Transcript Document
Definition of COPD COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. Inflammation in INFLAMMATION IN COPD COPD Small airway disease Parenchymal destruction Airway inflammation Airway remodeling Loss of alveolar attachments Decrease of elastic recoil AIRFLOW LIMITATION Pathogenesis of COPD Noxious particles and gases Host factors Lung inflammation Anti -oxidants Oxidative stress Anti -proteinases Proteinases Repair mechanisms COPD pathology Diagnosis of COPD EXPOSURE TO RISK FACTORS SYMPTOMS cough sputum dyspnea tobacco occupation indoor/outdoor pollution SPIROMETRY Spirometry: Normal and Patients with COPD Spirometry “How-To” Resources from GOLD Spirometry Guide Spirometry Quick Guide Spirometry Teaching Slide Set To help health care professionals understand how to perform & evaluate spirometry. All resources available at www.goldcopd.org. Classification of COPD Severity by Spirometry Stage I: Mild FEV1/FVC < 0.70 FEV1 > 80% predicted Stage II: Moderate FEV1/FVC < 0.70 50% < FEV1 < 80% predicted Stage III: Severe FEV1/FVC < 0.70 30% < FEV1 < 50% predicted Stage IV: Very Severe FEV1/FVC < 0.70 FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure Therapy at Each Stage of COPD I: Mild II: Moderate III: Severe IV: Very Severe • FEV1/FVC < 70% • FEV1/FVC < 70% • FEV1 > 80% predicted • FEV1/FVC < 70% • FEV1/FVC < 70% • 50% < FEV1 < 80% predicted • 30% < FEV1 < 50% predicted • FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure Active reduction of risk factor(s); influenza vaccination Add short-acting bronchodilator (when needed) Add regular treatment with one or more long-acting bronchodilators (when needed); Add rehabilitation Add inhaled glucocorticosteroids if repeated exacerbations Add long term oxygen if chronic respiratory failure. Consider surgical treatments Differential Diagnosis: COPD and Asthma COPD ASTHMA • Onset in mid-life • Onset early in life (often childhood) • Symptoms slowly progressive • Symptoms vary from day to day • Long smoking history • Symptoms at night/early morning • Dyspnea during exercise • Allergy, rhinitis, and/or eczema also • Largely irreversible airflow limitation present • Family history of asthma • Largely reversible airflow limitation COPD and Co-morbid Conditions Common co-morbid conditions in COPD patients: Cardiovascular disease Lung cancer Osteoporosis Musculoskeletal disorders Depression/anxiety Obesity/type II diabetes Physicians should identify and treat co-morbid conditions that impact on the clinical course of COPD. Smoking prevention and cessation, weight control, exercise, and rehabilitation have the potential to beneficially affect COPD and co-morbid conditions. Preventing COPD Exacerbations Prevent respiratory infections: pneumococcal vaccine, annual influenza vaccine. Avoid air pollution: remain indoors and close windows on bad air pollution days. Quit smoking and avoid exposure to secondhand smoke. Understand medication regimen and proper inhaler use. Patients with severe COPD and repeated exacerbations (3 or more in a year): use inhaled glucocorticosteroids. Recognize and respond to early signs of exacerbations to minimize impact when exacerbations do occur. Risk Factors for COPD Genes Oxidative stress Exposure to particles Gender ● Tobacco smoke Age ● Occupational dusts, organic and inorganic Respiratory infections ● Indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings ● Outdoor air pollution Lung growth and development Socioeconomic status Nutrition Comorbidities Brief Strategies to Help the Patient Willing to Quit Smoking • ASK visit. • ADVISE Systematically identify all tobacco users at every • ASSIST Strongly urge all tobacco users to quit. Determine willingness to make a quit attempt. Aid the patient in quitting. • ARRANGE Schedule follow-up contact. • ASSESS Anatomy of the Lower Respiratory System Trachea Main bronchi Left Right Bronchioles Acinus Bronchus rigid because of C-shaped cartilage rings Alveolus Acinus Capillary Attenuated epithelium Alveolar space Alveolus Capillaries Anatomy of the Airways Trachea and major bronchi Bronchioles Smooth muscle Connective tissue Cartilage Mucous membrane Airway mucous membrane Mucus Cilia Secretory cells Ciliated cells Basal membrane Submucosa Epithelium