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COPD update .ppt
1. Acute tracheobronchitis
• Etiology:
– Viruses
• Influenza A & B, para influenza
• Respiratory syncytial virus
• Adenovirus & Rhinovirus
• Acute & chronic bronchitis, dusts, chemical irritants
• Weakness
– Chronic sinusitis and Rhinitis
2. Pathology and Pathophysiology
• Congestion of mucus membrane, edema,
leukocytes cause sputum production
• Cilia, Phagocyte & Lymphocyte are disturbed
• Bactries attack normal bronchus and mucopurulent
exudate and necrotic cell collections
• Bronchospasm
– Dueto edema and mucus secreation
3. Clinical finding
• First day
• Retrosternal irritation
• Weakness and sweat
• Cough
– Dry and worse, later with sputum
• Fever 38.5-39.5c 3-5 days
• Dyspnea
– Airway obstruction
• Tachypnea
4. Physical exam
• Inspection, Palpation & Percussion are normal
• Auscultation:
– Ronchi
– Sometime crickles
– One side local finding (Bronchopneumonia)
13. COPD
• Definition:
• COPD = COLD
– Chronic bronchitis
– Emphysema
– Small airway disease
• 4th leading cause of death
• 10 million people in the USA
14. Types of COPD
• Type A COPD = emphysemia.
• Type B COPD = chronic bronchitis.
• Predominanat chronic bronchitis.
• Predominant emphysemia.
15.
16. Chronic bronchitis
• Definition:
– Chronic inflammation of the bronchus
– 2 years, 3 months/a year cough & sputum
– types. Of chronic bronchitis.
17. • Age over 35 years, current or ex
smokers plus at least one of the
following:
1.Breathlessness
2.Cough
3.Sputum
4.Wheezing
5.Winter bronchitis
18.
19.
20.
21. Risk factors:
– Cigarette smoking
– Airway reaction
– Respiratory system infection
– Occupation
– Air pollution
– Second hand smoking
– Genetic considerations
22. • Smoking :
Decline of FEV1 proportional to smoking.
Pack- year = packs of cigarette used in a day
multiply by years of smoking.
Effects of smoking :
1.Hyperplasia of mucus glands.
2.Hypomotility of cillia.
3.Reduced alveolar macrophage activity.
4.Muscular spasm .
23. • Airways reaction :
Character of asthma.
Also seen in COPD.
Dutch theory ( asthma , ch bronchitis ,
emphysemia are variant of the same
pathologic process).
British theory ( COPD and asthma are
different , asthma is mainly allergic process,
COPD results from damage and
inflammation due to smoking)
24. • Air pollution ( indoor , outdoor).
• Passive smoking ( children exposure to
smoke of cigarette decreases lung maturity ,
smoking during pregnancy decreases lung
function of children after delivery).
26. Cout…
• mucusal edema .
• Smooth muscle thickening.
• Bronchial fibrosis.
• These change cause airflow limitation.
27.
28.
29.
30.
31. Clinical finding
• Symptoms:
– Cough
– Sputum (mucoid , mucopurulent)
– Chest tightness(morning due to secretion
accumulation).
– Hand grip physical exercise decrease
– Dyspnea
• Bronchospasm & expectoration
– Headache & Fever
– Right side failure
• Lower limb edema
32.
33. • Sign:
– Smokers
– Blue bloaters
• Cyanosis & edema
• Weight loss
– Temporal & loss of subcutaneous lipid
» ↓ nuitrition
» Increased TNF-α
34.
35. • Inspection:
– Paradoxical inwards movements (Hoover's Sign)
• Palpation:
– Normal, suprasternal notch more than 3 fingers
• Percussion:
– If combined with emphysema hyper resonance
• Auscultation:
– Coarse crepitation & Ronchi, FET more than 6 seconds
• Corpulmonale
36.
37.
38.
39. CHEST X-RAY
– Diaphragm is normal
– Broncho vascular marking increased
– Right failure
• Pul. Artery promenent
• Cardiomegaly
40.
