COPD

CHRONIC OBSTRUCTIVE PULMONARY DISORDER

1. CHRONIC OBSTRUCTIVE PULMONARY DISORDER(COPD) ASHWINI SOMAYAJI 1 ST M.PHARM PHARMACOLOGY

2. COPD is a disease characterised by persistent air flow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway and the lung to noxious particles or gases. COPD is a lung disease that makes it hard to breathe. It is caused by damage to the lungs over many years, usually from smoking. INTRODUCTION:

3. COPD is often a mix of two diseases: CHRONIC BRONCHITIS : In chronic bronchitis, the airways that carry air to the lungs (bronchial tubes ) get inflamed and make a lot of mucus. This can narrow or block the airways, making it hard to breathe.

4. EMPHYSEMA:   In a healthy person, the tiny air sacs in the lungs are like balloons. As you breathe in and out, they get bigger and smaller to move air through your lungs. But with emphysema, these air sacs are damaged and lose their stretch. Less air gets in and out of the lungs, which makes feel short of breath.

5. COPD is almost always caused by smoking. Over time, breathing tobacco smoke irritates the airways and destroys the stretchy fibers in the lungs. Other things that may put at risk include breathing chemical fumes, dust, or air pollution over a long period of time.  Second hand smoke also may damage the lungs. CAUSES:

6. It may be more likely to get COPD if had a lot of serious lung infections when person were a child. People who get emphysema in their 30s or 40s may have a disorder that runs in families, called alpha-1antitrypsin deficiency. But this is rare. It usually takes many years for the lung damage to start causing symptoms, so COPD is most common in people who are older than 60.

7. Genetic plays importent role in the development of COPD. It is more common among relatives of those with COPD who smoke than unrelated smokers. Currently, the only clearly inherited risk factor is alpha 1-antitrypsin deficiency(AAT).  This risk is particularly high if someone deficient in alpha 1-antitrypsin also smokes.

8. Cough: A chronic cough is often the first symptom to occur. When it exists for more than three months a year for more than two years, in combination with sputum production. The amount of sputum produced can change over hours to days. SYMPTOMES:

9. SHORTNESS OF BREATH : Shortness of breath is often the symptom that bothers people the most.  It is commonly described as: " breathing requires effort," " feel out of breath," or ‘ can't get enough air in".  Typically the shortness of breath is worse on exertion of a prolonged duration and worsens over time.

10. In the advanced stages it occurs during rest and may be always present. ]  It is a source of both anxiety and a poor quality of life in those with COPD.  Many people with more advanced COPD breath through  pursed lips and this action can improve shortness of breath in some.

11. In COPD, it may take longer to breathe out than to breathe in.  Chest tightness may occur but is not common and may be caused by another problem.  Those with obstructed airflow may have wheezing or decreased sounds with air entry on examination of the chest with a stethoscope. Other features:

12. A barrel chest is a characteristic sign of COPD, but is relatively uncommon. Tripod positioning may occur as the disease worsens. Advanced COPD leads to high pressure on the lung arteries, which strains the right ventricle of the heart..This situation is referred to as   cor pulmonale , and leads to symptoms of leg swelling and bulging neck veins.  COPD is more common than any other lung disease as a cause of cor pulmonale .  Cor pulmonale has become less common since the use of supplemental oxygen.

13. COPD often occurs along with a number of other conditions, due in part to shared risk factors.  These conditions include ischemic heart disease, high blood pressure, diabetes mellitus, muscle wasting, osteoporosis, lung cancer, anxiety disorder and depression.  In those with severe disease a feeling of always being tired is common.  Fingernail clubbing is not specific to COPD and should prompt investigations for an underlying lung cancer.

14. Exacerbation An  acute exacerbation of COPD  is defined as increased shortness of breath, increased sputum production, a change in the color of the sputum from clear to green or yellow, or an increase in cough in someone with COPD.  This may present with signs of increased work of breathing such as fast breathing, a fast heart rate, sweating, active use of muscles in the neck, a bluish tinge to the skin, and confusion or combative behaviour in very severe exacerbations.  Crackles may also be heard over the lungs on examination with a stethoscope.

15. PATHOPHYSIOLOGY: Abnormal inflammatory response of the lungs due to toxic gases. Response occurs in the airways ,parenchyma & pulmonary vasculature Narrowing of the airway takes place. Destruction of parenchyma leads to emphysema.

