C

OPD
Chronic
Obstructive
Pulmonary
 COPD is also known
as
 chronic obstructive lung disease
(COLD),
 chronic obstructive airway
disease (COAD),
 chronic airflow limitation (CAL)
and
 chronic obstructive respiratory
 1.Emphysema
2.Chronic
Bronchitis
Emphysema

Emphysema is characterized
by loss of elasticity (increased
pulmonary compliance) of the lung
tissue caused by destruction of
structures feeding the alveoli.
Pathophysiology
Smoking/Pollutants

Attraction of inflammation cells

Release of
elastase
inhibition of alpha 1- inherited alpha 1-antitrypsin
antitrypsin deficiency

destruction of elastic
fibers

Emphysema
Chronic Bronchitis
Chronic bronchitis is a
chronic inflammation of the bronchi
(medium-size airways) in the lungs.
It is generally considered one of the
two forms of (COPD).It is defined
clinically as a persistent cough that
produces sputum (phlegm) and
mucus, for at least three months in
two consecutive years.
Pathophysiology
smoking/polluti
on

continued irritation of lung

passages

inflammati excessive mucus

on production

narrowing of the
bronchi

Chronic
Bronchitis
 Normal
cell

hypertrop
hy

hyperplas
ia
Common Signs and Symptoms
· tachypnea, a rapid breathing rate

· wheezing sounds or crackles in the lungs heard

through a stethoscope

· breathing out taking a longer time than breathing

in

· enlargement of the chest, particularly the front-to-

back distance (hyperinflation)

· active use of muscles in the neck to help with

breathing
· breathing through pursed lips

· increased anteroposterior to lateral ratio of the

How COPD is Diagnosed
COPD usually is first diagnosed on
the basis of a medical history which
discloses many of the symptoms of
COPD and a physical examination
which discloses signs of COPD.
Other tests to diagnose COPD
include chest x-ray, computerized
tomography (CT or CAT scan) of the
chest, tests of lung function
(pulmonary function tests) and the
measurement of oxygen and carbon
dioxide levels in the blood.
 The diagnosis of COPD should be
considered in anyone who has
dyspnea, chronic cough or sputum
production, and/or a history of
exposure to risk factors for the
disease such as regular tobacco
smoking. No single symptom or sign
can adequately confirm or exclude
the diagnosis of COPD although
COPD is uncommon under the age
of 40 years.
Common Diagnostic
Procedure
Spirometry
The diagnosis of COPD is confirmed by spirometry, a
test that measures breathing. Spirometry measures the forced
expiratory volume in one second (FEV1) which is the greatest
volume of air that can be breathed out in the first second of a
large breath. Spirometry also measures the forced vital capacity
(FVC) which is the greatest volume of air that can be breathed
out in a whole large breath. Normally at least 70% of the FVC
comes out in the first second (i.e. the FEV1/FVC ratio is >70%). In
COPD, this ratio is less than normal, (i.e. FEV1/FVC ratio is
<70%) even after a bronchodilator medication has been given.

Spirometry can help to determine the severity of COPD.

The FEV1 (measured post-bronchodilator) is expressed as a
percent of a predicted "normal" value based on a person's age,
gender, height and weight:
Other tests
An x-ray of the chest may show an over-expanded
lung (hyperinflation) and can be useful to help exclude
other lung diseases.
Complete pulmonary function tests with measurements
of lung volumes and gas transfer may also show
hyperinflation and can discriminate between COPD
with emphysema and COPD without emphysema.
A high-resolution computed tomography scan of the
chest may show the distribution of emphysema
throughout the lungs and can also be useful to
exclude other lung diseases.
A blood sample taken from an artery can be tested for
blood gas levels which may show low oxygen levels
(hypoxemia) and/or high carbon dioxide levels
(respiratory acidosis). A blood sample taken from a
vein may show a high blood count (reactive
polycyctemia), a reaction to long-term hypoxemia.
 COPD

MANAGEMENT
Risk Factor Reduction
 Don't smoke.
 Don't allow others to smoke in your
home.
 Stay away from or reduce your time
around things that irritate your nose,
throat, and lungs, such as dust or pets.
 If you catch a cold, get plenty of rest.
 Take your medicine exactly the way your
doctor instructs you.
 Eat a healthy diet.
 Wash your hands often.
 Do not share food, cups, glasses, or
eating utensils.
 Pharmacotherapy in COPD
COPD severity

Mild……….……..Ø SABD1 prn

Ø Tiotropium or LABA2 + SABD prn

Moderate………….Ø Tiotropium + LABA + SABA3 prn

Ø Tiotropium + LABA (+ theophylline) + SABA prn

Dyspnea
&
disability
Severe……..……Ø Tiotropium + LABA/ICS4 + theophylline + SABA prn
1. SABD : Short-acting bronchodilator (beta2-agonist or anticholinergic)
2. LABA : Long-acting beta2-agonist (e.g. formoterol or salmeterol)
3. SABA : Short-acting beta2-agonist (e.g. salbutamol)
4. LABA/ICS : Long-acting beta2-agonist combined with inhaled
corticosteroid in one preparation
Bronchodilators

 Bronchodilators are medicines that relax

smooth muscle around the airways,
increasing the calibre of the airways and
improving air flow.
β2 agonists
 β2 agonists stimulate β2 receptors on
airway smooth muscles, causing them to
relax.
Anticholinergic
 Anticholinergic drugs cause airway
smooth muscles to relax by blocking
stimulation from cholinergic nerves
Corticosteroids
 Corticosteroids act to reduce the
inflammation in the airways, in theory
reducing lung damage and airway
narrowing caused by inflammation.
Unlike bronchodilators, they do not act
directly on the airway smooth muscle and
do not provide immediate relief of
symptoms.
Thank you!
Geronimo C. Burce BSN, RN