CHRONIC OBSTRUCTIVE PULMONARY DISEASE.pptx

COPD - EXPLAINED IN DETAIL

1. ADULT HEALTH NURSING I DISORDERS OF RESPIRATORY SYSTEM “ CHRONIC OBSTRUCTIVE PULMONARY DISEASE ” Ms. Vaibhavi N Prabhudessai MSc (N) (MSN – Critical Care Nursing Department of Medical Surgical Nursing

2. COPD X-RAY NORMAL X-RAY

3. INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) is a progressive and irreversible respiratory disorder primarily involving the airways and lung parenchyma. It leads to chronic airflow limitation and tissue destruction, resulting from an abnormal inflammatory response of the lungs to harmful particles or gases . The disease is preventable and treatable, but not completely curable. It represents a major global health burden, being one of the leading causes of morbidity and mortality worldwide . COPD includes two major pathological conditions: Chronic Bronchitis: Inflammation of the bronchial tubes leading to mucus hypersecretion . Emphysema: Destruction of alveoli causing loss of elastic recoil and gas exchange surface. Chronic Asthama : Narrowing and swelling of the airway Many patients have overlapping features of all conditions.

4. DEFINITION Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2024) - “ COPD is a common, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases.” Key components of definition: Persistent symptoms (chronic cough, sputum, dyspnea ) Airflow limitation (not fully reversible) Exposure to harmful substances (smoke, dust, fumes) Structural damage (airway narrowing, alveolar destruction) According to WHO (2023) - “Chronic Obstructive Pulmonary Disease (COPD) is a chronic, progressive lung disease that causes airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis, and is primarily caused by significant exposure to harmful particles or gases.”

5. INCIDENCE Global Scenario COPD affects over 392 million people globally (WHO, 2023). It is the 3rd leading cause of death after cardiovascular diseases and stroke. Approximately 3 million deaths occur annually due to COPD. More common in low- and middle-income countries (LMICs) due to poor air quality and biomass exposure . Indian Scenario India accounts for nearly 13% of global COPD deaths. Prevalence: 55.3 million people (ICMR, 2023). Common among rural women due to exposure to biomass fuel smoke (firewood, cow dung). States with high prevalence: Maharashtra, Goa, Tamil Nadu, Rajasthan, Uttar Pradesh. Smoking remains a major contributor in urban males; indoor air pollution dominates in rural females.

6. ETIOLOGY A. Environmental Causes Cigarette smoking (most common cause; 85–90% of cases) Secondhand smoke (passive smoking) Air pollutants – industrial fumes, vehicle exhaust, particulate matter Biomass fuel exposure – smoke from cooking or heating with coal, wood, dung B. Genetic Causes Alpha-1 Antitrypsin Deficiency (AATD): A rare hereditary condition that causes early-onset emphysema due to unopposed proteolytic enzyme activity .

7. ETIOLOGY C . Infectious Causes Repeated childhood respiratory infections weaken airway defenses . Chronic bacterial infections (H. influenzae , Streptococcus pneumoniae ). D. Other Causes Occupational exposure (miners, welders, textile workers) Age (>60 years) (natural decline in lung elasticity) Socioeconomic factors (poor nutrition, overcrowding, poor housing)

8. TYPES COPD involves the following sub – classification of disease, Chronic Bronchitis Productive cough for at least 3 months in two consecutive years. Long-term irritation → inflammation of bronchial mucosa → hypertrophy of mucus glands → excess mucus → airway narrowing and obstruction . Clinical Picture: “Blue bloater” appearance (cyanosis, overweight) Chronic cough with sputum Frequent infections Hypoxemia and hypercapnia due to mucus plugging

9. TYPES Emphysema Permanent enlargement of airspaces distal to terminal bronchioles, with destruction of alveolar walls and loss of elastic recoil. Breakdown of alveolar walls → reduced surface area for gas exchange → air trapping → hyperinflated lungs → barrel-shaped chest → reduced diffusion capacity → hypoxemia Clinical Picture: “Pink puffer” appearance (thin, pursed-lip breathing, minimal sputum) Dyspnea , hyperventilation Little or no cyanosis until late stage

10. TYPES Asthma-COPD Overlap Syndrome (ACOS ) Patients show features of both asthma and COPD. Airflow obstruction is partly reversible. Responds to bronchodilators and corticosteroids better than classical COPD.

11. PHASES GOLD Classification, Stage Severity FEV₁ (% predicted) Clinical Manifestations GOLD 1 Mild ≥80% Chronic cough, minimal symptoms GOLD 2 Moderate 50–79% Dyspnea on exertion, reduced exercise tolerance GOLD 3 Severe 30–49% Worsening dyspnea , frequent exacerbations GOLD 4 Very Severe <30% Chronic respiratory failure, cor pulmonale

12. PATHOPHYSIOLOGY Chronic exposure to irritants (smoke, dust, pollutants) ↓ Inflammation of bronchi, bronchioles, alveoli ↓ Edema + goblet cell hyperplasia + mucus hypersecretion ↓ Airway obstruction + air trapping + alveolar wall destruction ↓ ↓ Elastic recoil + hyperinflation of lungs ↓ Ventilation-perfusion (V/Q) mismatch ↓ Hypoxemia + Hypercapnia ↓ Pulmonary vasoconstriction → Pulmonary hypertension ↓ Right ventricular hypertrophy → Cor Pulmonale ↓ Respiratory failure

