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COPD is characterized by chronic cough, sputum production, and shortness of breath. A diagnosis is made based on spirometry showing reduced airflow. Treatment focuses on smoking cessation, bronchodilators to open airways, and managing infections and inflammation. The goals are improving symptoms and quality of life while preserving lung function and preventing exacerbations.
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Lecture about COPD and its management comprehensively
COPD is characterized by chronic cough, sputum production, and shortness of breath. A diagnosis is made based on spirometry showing reduced airflow. Treatment focuses on smoking cessation, bronchodilators to open airways, and managing infections and inflammation. The goals are improving symptoms and quality of life while preserving lung function and preventing exacerbations.
COPD is characterized by chronic cough, sputum production, and shortness of breath. A diagnosis is made based on spirometry showing reduced airflow. Treatment focuses on smoking cessation, bronchodilators to open airways, and managing infections and inflammation. The goals are improving symptoms and quality of life while preserving lung function and preventing exacerbations.
Symptoms and Signs • Cough, usually worse in the mornings and productive of a small amount of colorless sputum • Breathlessness: The most significant symptom, but usually does not occur until the sixth decade of life • Wheezing: May occur in some patients, particularly during exertion and exacerbations • Hyperinflation (barrel chest) • Wheezing – Frequently heard on forced and unforced expiration • Diffusely decreased breath sounds • Hyperresonance on percussion • Prolonged expiration (in severe disease) • Tachypnea and respiratory distress with simple activities • Use of accessory respiratory muscles and paradoxical indrawing of lower intercostal spaces (Hoover sign) • Cyanosis • Elevated jugular venous pulse (JVP) • Peripheral edema Certain characteristic : Chronic Bronchitis • Patients may be obese • Frequent cough and expectoration are typical • Use of accessory muscles of respiration is common • Coarse rhonchi and wheezing may be heard on auscultation • Patients may have signs of right heart failure (ie, cor pulmonale), such as edema and cyanosis Certaim characteristics: Emphysema • Patients may be very thin with a barrel chest • Patients typically have little or no cough or expectoration • Breathing may be assisted by pursed lips and use of accessory respiratory muscles; patients may adopt the tripod sitting position • The chest may be hyperresonant, and wheezing may be heard • Heart sounds are very distant Diagnosis • The formal diagnosis of COPD is made with spirometry; when the ratio of forced expiratory volume in 1 second over forced vital capacity (FEV1/FVC) is less than 70% • Severity – Stage I (mild): FEV1 80% or greater of predicted – Stage II (moderate): FEV1 50-79% of predicted – Stage III (severe): FEV1 30-49% of predicted – Stage IV (very severe): FEV1 less than 30% of predicted or FEV1 less than 50% and chronic respiratory failu • Chest radiograph : Emphysema – Flattening of the diaphragm – Increased retrosternal air space – A long, narrow heart shadow – Rapidly tapering vascular shadows accompanied by hyperlucency of the lungs – Radiographs in patients with chronic bronchitis show increased bronchovascular markings and cardiomegaly • Chest Radiograph : Bronchitis – Chronic bronchitis is associated with increased bronchovascular markings and cardiomegaly. Differential Diagnosis • CHF • Chronic asthma Treatment • The goal of COPD management is to improve a patient’s functional status and quality of life by preserving optimal lung function, improving symptoms, and preventing the recurrence of exacerbations. • Diet Inadequate nutritional status associated with low body weight in patients with COPD is associated with impaired pulmonary status, reduced diaphragmatic mass, lower exercise capacity, and higher mortality rates. • Smoking Cessation • Bronchodilator Bronchodilators are the backbone of any COPD treatment regimen. They work by dilating airways, thereby decreasing airflow resistance. This increases airflow and decreases dynamic hyperinflation. • Beta 2-agonist and cholinergic antagonist – Beta2-agonist bronchodilators activate specific B2- adrenergic receptors on the surface of smooth muscle cells, which increases intracellular cyclic adenosine monophosphate (cAMP) and smooth muscle relaxation. – Anticholinergic drugs compete with acetylcholine for postganglionic muscarinic receptors, thereby inhibiting cholinergically mediated bronchomotor tone, resulting in bronchodilation • Management of Inflammation – Steroid is effective in acute exacerbation – the use of oral steroids in persons with chronic stable COPD is widely discouraged, – inhaled corticosteroids should be used only in conjunction with a long-acting beta agonist. • Management of infection – In patients with COPD, chronic infection or colonization of the lower airways is common from S pneumoniae, H influenzae, and M catarrhalis. In patients with chronic severe airway obstruction, P aeruginosa infection may also be prevalent. – Empiric antimicrobial therapy is recommended in patients with an acute exacerbation – In a study by Daniels et al, the addition to doxycycline to corticosteroids was found to somewhat improve treatment for acute exacerbation of COPD (AECOPD). • Oxygen Therapy and Hypoxemia Thank You