Chronic obstructive pulmonary disease COPD

Chronic obstructive pulmonary disease COPD

Defn :

COPD is a chronic progressive disorder characterized by airway obstruction with little or no reversibility .

The spectrum of copd covers

1. chronic bronchitis and
2.  emphysema.

It is characterized by

1. FEV1  <80 %
2. FEV1/FVC <70%

Chronic bronchitis

·         Defn :It is a clinical diagnosis defined when a cough and sputum occurs on most days for at least 3 consecutive months for at least 2 successive years.

·         Ak/a“Blue bloaters”

Emphysema

·         It is defined as the permanent dilation of the air spaces distal to the the terminal bronchiole.

·         2 types :

1. Centriacinar
2. Panacina

      Ak/a “pink puffers

Risk factors for COPD

1. Tobacco smoke –about 95%
2. Occupation : coal miners, fumes
3. Outdoor or indoor air pollution—dust , smoke
4. Low socioeconomic condition
5. Infections
6. Genetic predisposition –α-1 antitrypsin deficiency.

Pathophysiology

Clinical features

Symptoms :

1. Age : usually >40 years
2. Persistent cough (for at least 3 consecutive months for at least 2 successive years).
3. Sputum production(scanty mucoid , or mucopurulent or purulent )
4. Breathlessness
5. Repeated similar attacks in past

Signs

1. Vitals

1. Pulse : tachycardia
2. RR : tachypnoea
3. Temp : may be raised

2. General physical examination  :

a. Patient dyspnoeic and restless

1. Polycythaemia : plethora
2. Central cyanosis
3. Pedal edema may be present ( with features of RHF)
4. Flapping tremors (due to high CO2)
5. Use of accessory muscles of respiration
6. Tracheal tug present

3. Respiratory system examination :

1. Inspection :

1. Use of accessory muscles of respiration
2. Indrawing of costal margin and intercostal spaces
3. “Pursed lip” breathing

b.Palpation :

1. Increased AP diameter, barrel shaped chest
2. Diminished chest expansion
3. Tracheal tug

c. Percussion :

1. Hyperresonant lung fields

d. Auscultation :

1. Diminished vesicular breath sounds with prolonged expiration
2. Fine crepitations (more in chronic bronchitis predominant)
3. Wheeze ( more in emphysema predominant)

Investigations

1. CBC : Hb-- increased,

                PCV---   “

                leucocytosis

2.      Sputum : GM stain, C/S, AFB staining

3.      Chest X- ray:

·         Hyper inflated lung fields

·         Tubular heart

·         Flat diaphragm

·         Emphysematous bulla may be seen 

4. Spirometry :

1. FEV1  <80 %
2. FEV1/FVC <70%

5. ECG :

a. P -pulmonale

6. ECHO

7. CT scan

Management

1. General management :

1. Cessation of smoking
2. O2 if cyanosed patient
3. Nebulisation

2.      Pharmacologic management

A  Bronchodilator therapy:

1.      Short acting bronchodilators : salbutamol , terbutaline

2.      Ipatropium bromide, Tiotropium

3.      Long acting bronchodilators : salmeterol, Formoterol

4.      Theophylline and its derivatives

Bronchodilators are more effective in nebulization form . If nebulization not available use as inhalers(MDI)

B.Corticosteroids

·         They reduce the frequency and severity of exacerbations.

·         Inhaled corticosteroids ( fluticasone, budesonide )

·         Oral( prednisolone ) or IV corticosteroids (IV hydrocortisone) during exacerbations.

3.      Antibiotics

Usually during exacerbations

1.      Cap Amoxicillin 250-500 mg 8 hrly or

2.      Co –trimoxazole 960 mg 12 hrly

     for 7-10 days

Or Azithromycin 500 mg od for 5 days

O2 therapy

Long term domicillary O2 therapy in recurrent cases.

Immediate O2 therapy during exacerbations.

5        Additional T/t

• Diuretics : frusemide if pedal edema present.
• Chest physiotherapy- postural drainage
• Lung volume reduction surgery
• Lung Transplantation

Complications

1. Cor pulmonale
2. Pneumothorax by rupture of subpleural blebs
3. Respiratory failure
4. Pulmonary hypertension
5. Lung carcinoma --rare