COPD

Chronic Obstructive Lung Disease

COPD

A set of lung diseases that limit air flow and

is not fully reversible.
– COPD patients report they are “hungry” for
air
– Usually progressive and is associated with
inflammation of the lungs as they respond to
noxious particles or gases
– Potentially preventable with proper
precautions and avoidance of precipitating
factors
– Symptomatic treatment is available
 Two Major Causes of COPD

Chronic Bronchitis is characterized by

– Chronic inflammation and excess mucus
production
– Presence of chronic productive cough

Emphysema is characterized by
– Damage to the small, sac-like units of the lung
that deliver oxygen into the lung and remove
the carbon dioxide
– Chronic cough
Normal versus Diseased Bronchi
Emphysema
 Epidemiology
 About 13.9% of the U.S. adult population (25+
years) have been diagnosed with COPD

– An estimated 15-19% of COPD cases are work-related

 24 million other adults have evidence of troubled

breathing, indicating COPD is under diagnosed by
up to 60%
COPD-A Major Cause of
Hospitalization & Death

COPD was the:

Leading cause of hospitalizations in the U.S.

in 2000

Fourth leading cause of death

 COPD in the Mining Industry

Studies show:
 An increased number of cases of chronic bronchitis in
coal & gold miners

 Long-term exposures to low levels of silica may lead to

the development of chronic bronchitis & emphysema

 Chronic exposure to coal dust, particularly high levels,

may lead to severe respiratory impairment (emphysema)

.
 Coal mining was at the top of a list of industries
with a significantly elevated death rate from
COPD

 Non-metal and metal mines were also in the top

5 industries for elevated COPD death rate

 Top 5 occupations for elevated COPD death rate

included:
– Helpers, mechanics and repairers

– Mining machine operators

Cause of COPD

Smoking is the primary risk factor

– Long-term smoking is responsible for 80-90 %
of cases
• Smoker, compared to non-smoker, is 10 times
more likely to die of COPD

Prolonged exposures to harmful particles

and gases from:
– Second-hand smoke,
– Industrial smoke,
– Chemical gases, vapors, mists & fumes
– Dusts from grains, minerals & other materials
Other Risk Factors for COPD

History of childhood respiratory

infections

Genetic makeup

Increasing age
Ways to prevent or slow the
progression of COPD

 Stop smoking, if you smoke, to prevent further

damage to your body
– Smoking cessation is critical for all severities of COPD

 Avoid or protect yourself from exposures to

– Second-hand smoke
and
– Other substances such as chemical vapors,
fumes, mists, dusts, and diesel exhaust fumes
that irritate your lungs
 COPD Treatment

 COPD can be managed, but not cured

 Treatment is different for each individual and is

based on severity of the symptoms
 Early diagnosis and treatment can
– Slow progress of the disease
– Relieve symptoms
– Improve an individual’s ability to stay active
– Prevent and treat complications
– Improve quality of life
Medications used to
treat symptoms
Bronchodilators –
• Relaxes muscles around airways

Steroids
• Reduces inflammation

Oxygen therapy
• Helps with shortness of breath
Medications used
to prevent complications
Annual flu vaccine
– Reduces risk of flu and its complications

Pneumonia vaccine
– Reduces risk of common cause of pneumonia
COPD
 COPD

A disorder characterized by an impaired

mucuciliary transport, bronchial lumen
narrowing and parenchymal tissue
destruction leading to an increase in
retention of pulmonary system
Decrease ERV and VC, increase RV
 COPD

 Peripheral airway diseases

– Characterized by an inflammation, fibrosis and
narrowing of the terminal and respiratory
bronchioles
– Associated with long term exposure to pulmonary
irritants, primarily cigarette smoking
– Patient experiences little or no signs or symptoms
– Inflammation and structural changes can be
reduced or reversed by cessation of smoking
– This is sometimes classified as a precursor to
rather than a component of COPD
 COPD

 Chronic bronchitis
– Inflammation in the bronchi that causes an
irritating and productive cough that lasts for at
leasts 3 months for 2 consecutive years
– Develops in heavy smokers and to a lesser extent,
occupational exposure to vegetable and metal
dusts and environmental pollution
– Pathologic changes:
• Increase in mucus-porducing goblet cells
• Decrease in the number and action of ciliated epithelial
cells
• Narrowing of airways
 COPD
 Chronic bronchitis
– General appearance
• Presence of chronic productive cough – hallmark
• Cyanotic
• Shortness of breath
• Blue bloaters
• Edematous
• Overweight
• Recurrent respiratory tract infection
– Decrease in VC, normal RV if (-) emphysema
– Arterial blood gas
• Decrease PO2
• Respiratory acidosis – increase CO2 in the lungs
– Complications: emphysema and cor pulmonale
 COPD

Emphysema
– A chronic inflammation, narrowing, thickening
and destruction of the respiratory bronchioles
and alveoli wherein the alveoli loses its elastic
recoil
– Usually a condition that develops secondary to
peripheral airway disease and chronic
bronchitis (occurs in smokers)
– May also be a primary auto-immune disease
secondary to a deficiency of the enzyme
antitrypsin (occurs in non-smokers)
 COPD

Emphysema
– Types of emphysema
• Centriacinar
• Panacinar
• Distal acinar
 COPD
 Emphysema
– General appearance
• Chronic labored breathing
• Attacks of shortness of breath
• Supraclavicular or intercostal retractions
• Pink-puffers
• Abnormal posture
• Clubbing of the fingers
• Hypertrophy of accessory muscles
• Use of pursed-lip breathing during expiration
• Barrel chest
• Diminished breath sounds
 COPD
 Asthma
– A disease characterized by hyper sensitivity and
reactivity of the trachea and bronchi to various stimuli
which leads to bronchospasm and increase in the
production of mucus
– Seen in younger generations
– Predisposing factors
• Allergens
• Pharmacoligical stimuli
• Environmental air pollution
• Occupational factors
• Emotional factors
• Level of activity
• Infection
 COPD

Asthma
– Types of asthma
• Atopic asthma
• Non-atopic asthma
• Drug induced asthma
• Occupational asthma
 COPD

 Asthma
– Triad of asthma
• Dyspnea
• Wheezes
• Cough
– General appearance
• Often thin
• Chronically fatigue
• Poor posture
• Abnormal breathing pattern
• Severe attacks of shortens of breath
 COPD

Bronchiectasis
– Permanent dilatation of the medium-sized
bronchioles (4th-9th generation)
– Usually occurs in childhood and may be caused
by a previous, necrotizing infection
– Accumulation of purulent secretions
– Productive cough
– Dyspnea
– Hemoptosis
 COPD

Bronchiectasis
– Infection of the medium size bronchioles 
inflammatory reactions  exudate response of
mucus secreting glands  accumulation of
secretions  obstruction of distal airways 
dilation of bronchus proximal to the
obstruction; distal to it would cause atelectasis
 decrease expiratory airflow  retention 
of secretions  recurrence of infection
 COPD
 Cystic fibrosis
– A genetically based disease (autosomal recessive)
that involves malfunction of the exocrine glands
leading to abnormal secretions of the body
– High concentration of Na and Cl in the sweat
– Diffuse lung disease
– Malfunction if the pancreas
– Increased production of viscous mucus
– Periodic pulmonary infection
– Managed throughout life with diet, pancreatic
enzyme replacement, medication and preventive
chest PT
 COPD

Cystic fibrosis
– General appearance
• Barrel-chested – due to hyperinflation
• Lethargic
• Anorexic
• Cyanotic if hypoxemia is severe
• Chronic cough
• Labored breathing
• Decrease exercise capacity and endurance