Characterized

by limitation of
airflow usually
resulting from
an increase in
resistance
caused by
partial or
complete
obstruction due

Etiology
1. Exposure to
tobacco
smoke
whether
active or
passive.
(Environment
al)
2. Airway
Hyperresponsive
ness
3. Impaired lung

Exposure to Tobacco
Smoke

Pathology of COPD

Muscles of Breathing
One of the
signs of lung
function
deficiency is the
use of
accessory
muscles in
breathing. This
is manifested
by the buldging
appearance of
the clavicle
head, and
sternal head.
This occurs due
to air trapping
in the lungs
thus the body

Clinical
Presentation

1. Symptoms: Cough,
sputum, dyspnea.
2. History of exposure to
smoke or other hazardous
fumes.
3. Abnormal decline in
activity due to
exacerbation upon
exertion.
4. Spirometry: FEV1:FVC ratio
< 70%,
Postbronchodilator FEV1 <
80%
5. Frequent respiratory
infections.
6. Low BMI (Chronic COPD)
7. Barrel Chest: Due to
hyperinflation of lungs.
8. Pursed lip breathing: to
help expiration.

COPD & Asthma, there is a

difference

Pulmonary Function Test:

Spirometry

Stages of COPD

Therapeutic Strategy

Stepwise Treatment of COPD

Bronchodilators

Bronchodilators

Corticosteroids
Inhaled
corticosteroids
are not as
efficacious in COPD
They are
usually
reserved for
as
in Asthma.

patients with FEV1 < 50%

As for Oral corticosteroids they
should be reserved for
exacerbations, and some severe
cases only.
Osteoperosis of the spine and ribs is
common in COPD patients receiving
systemic corticosteroids frequently.

Corticosteroids

Patient Presentation
Thomas Jones
Chief complaint:
Why cant I just take prednisone every
day? It always works when I get admitted
to the hospital.
History of Present
Illness:
Age: 66, unstable COPD
Past Medical History:
COPD 12 years, HTN 20
years, GERD 5 years, CAD
MI 5 years ago

Patient Presentation
Family History:
Mother: Died from emphysema at age 82.
Father: History of Coronary Artery
Disease.
Social History:
History of smoking: 35 Pack/Year. Quit 3
months ago, occasional relapse. Claims to
have not smoked for a week.
Alcohol consumption: 2 beers daily.
Lives with daughter.

Patient Presentation
Current
Medication
1. Metaprolol
tartrate 50 mg
BID
2. Salmeterol 50
mcg BID
3. Tiotropium 18
mcg daily
4. Lisinopril 20 mg
daily
5. Esomeprazole 20
mg daily
6. Albuterol 1-2
puffs PRN
7. Asprin 81 mg
daily

Patient Presentation
Review of systems:
SOB, Non-productive cough, Fatigue,
Exercise intolerance.

Physical examination:
Mild respiratory distress from walking
down the hallway.
Vital signs: BP 138/88, P 85, RR 26, T
37.5C; Wt 95 kg, Ht 5'11
Lungs: Tachypnea, prolonged
expiration, decreased breath sounds.
No clubbing, cyanosis, or edema.
All other results are normal.

Lab results

Interpretation of Lab Results:

Creatinine clearance = 88.76 mL/min Stage II CKD
Hemoglobin is low. (Normal: 13.5-17.5)
Hematocrit is low. (Normal: 38.8-50%)
Albumin is low. (Normal: 3.5-5)

Pulmonary function tests

Conclusion: Patients pulmonary function was

enhanced after the addition of tiotropium

Assessment
The patient has Stage III: Severe
COPD that is unstable.
Patient has grade III severe Dyspnea.
Patient does not have hypoxia and so
does not require oxygen therapy.
Patients COPD is uncontrolled due to
inadherance to instructions; He
continues to smoke, and is possibly
not using his inhalers correctly.

Drug-related Symptoms
The non-productive cough the
patient is experiencing is not a
symptom of COPD but a side effect of
Lisinopril, the ACE inhibitor he is
taking for his blood pressure.