16. Destruction of lung parenchyma leads to an imbalance of proteinases /anti- proteinases . (this proteinases inhibitors prevents the destructive process) Pulmonary vascular changes Thickening of vessels Collagen deposit Destruction of capillary beds Mucus hypersecretion (cilia dysfunction, airflow limitation, corpulmonale (RVF))

17. Chronic cough and sputum production

18. Irritants irritate the airway Excess mucus production Inflammation Cause the mucus secreting glands and goblet cells to increase in number. Chronic bronchitis:

19. Ciliary function is reduced. More mucus production Bronchial walls become thickened and lumen narrows and mucus plug the airway Alveoli adjacent to the bronchioles may become damaged and fibrosed . Alter function of alveolar macrophages and infection

20. EMPHYSEMA Emphysema is defined as enlargement of the air spaces distal to the terminal bronchioles, with destruction of their walls of the alveoli Pathology : As the alveoli are destroyed the alveolar surface area in contact with the capillaries decreases. Causing dead spaces (no gas exchange takes place)

21. Leads to hypoxia. In later stages: CO 2 elimination is disturbed and increase in CO 2 tension in arterial blood causing Respiratory acidosis (Decrease pulmonary blood flow is increased forcing the RV to maintain high B.P. in PA.)

22. Classification: Centrilobular - The respiratory bronchiole (proximal and central part of the acinus ) is expanded. The distal acinus or alveoli are unchanged. Occurs more commonly in the upper lobes.

23. Panlobular – The entire respiratory acinus , from respiratory bronchiole to alveoli, is expanded. Occurs more commonly in the lower lobes, especially basal segments, and anterior margins of the lungs.

24. DIAGNOSIS:

25. TREATMENT:

26. In chronic obstructive pulmonary disease (COPD), two lung diseases make breathing more difficult. Chronic bronchitis inflames and narrows airways (bronchi) and makes phlegm, while emphysema destroys parts of the lungs. If you smoke, quitting smoking can prevent more damage to your lungs. Even second hand smoke can worsen COPD, so one should try avoiding it. AVOID SMOKING

27. BRONCHODILATOR doctor may prescribe bronchodilators to help relax the muscles around your airways, making breathing easier. Short-acting bronchodilators provide brief relief fast, while long-acting bronchodilators can relieve constriction for a long time and are often used overnight. Bronchodilators are usually taken as an inhaled medication.

28. BETA-2 AGONIST: Eg : Methylxanthin Theophylline Inhaled therapy is preferred. long acting inhaled bronchodilators are convenient and more effective.

29. Adverse effect: Can produce resting sinus tachycardia and pecipitate cardiac arrhythmia. Exaggerrated somatic tremor in some older patients Hypokalemia in combination with thiazide diuretics.

30. ANTICHOLINERGIC: Eg : ipratropium , oxitroprium etc. Short acting drugs block M2 and M3 reseptors and modify transmission at pre- ganglionic junction.

31. CORTICOSTEROIDS FOR INFLAMMATION: Corticosteroids, also called steroids, help reduce mucus production and inflammation in lungs, making breathing easier. Most people with COPD take corticosteroids by inhaler, but sometimes they are taken in pill form. may need to boost calcium intake if take steroids long-term,

32. VACCINES-FLU & PNEUMONIA: If you have COPD, you're at higher risk for complications from infections like the flu and pneumonia. want to do all ONE can to reduce risk of illness. should get vaccinated against seasonal flu every year and receive a pneumococcal (pneumonia) vaccine with a booster shot as needed.

33. OXYGEN THERAPY: lungs are vital for getting the oxygen need, but COPD reduces lung function. In severe cases, doctor may prescribe supplemental oxygen. In addition to helping with normal body functions, it can help increase stamina and improve sleep.

34. LUNG SURGERY In rare cases of severe COPD that doesn’t improve with medication, doctor may suggest lung surgery . While not right for everyone, a procedure like lung volume reduction surgery can improve lung capacity and ability to breathe.

35. With this surgery, 20%-30% of the most diseased lung tissue is removed, leaving the healthiest part of the lung to perform better. Lung transplant surgery is another option in other severe cases.

36. PULMONARY REHABITATION: Pulmonary rehabilitation uses exercise, disease management, nutrition, and psychosocial counselling to help feel better and stay active. learning techniques for staying fit and managing shortness of breath, so can improve quality of life, decrease the amount of time spent in the hospital, and improve ability to exercise.

37. Decramer M, Janssens W, Miravitlles M (April 2012). "Chronic obstructive pulmonary disease".  Lancet   379  (9823): 1341–51. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez- Roisin R, van Weel C, Zielinski J (September 2007). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary" . Am. J. Respir . Crit. Care Med.  176  (6): 532–55.  doi : 10.1164/rccm.200703-456SO .  PMID   17507545 . REFERENCES

38. Jump up^   Nathell L, Nathell M, Malmberg P, Larsson K (2007).  "COPD diagnosis related to different guidelines and spirometry techniques" .  Respir . Res.  8  (1): 89. doi : 10.1186/1465-9921-8-89 .  PMC   2217523 .  PMID   18053200 . Vestbo , Jørgen (2013).  "Definition and Overview"  (PDF).  Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease . Global Initiative for Chronic Obstructive Lung Disease. pp. 1–7.