13. RISK FACTORS Modifiable Non-Modifiable Smoking Age (older adults >40 years) Exposure to air pollution Genetic predisposition (AAT deficiency) Occupational exposure Gender (historically higher in males) Poor nutrition Family history Indoor biomass smoke Pre-existing lung disease

14. CLINICAL MANIFESTATIONS Early Signs: Chronic cough (especially morning) Sputum production (white/yellow) Mild breathlessness on exertion Progressive Signs: Dyspnea at rest Wheezing and prolonged expiration Cyanosis (bluish lips/fingers) Barrel chest (increased AP diameter) Use of accessory muscles for breathing Fatigue and weight loss Clubbing (in advanced stages ) Systemic Findings: Edema and distended neck veins (due to cor pulmonale ) Anxiety and confusion (due to hypoxia)

15. DIAGNOSTIC EVALUATIONS Investigation Purpose and Findings Spirometry ↓FEV₁/FVC ratio <0.70 confirms irreversible airflow limitation Arterial Blood Gas (ABG) ↓PaO₂ (hypoxemia), ↑PaCO₂ (hypercapnia), respiratory acidosis Chest X-ray Hyperinflated lungs, flattened diaphragm, widened intercostal spaces High-Resolution CT Scan (HRCT) & MRI Detects emphysema, bullae, airway wall thickening Sputum Examination Detects infection (bacterial pathogens) Pulse Oximetry Monitors SpO ₂ (<90%) Alpha-1 Antitrypsin Test Checks for genetic deficiency in younger patients (<40 years)

16. MEDICAL MANAGEMENT Category Drugs / Therapy Rationale Bronchodilators Salbutamol (β₂-agonist), Ipratropium (anticholinergic), Tiotropium Relax bronchial smooth muscles and relieve airflow obstruction Inhaled Corticosteroids Budesonide, Fluticasone Reduce airway inflammation and mucus secretion Combination Therapy Salmeterol + Fluticasone (LABA + ICS) Enhances bronchodilation and anti-inflammatory effects Mucolytics Acetylcysteine , Ambroxol Break down thick mucus for easier expectoration

17. MEDICAL MANAGEMENT Category Drugs / Therapy Rationale Antibiotics Amoxicillin, Azithromycin Treat acute bacterial exacerbations Oxygen Therapy 1–2 L/min via nasal cannula Maintain SpO ₂ 88–92% (avoid CO₂ narcosis) Diuretics Furosemide Manage edema secondary to cor pulmonale Preventive Vaccinations Pneumococcal, Influenza Prevent secondary infections Pulmonary Rehabilitation Breathing exercises, exercise training, education Improve physical capacity and quality of life

18. SURGICAL MANAGEMENT Procedure Indication Rationale Bullectomy Large bullae compressing healthy lung tissue Reduces dead space, improves ventilation Lung Volume Reduction Surgery (LVRS) Localized emphysema in upper lobes Removes diseased lung tissue, allowing better expansion of healthy tissue Endobronchial Valve Surgery   Patients with severe heterogeneous emphysema and hyperinflation who are poor candidates for open surgery   Collapses the most damaged lung segments, reduces hyperinflation & improves function of healthier segments. Lung Volume Reduction Coil Therapy (LVRC) Severe emphysema, especially in patients unsuitable for LVRS or EBV Reduces hyperinflation, improves elastic recoil, and decreases dynamic airway collapse Lung Transplantation End-stage COPD, severe hypoxia Restores normal ventilation and oxygenation

19. NURSING MANAGEMENT Nursing Action Rationale Assess respiratory pattern and effort Early detection of respiratory distress Maintain semi-Fowler’s or orthopneic position Enhances chest expansion and oxygenation Administer oxygen therapy cautiously Prevents CO₂ retention and narcosis Encourage pursed-lip and diaphragmatic breathing Promotes alveolar ventilation and prevents air trapping Monitor ABGs and SpO ₂ levels Evaluates oxygenation and CO₂ retention Provide small, frequent, high-calorie meals Prevents fatigue and maintains nutrition Encourage adequate fluid intake (2–3 L/day) Helps liquefy secretions Teach smoking cessation and avoidance of irritants Slows disease progression Educate on inhaler use and medication adherence Ensures effective therapy and symptom control Encourage rest and energy conservation Prevents fatigue and dyspnea

20. COMPLICATIONS Respiratory failure Acute exacerbation of COPD Pulmonary hypertension Cor pulmonale (right-sided heart failure) Pneumothorax (due to ruptured bullae) Polycythemia (due to chronic hypoxia) Recurrent respiratory infections

21. COMPLICATIONS Actual Diagnoses Ineffective Airway Clearance related to mucus hypersecretion . Impaired Gas Exchange related to alveolar destruction. Activity Intolerance related to imbalance between oxygen supply and demand. Imbalanced Nutrition: Less than Body Requirements related to dyspnea and fatigue. Anxiety related to breathlessness and hypoxia . Potential (Risk) Diagnoses Risk for Infection related to retained secretions. Risk for Cor Pulmonale related to pulmonary hypertension. Risk for Fluid Volume Excess related to right heart failure. Risk for Ineffective Breathing Pattern related to airway obstruction. Risk for Injury related to improper oxygen therapy (CO₂ narcosis).