Goals of Therapy
1. Prevention of
hospitalization, or
reduction of hospital stay.
2. Prevention of acute
respiratory failure, or
death.
3. Resolution of symptoms.
4. Return to a baseline
clinical status and quality
of life.
5. Prevention of development
of Cor Palmonale

Smoking Cessation
Smoking cessation is the first and most crucial intervention
that could slow the progression of COPD. Patients require
extensive education on the effect of smoking in their specific
cases. After that a suitable regimen is put in place to provide
the patient with assistance in his lifestyle change.
1. Smoking cessation aids:
. Nicotine-replacement therapies
. Bupropion
1. Smoking cessation clinics.

Nonl
a
c
i
g
o
l
o
c
a
Pharm

n
1. Smoking cessatio
nsion &
e
rt
e
p
y
(H
n
o
ti
c
u
d
re
2.Weight
GERD)
tion of
n
e
v
re
(P
n
o
ti
a
iz
n
u
3. Imm
n)
io
t
c
fe
in
y
b
n
o
ti
a
b
r
e
exac
(GERD)
n
o
ti
a
s
s
e
c
l
o
h
o
lc
A
.
4
cise)
r
e
x
(E
n
o
ti
a
it
il
b
a
h
5. Pulmonary re
6.Low fat diet (CAD)

Cindys Plan
l
a
c
i
g
o
l
o
c
a
Pharm
mg BID
0
5
e
t
a
r
t
r
a
t
l
lo
1. Metapro
BID
g
c
m
0
5
l
o
r
e
t
e
2. Salm
aily
d
g
c
m
8
1
m
iu
p
3. Tiotro
g
4. Losartan 50 m
ily
a
d
g
m
0
2
le
o
z
a
r
5. Esomep
s PRN
ff
u
p
-2
1
l
o
r
e
t
u
6. Alb
aily
d
g
m
1
8
in
r
p
s
A
.
7
daily
g
c
m
0
0
5
t
s
a
il
m
8. Roflu
r 3 days
fo
y
il
a
d
g
m
0
5
1
9. Bupropion
then twice
daily

Qaiss
Plan

Nonl
a
c
i
g
olo on:
c
a
m
Phar g Cessati

o ki n
m
S
1.
pion
ntal
e
m
Bupro
n
nviro ures to
E
r
e
h
xpos
E
2. Ot
:
s
r
and
e
Trigg ional dusts
at
occup
.
fumes ary
ude
l
n
c
o
n
i
m
l
:
3. Pu
ation breathing
t
i
l
i
b
ing,
Reha
n
i
a
ical
r
t
d
e
e
s
i
m
c
l
r
exe
ptima
o
,
s
cial
e
o
s
i
s
c
o
r
h
e
ex
psyc
,
t
n
e
treatm and health 2
rt,
suppo n. Minimum
tio
educa
s.
:
month e changes -24.9,
18.5
estyl
f
o
i
t
L
I
.
4
e BM
s
a
ke to
e
a
r
t
c
n
i
de
c
i
l
aily to
alcoho

Qaiss
Plan

l
a
c
i
g
acolo
e

trat
r
a
t
Pharm
l
prolo

et a
M
.
BID
1
o
p
g
mg
0
4
50 m
n
arta
s
i
m
l
2. Te
mc g
8
daily
1
m
u
i
p
o
r
ot
3. Ti ule
caps
rol/
e
t
ned
i
e
b
m
l
m
o
a
ne c
4. S
o
s
a
c
cg 2
m
Fluti
0
5
50/2
r
e
l
a
inh
aily
d
e
c
i
w
puffs t razole
mg
nsop
0
a
5
L
1
.
5
ion
p
o
r
he n
p
t
u
s
B
y
a
.
6
r3d
o
f
y
l
i
da
aily
d
e
c
i
tw
prn
l
o
r
e
but
l
A
mg
.
7
1
8
n
ri

Patient Education
The patient should
be educated in the
proper use of MDIs
to ensure the
maximal efficiency of
his regimen.

Monitoring
Pulmonary function test should be
repeated after 1 month to assess
improvement.
Blood gases should be monitored for
the development of hypoxia.
Hypertension: measure blood
pressure and pulse after 1 month.
Coronary artery disease: measure
cholesterol and triglycerides after 1
month.

Follow up
Dyspnea score and Quality of life
should be measured periodically.
Quality of life questionnaire:
1. Chronic Respiratory Questionnaire
(CRQ)
2. St. GeorgesRespiratory
Questionnaire (SGRQ)

Stay healthy, stay

alive.