CHRONIC OBSTRUCTIVE

PULMONARY DISEASE (COPD)

DEFINITION
It is defined as the airflow limitation that is not fully
reversible characterized by the airflow obstruction resulting
from Chronic Bronchitis or Emphysema

INCIDENCE
The prevalence rate of COPD in Indian males is 5% and
in women 2.7%, male to female ratio being 1.6:1

ETIOLOGY
SMOKIN
G

AIR
POLLU
TION

SECON
D
HAND
SMOK
ER

HERIDI
TY

CHILDH
OOD
RTI

OCCUPA
TION
EXPOSU
RE

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS

Chronic cough
Sputum production
Shortness of breath
Lack of energy
Dyspnea
Dry mouth
Weight loss
Feeling nervous
Barrel chest
Difficulty sleeping
Loss of lung elasticity
Slower expiration
Hypoxemia
Wheezing on forced expiration
Hyperinflation
Breath sounds decreased
Prolonged expiration
Coarse crackles sound at lung base
Distant heart sounds
Respiratory tract infections

DIAGNOSTIC FEATURES

History collection any kind respiratory diseases, family history

any bad Habits, any triggering factors.
Physical examination On Inspection engorged neck veins. On
Palpation pulse rate, respiratory rate is increased. Any cyanosis,
assessment of sputum characteristics, breathing sounds,
peripheral edema.
Chest X-Ray Shows low, flat diaphragm, increased Anterior
Posterior diameter of thorax and over distension of lungs.
Arterial Blood Gas (ABG) Analysis Shows mild to moderate
hypoxemia without hypercapnea.
Sputum & Hematology Gram stain, culture and sensitivity test
to detect the bacterial growths.
Pulmonary Function Tests (Spirometery) The FEV1 / FVC ratio
is less than 70%.

1.

MEDICAL
MANAGEMENT
Broncho-dilators:
It will relieve bronchospasm by altering smooth muscle tone and

reduce airway obstruction by allowing increased oxygen distribution.

GROUP

DRUG NAME

DOSE

ROUTE

Beta2-

Salbutamol

2-3 puffs every 4-8

Adrenergic

Albuterol

hrs/day

Inhalation

Agonist

Salmeterol

2-3 puffs every 2

hrs/day

Antichollinergi

Ipratropium

2 puffs every 4

cs

Bromide

hrs/day

Aminophylline

Methyxanthin

Theophylline

As per physician

Intraveno

order

us

es

Inhalation

MEDICAL MANAGEMENT
2. Corticosteroids:
It shortens the recovery times, improves the lung function
and reduces the hypoxemia. A short trial course is only used and
it is usually combined with Beta2 Agonist (Corticosteroids +
Beta2 Agonist) such as Formoterol, Salmeterol.
3. Mucolytics:
It is used to reduce the mucus production or enhance the
elimination of mucus in patients with COPD.

MEDICAL MANAGEMENT
4. Antibiotics:
Usually low-cost broad spectrum antibitoics are preferred to
reduce the episodes of infection process. But it is not routinely
recommended for COPD patients.
5. Alpha 1 Antitrypsin (AAT):
IV infusion of AAT can be given weekly or biweekly basis.

MEDICAL MANAGEMENT
6. Oxygen Therapy:
Oxygen therapy can be administered (15 Hrs/Day) as long
term continuous therapy to prevent the acute dyspnea. Oxygen
by nasal cannula should increase Partial Arterial Pressure of
Oxygen (PaO2 > 60 mm Hg) and Arterial Oxygen Saturation
(SaO2 > 90%).

MEDICAL MANAGEMENT
7. Vaccination:
Pneumococcal

and

influenza

vaccination

are

recommended for all the patients with COPD at the earlier stage
to reduce the symptoms.

MEDICAL MANAGEMENT
STAGES

FEV1

FEV1 / FVC

S/S

DRUGS

>80%

<70%

With / without symptoms

of cough & sputum
production

SABD

II

<50-80%

<70%

Shortness of breath

SABD &
LABD

(Moderate)
III
(Severe)

<30-50%

<70%

Shortness of breath,
reduced exercise capacity,
repeated excerbations

BD & glucocarticoids

IV

<30-50%

<70%

Signs & symptoms of

chronic respiratory
failure

BD & glucocarticoids

I
(Mild)

(Very
severe)

SURGICAL MANAGEMENT
1.

Bullectomy:
Bullae are enlarged airspaces that dont contribute to

ventilation, but occupy space in thorax. These areas are

surgically excised procedure called as Bullectomy. It can be
done by

Video Assisted Thorascope or by limited

thoracotomy incision.

SURGICAL MANAGEMENT
2. Lung Volume Reduction Surgery (LVRS):
It involves the removal of a portion of the diseased lung
parenchyma, so that the patients chest wall and diaphragm can
return to normal positions and thereby easing breathing. It can
be done by either Mediastinoscopy or Video Assisted
Thorascopic surgery.

SURGICAL MANAGEMENT
3. Lung Transplantation:
It can be performed for the patient under 65 yrs of age
with an FEV1 below 30% without an evidence of pulmonary
hypertension. Long term services is patient undergo bilateral
lung transplantation rather than single lung. Infection is the
most significant complication.