Pathology
• Emphysema • Inflammation affecting the alveoli. • Scar tissue formation following inflammatory
process • Destruction of alveolar walls. • Reduction in surface area for gas exchange. • Damaged membrane for gas transfer • Scar tissue leads to restriction and reduced
COPD
Shane O’Reilly COPD Service Clinical Lead
What is COPD
• Chronic Obstructive Pulmonary Disease is an umbrella term used to describe different conditions that have similar symptoms and causes.
– Inflammation – Bronchoconstriction – Phlegm
Pathology
• Irritation of the airways causes inflammatory response.
• Smoking causes elastase to be released from the inflammatory mediators.
Chronic productive cough
Breathlessness
Night time waking with breathlessness
and or wheeze Significant diurnal or day to day variability
of symptoms
COPD Nearly All
Stopping smoking at any age has beneficial effects on the lung function of patients with COPD.
Srivastava P et al. BMJ 2006;332:1324-1326
©2006 by British Medical Journal Publishing Group
Rare Common Persistent and progressive Uncommon
Uncommon
Asthmቤተ መጻሕፍቲ ባይዱ Possible
Often Uncommon
Variable Common
Common
Spirometry
• FEV1 – Forced Expiratory Volume in one second
• Shortness of breath • Cough • Phlegm • Chest infections • Reduction in exercise tolerance • Weight gain or loss • Cor pulmonale
Treatment
• Smoking Cessation • Pharmacology • Oxygen • Pulmonary Rehabilitation • Self management advice and education • NIV
and corticosteroid
Inhaled Therapy
• Short acting Beta 2 agonist • Short acting Anticholonergic • Long acting Beta 2 agonist • Long acting Anticholonergic • Combination long acting Beta 2 agonist
• Elastase starts to break down the elastic nature of the airways.
• It is the continual nature of the irritation that causes the long term inflammation and damage to the airways
• The two main conditions under the umbrella are chronic bronchitis and emphysema.
COPD
• Obstructive – Main cause of breathlessness. 3 components to obstruction
• FVC – Forced Vital Capacity • FEV1/FVC Ratio Below 70% for
obstruction • NICE
– >80% Mild – 50 – 80% Moderate – 30 - 50% Severe – <30% Very Severe
Clinical Features
Pathology
• Chronic Bronchitis • Affects the bronchioles. • Irritation causes chronic inflammation. • Reduction in size of lumen • Increased airflow resistance • Increased number of goblet cells • Less compliant lungs • Greater effort to breathe
lung compliance
Diagnosis
• History
– Age – Smoking – Cough – Phlegm – Short of Breath
• Spirometry
COPD and Asthma
Smoker or exsmoker
Symptoms under age 45