Chronic Pulmunary Disease PRESENTATION 3.pptx

COPD

1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 10298 10389 Reviewed by: Dr Huballah

2. Outline Definition of COPD Types/classification of COPD Causes of COPD exacerbation Pathophysiology with diagrammatic illustration Clinical features Investigation and Diagnosis of COPD Differential Diagnosis of COPD Asthma versus COPD Treatment of COPD Classes of drugs used in the treatment of COPD Complications of COPD Associated co-morbidities

3. Definition Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.

4. Types COPD is subdivided into Chronic bronchitis Emphysema Bronchiolitis

5. Chronic bronchitis Chronic bronchitis -Is defined as persistent cough with sputum production for at least 3 months in at least 2 consecutive years in the absence of any other identifiable cause. Common among habitual smokers and inhabitants of smog-polluted cities. It causes atypical metaplasia and dysplasia of the respiratory epithelium providing a rich soil for cancerous transformation.

6. Emphysema Defined as abnormal and permanent enlargement of air spaces distal to the terminal bronchiole, accompanied by destruction of their walls. It is classified according to the distribution: • Centri -acinar emphysema- Distension and damage of lung tissue are concentrated around the respiratory bronchioles, while the more distal alveolar ducts and alveoli tend to be well preserved. This form of emphysema is extremely common. • Pan-acinar emphysema. This is less common but is the type associated with α1-antitrypsin deficiency. Distension and destruction affect the whole acinus, and in severe cases, the lung is just a collection of bullae. Severe airflow limitation and mismatch occur.

7. • Irregular emphysema-There is scarring and damage that affect the lung parenchyma is patchy, independent of the acinar structure.

8. Gold Classification

9. Risk factors Tobacco smoking Inhalation toxic particles and gases from household and outdoor air pollution Abnormal lung development and accelerated lung ageing Mutations in the SERPINA1 gene that leads to α-1 antitrypsin deficiency.

10. Causes of COPD exacerbation Respiratory infections: such as viral and bacterial infections like pneumonia Air pollution: smoke, dust and chemical fumes Weather changes: Cold air or changes in humidity levels Allergens exposure: e.g pollen or mold Non-compliant to medications Strenous physical exertion

11. Pathophysiology CHRONIC BRONCHITIS Long-standing irritation by inhaled substances such as tobacco smoke, dust from grain, cotton and silica Hypertrophy of the mucosal and submucosal glands and increase in goblet cells of the small bronchi and bronchioles Hypersecretion of mucus The smoke has an adverse effect on surfactant, favouring over-distension of the lungs.

12. EMPHYSEMA Alpha1-antitrypsin is a proteinase inhibitor produced in the liver; it is secreted into the blood and diffuses into the lung. Here it inhibits proteolytic enzymes such as neutrophil elastase, which are capable of destroying alveolar wall connective tissue. In α1-antitrypsin deficiency, the protein accumulates in the liver, leading to low levels in the lung. Deficiency can also cause liver disease

13. Clinical features Chronic dyspnea Chronic cough with or without sputum production Wheezing Chest tightness Weight loss Fatigue Muscle mass loss anorexia

14. Investigations Lung function tests show evidence of airflow limitation. The FEV1:FVC ratio is reduced <70% PEFR is low. FEV1 <80% of normal (reduced) FVC is normal or reduced TLC normal or increased RV is increased Decreased vital capacity 2 . Chest X-ray- Hyperinflated lungs >6 anterior ribs seen above the diaphragm in the mid-clavicular line Flattened diaphragm Large central pulmonary arteries Decreased peripheral vascular marking Presence of bullae

15. Chest X-ray

16. 3. HRCT scans –presence of bullae Haemoglobin level and packed cell volume Blood gases –hypoxemia and hypercapnia Sputum examination ECG- tall p wave ,right ventricular hypertrophy Echocardiography α1- Antitrypsin levels and genotype

17. Diagnosis

18. Diagnosis

19. Differential diagnosis Asthma Congestive heart failure Bronchiectasis Tuberculosis Obliterative bronchiolitis

20. Treatment Supportive care- Nutrition Oxygen therapy Pulmonary rehabilitation Additional measures: Vaccination-pneumococcal, COVID-19 and influenza vaccine Alpha1 anti-trypsin replacement

21. Treatment

22. Classification of drugs

23. Complications Respiratory insufficiency and respiratory failure are the most common Pneumonia Cor pulmonale Pulmonary hypertension Pneumothorax Skeletal muscle dysfunction Depression and anxiety disorders Severe hypoxemia and acidosis Lung cancer Atelectasis Pleural effusion Pulmonary bullae

24. Associated co-morbidities

25. References POCKET-GUIDE-GOLD-2023