlLaLe Lhe alrways resulLlng ln hyper secreLlon of mucus and lnflammaLlon
1hls consLanL lrrlLaLlon causes Lhe mucussecreLlng glands and gobleL cells Lo lncrease ln number clllary
funcLlon ls reduced and more mucus ls produced 1he bronchlal walls become Lhlckened Lhe bronchlal
lumen ls narrowed and mucus may plug Lhe alrway Alveoll ad[acenL Lo Lhe bronchloles may become
damaged and flbrosed resulLlng ln alLered funcLlon of Lhe alveolar macrophages 1hls ls slgnlflcanL
because Lhe macrophages play an lmporLanL role ln desLroylng forelgn parLlcles lncludlng bacLerla As a
resulL Lhe paLlenL becomes more suscepLlble Lo resplraLory lnfecLlon A wlde range of vlral bacLerlal
and mycoplasmal lnfecLlons can produce acuLe eplsodes of bronchlLls

S|gns and Symptoms
O LongLerm cough
O lncreased mucus producLlon
O uyspnea
O lrequenL clearlng of Lhe LhroaL
O Ldema and welghL galn

D|agnos|s
1he presence of a producLlve longLerm cough LhaL lasLs 3 monLhs ouL of Lhe year for 2 consecuLlve
years polnLs docLors ln Lhe dlagnosLlc dlrecLlon of chronlc bronchlLls A dlagnosls of chronlc bronchlLls ls
made by obLalnlng a compleLe hlsLory lncludlng famlly envlronmenLal and occupaLlonal exposure and
smoklng hlsLory
ulagnosLlc LesLs may lnclude
O ArLerlal 8lood ases
O ChesL xray
O ulmonary funcLlon LesLs
O CompleLe blood counL

@reatment
1he maln goals ln Lhe LreaLmenL of chronlc bronchlLls ls Lo keep Lhe alrways open and funcLlonlng
properly Lo help clear Lhe alrways of mucus Lo avold lung lnfecLlons and Lo prevenL furLher dlsablllLy
1reaLmenL meLhods lnclude
CulLLlng smoklng
O AnLlbloLlcs (lf a bacLerlal lnfecLlon ls presenL)
O 8ronchodllaLors
O osLural uralnage
O ChesL physloLherapy
O llulds (Lo llqulfy secreLlons)
O CorLlcosLerolds

revent|on
As wlLh any Lype of CCu qulLLlng smoklng remalns Lhe mosL lmporLanL facLor ln Lhe LreaLmenL and
prevenLlon of chronlc bronchlLls Smoklng causes Lhe alrways ln Lhe lungs Lo become consLrlcLed or
narrowed and paralyzes Lhe cllla ln Lhe lungs whlch help Lhe lungs remove lrrlLaLlng parLlcles Smoklng
also causes surfacLanL Lhe fluld LhaL helps Lhe lungs Lo expand Lo become lnacLlvaLed

Lmphysema
Lmphysema ls characLerlzed by desLrucLlon of Lhe walls of Lhe alveoll wlLh resulLlng
enlargemenL of abnormal alr spaces As ln chronlc bronchlLls clgareLLe smoklng ls sLrongly lmpllcaLed as
a causaLlve facLor ln mosL cases of emphysema ueflclency of a1anLlLrypsln an enzyme LhaL normally
lnhlblLs Lhe acLlvlLy of proLeolyLlc enzymes and Llssue desLrucLlon ln Lhe lungs conLrlbuLes Lo Lhe
developmenL of emphysema especlally when comblned wlLh exposure Lo clgareLLe smoke

S|gns and Symptoms
1he prlmary sympLoms of emphysema are
O ShorLness of breaLh
O apld breaLhlng
O Jheezlng
O Chronlc cough wlLh or wlLhouL spuLum
O uecreased exerclse Lolerance
O Loss of appeLlLe leadlng Lo welghL loss
O 8arrel chesL



D|agnost|c @est|ng
1he paLlenLs reporLed sympLoms and hlsLory provlde Lhe lnlLlal clues upon examlnaLlon ulagnosLlc
LesLs lnclude
O ChesL xrays
O ulmonary luncLlon 1esLs
O ArLerlal 8lood ases
O CompleLe 8lood CounL

@reatment Cpt|ons
1he ma[or ob[ecLlve of LreaLmenL of emphysema ls Lo lmprove Lhe quallLy of llfe slow Lhe progresslon
of Lhe dlsease and LreaL Lhe alrways Lo relleve Lhelr apparenL lack of oxygen 1reaLmenL opLlons lnclude
O 8ronchodllaLors
O Aerosol Lherapy
O AnLlbloLlcs and/or anLlmlcroblals
O CorLlcosLerolds
O Cxygen Lherapy
revent|on
-o oLher prevenLaLlve facLor carrlers more welghL Lhan smoklng cessaLlon ln Lhe prevenLlon and
LreaLmenL of emphysema ,any opLlons are avallable for smokers who are havlng a hard Llme qulLLlng
on Lhelr own JlLh sLop smoklng alds counsellng and supporL groups smoklng can be a Lhlng of Lhe pasL
for Lhose wlLh a sLrong deslre Lo make poslLlve llfesLyle changes