COPD(Chronic Obstructive Pulmonary Disease)Ayurveda

Chronic obstructive pulmonary disease..It is one of the most affecting lung disease.. In detailed explanation of disease is there and including its ayurvedic aspect of management is also there...
#Ayurveda#Emphysema#Chronic brochitis

1. Presnted By: Raghavendra Pujari 4 th year BAMS SVM AMC ILKAL COPD

2. INTRODUCTION One of the top three causes of death worldwide
90% of deaths in middle and low SE countries
Numbers to increase in the coming years

3. Epidemiology In India, COPD is the second most common lung disorder after pulmonary tuberculosis. the various studies done in the past 30 years on the prevalence of chronic bronchitis and COPD in India. The disease is frequently encountered in the middle-age persons and is rare below the age of 35 years. Chronic productive pulmonary disease. because of smoking. However, it is important that the male-to-female and smoker to non smoker ratio is not as high in India as seen in westen countries. This is due to high prevalence of COPD females in the rural areas due to indoor air pollution biomass fuel exposure.

4. Definition GOLD 2022:
Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.

5. Disease Development and progress Cigarette Smoking

Tobacco Use

Genetic Factors

Air Pollution

6. Chronic Bronchitis

Emphysema

Small Airway Disease (Bronchiolitis)

7. Chronic Bronchitis ► Chronic bronchitis is defined clinically as cough with sputum expectoration for at least 3 months a year during a period of 2 consecutive years.

► Chronic bronchitis is associated with hypertrophy of the mucus-producing glands found in the mucosa of large cartilaginous airways.

8. Emphysema Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles , accompanied by the destruction of alveolar walls and without obvious fibrosis part of lung involved - Acnius

9. Centri acinar emphysema – smokers –upper lobe predominant

Pan Acinar (Proximal Acinar ) – alpha 1 anti trypsin deficiency-

► Para Septal (Distal Acinar )

Para cicatricial – irregular emphysema

10. Risk Factors Environmental Host Based Smoking Genetic Indoor air pollution Airway Hyperreactivity Occupation Low socioeconomic Status

11. Smoking Most important contributory factor to COPD Smoking Index Pack Years of Smoking Degree of FEV1 deteoration contributes to amount of smoking Environmental tobacco smoke Second hand Smoke Pre Natal Exposure

12. Indoor Air Pollution Occupational Exposure Low Socio Economic Status Childhood Respiratory Infections HIV-high viral load, Low CD4 count causes activation of Alveolar Macrophages and MMP

13. HOST FACTORS GENETICS-alpha 1 antitrypsin deficiency , BMP,proteinase anti proteinase imbalance ,AIRWAY HYPER RESPONSIVENESS Persistent Airflow Limitation

14. PATHO LOGY In patients with chronic bronchitis, there is hypertrophy of the mucous secreting glands. These glands are found in the submucosa of large cartilaginous airways. In patients with COPD the mean Reid index (ratio of thickness of the submucosal glands to that of the bronchial wall) increases to 0.52 (normal 0.44). In COPD, the major site of obstruction is the small airways. Other findings include goblet cell hyperplasia, accumulation of inflammatory cells in the mucosa and submucosa, peri -bronchial fibrosis, intraluminal mucous plugs and increased smooth muscle.

15. PATHOPHYSIOLOGY Chronic bronchitis and emphysema frequently co-exist; however, one process may dominate over the evidence of obstruction. Airways obstruction is invariably present by the time patient experiences breathlessness. Evidence of obstruction. Airways obstruction is invariably present by the time patient experiences breathlessness. Besides basic disease process in the airways in chronic bronchitis, loss of elastic recoil in emphysema through loss of radial support on airways also produces airways narrowing.

16. CLINICAL FEATURES Predominantly Chronic Bronchitis
The patient with predominantly chronic bronchitis usually presents with a history of cough and sputum production for many years along with a history of heavy tobacco smoking. Initially, the cough is present only during winter months. Over the years the cough becomes continuous and episodes of illness increase in frequency, duration and severity. Occasionally, the patient seeks medical help after the onset of peripheral oedema secondary to overt right ventricular failure. Patients with chronic bronchitis are over-weight and cyanotic. Because of this appearance these patients are referred to as ‘blue-bloaters’.

17. Predominantly Emphysema
There is a long history of exertional dyspnoea with minimal cough associated with production of only small amounts of mucoid sputum. The patient appears to be distressed on physical examination. The body buildis asthenic with evidence of weight loss.. Pink Puffer.