41.
42. Pulmonary function tests
• FEV1 & vital capacity decreased
• Total Lung Capacity & Residual Volume &
• RV/TLC increased
• Hypoxemia & Hypercapnea
• FEV1/FVC less than 70%
• Reversibility test: done after salbutamol
inhalation or 2 weeks course of 30 mg
prednisolone per day. An increase of 400ml or
greater in FEV1 indicates reversible
bronchospasm( asthma)
66. • Corticosteroid
– Asthmatic bronchitis
– Recurrent exacerbation or sever symptoms
– Resistant to bronchodilators
– Prednisolone 30mg/day trial :
• Before and 2-4 weaks after steroid therapy
spirometric evaluation to determine steroid
responsive COPD( 15-20% increase in FEV1 after
prednisolone trial).
67. • Antibiotics
– Acute exacerbation
– Acute bronchitis
– Prophylaxis of exacerbation
– 7-10 days from the folllowing antibiotics:
1:, amoxicillin –clavulanic acid
2:macroloides( azithromycin…)
3: fluroquinolones (levofloxacin…)
4:doxycyclin 100mg BID.
68. • Others therapies : fluid , steam inhalation , no
role to expectorant . Avoide sedatives.
69. Hospitalized patient
– Indication for hospitalization:
• Not responsive with outpatient treatment
• Acute Respiratory failure
• CPC (Corpulmonal)
• Pneumothorax
• Exacerbation of COPD( worsening dyspenia
,increased sputum purulence and volume) when
here are one of the following:
1. Cyanosis
2. So2 less than 90%
3. Ph less than 7,35
4. Po2 less than 7 KP
5. Worsening oedema
6. Acute confusion
70. Mx of exacerbation
• Short acting bronchodilators
• Oral corticosteroides( prednisolone 30
mg per day for 5 days)
• Antibiotics
• Supplemental oxygen therapy
• IV aminophylline NOT contraindicated,
no response with nebulizers
• Doxapram( res stimulant) in NIV not
available
• NIV; for hypercapnic repiratory failure
77. Emphysema
• Definition:
– Is characterized by destruction of alveolar
walls and permanent dilatation of gas-
exchanging air spaces(alveoli and terminal
bronchioles)
83. Pathology
• Centro acinar emphysyma
– Distention and destruction in resp
Bronchiole & alveolar duct
– Less destruction in alveoli
– due to smoking
– Upper lob & upper segment of lower
lob
84. Pathology
• Pan acinus emphysema
– Distention and destruction in alveoli
– due to α1- antitrypsin deficiency
– Lower lob
• α1- antitrypsin is anti-elastase
• Elastase and anti-elastase
imbalance
85.
86. Etiology
• Predisposing cause:(like chronic
bronchits)
– Old age , male prominent
– Air pollution, Smoking, occupation, genetic
and familial factors
– α1- antitrypsin
• 250mg/dl
• ZZ/SS homozygous = 0-50mg/dl
87. Etiology
• Stimulus cause:
– Obstructive disease of bronchioles‘
• Due to mucus aggregation & inflammation or allergy
– Bronchospasm
– Chronic bronchitis
– Pneumonia
– They cause easy air enterance but difficult air
exspulsion ( increased intra-alveolar pressure)
• Terminal bronchioles in ch bronchitis
– Valves structure easy air goes inside (inspiration) & difficult air
out (expiration), cause distention and destruction of alveolus
92. Chest-X-Ray
• Hyperinflation of chest includes
the following
• Diaphragm is flate
• Wide intercostal space , parallel ribs
• Hypertranslucency
• bullae
• Due to decrease perfusion
– Absence of peripheral vascular
• Small and vertical heart
93.
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95.
96. Dx
• History
• Sign and symptoms
• DDx:
– Bronchial asthma (episodes of
dyspenea and wheezing).
– Congestive heart failure
– Chronic bronchitis