18. VENTILATION PERFUSION MISMATCH Pink puffers Blue bloaters• Areas of Good Perfusion, but poor ventilation - Blue Bloaters - Chronic Bronchitis • Poor perfusion, Good Ventilation - Emphysema predominant Type

19. Proteinase Cell origin Neutrophil elastase Neutrophil ( monocyte ) Proteinase3 Neutrophil ( monocyte ) Cathepsin G Neutrophil ( monocyte mast cell) MMP1 Macrophage,epithelial cell MMP(( Gelanise B) Macrophage MMp12 (Macrophage elastage ) Macrophage Cathepsin L Macrophage

20. Inhibitor Cell of origin Class of proteinase inhibited Alpha 1 antitrypsin Hepatocyte Serine Alpha 2 Macroglobulin Hepatocyte ,lung fibrolast Serine MMP TIMPs 1,2,3,4 Resident Lung cell MMP SLPI Resident Lung cell Serine Elafin Large airway epithelial cell Serine Cystatin C Bronchial epithelial cell cysteine

21. PATHWAYS OF DIAGNOSIS OF COPD Symptoms: Shortness of breath,Chronic Cough,Sputum . Spirometry: A simple test used to help diagnose and monitor certain lung condition by measuring how much air patient can breathe out in one forced breath. Risk Factors:Host factors,Tobacco , Occupation, Indoor pollution

22. Physical signs Barrel shaped chest Accessory respiratory muscle. Prolonged expiration during quiet brathing Tripod position. Cyanosis. Polycythemia .

23. Differential Diagnosis Diagnosis Suggestive Features COPD Onset in mid life Symptom of slowly progressive History f smoking Asthma Onset in early life Symptoms vary widely from day to day Symptoms worse at night/early morning Tuberculosis Onset all ages Microbiological confirmation Congestive Heart Failure Chest x ray shows dilated heart Pulmanary edema Not airflow limitation Brochiectasis Large volume of purulentsputum Bactrial infection Chest x ray shows bronchial dilatation

24. COMPLICATION Cardiovascular Disaeases-Arrythmia . Lung Cancer GERD Weight loss.

25. Management of COPD General Principles: Smoking Cessation Vaccintion Pulmanary Rehabilitation

26. Smoking cessation Nicotine Patches. Nicotine Lozenges Nicotine Gums Nicotine spray Drugs: Bupoprin Varenicline Notryptilene

27. Vaccination for stable copd Influenza Vaccine SARS-Cov-2 COVID 19 vaccine Pneumococcal polysacchride vaccine(PPSV23)

28. Stable COPD Management Brochodilators : Long Acting Beta Agoninists (LABA) Long Acting Muscarinic Antagonsists (LAMA) Inhaled Corticosteroids. Methylxanthines .

29. Other Pharmacological Treatments Alpha 1 Antitrypsin Augmentation therapy. Antitussives Vasodilators.

30. Oxygen thearapy : The long term administration of oxyen increases survival in patients with severe chronic resting arterial hypoxemia. Ventilator Support:In Hospitilization free survival for selected patients.

31. Interventional Thearpy Lung Volume Reduction Surgery. Bullectomy . Transplantation Bronchoscopic Interventions.

32. Other Interventions Pulmonary Rehabilitation . Exercise Training. Vaccination. Nurtional Support – High Fat low carbohydrate. Psychological Support

33. TREATMENT OF COPD EXACERBATIONS An exacerbation of COPD is defined as an acute worsening of respiratory symptoms that results in additional therapy. Mild (treated with short acting bronchodilators only, SABDs) Moderate (treated with SABDs plus antibiotics and/or oral corticosteroids) Severe (patient requires hospitalization or visits the emergency room). Severe exacerbations may also be associated with acute respiratory

34. Ayurvedic Aspect of Management : In classsics also pathogenesis of Pranavaha Srotodusti described in regards of Kasa and Shvasa resembles the above mention description and can be summarized as due to indulgence in etiological factors, vitiated Prana and Udana situated in Pranavaha Srotas enforces Kapha , resulting into obstruction of channels of Pranavaha Srothas .

35. Management of COPD Timely and seasonal Shodhana ( biopurification ) should be performed in accordance with the patients strength like strong patients may undergo Vamana , Virechana , and Niruha basti as well as Nasya therapy in a appropriate seasons. These type of therapies alleviate Kapha and may dry up excess mucous secretions in the Pranavaha Srotasa Medications: Single drugs: Ardraka , Ela , Haridra , Trikatu , Pippali , Ashvagandha , Agnimantha , Ajmoda , Ajaji , Guduchi , Ativisha , Aragvadha , Karanjabija , Daruharidra , Lashuna , Rasona , Hingu . Preparations: Gojihvadi Kvatha , Dashmula Kvatha , Chitraka Haritaki Avleha , Choshath Prahari Pippali , Tamra Bhasma , Mahalakshmi Vilas Rasa, Loknath Rasa, Vyoshadi Churna , Sarpi Guda , Shringyadi Churna , Haritakyadi Modaka , Pippalyadi Gutika , Sitopaladi Churna , Talishadi Churna , Vyaghri Haritaki Avaleha . Rasayana : Pippali Rasayana , Chyavanaprasha , Agtsya Haritaki , Vyaghri Haritaki , Haridra Khanda , Ashwagandha , Guduchi etc. can be used as Rasayana