Internal Medicine of the Respiratory System Lec.2 (COPD).pdf

Chronic obstructive pulmonary disease. COPD DR Tamer Abdullah Moqbel Internal medicine specialist. Chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease (COPD) is defined as a preventable and treatable disease characterized by persistent respiratory sy...

Chronic obstructive pulmonary disease. COPD DR Tamer Abdullah Moqbel Internal medicine specialist. Chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease (COPD) is defined as a preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases. COPD include : Chronic bronchitis. Emphysema. COPD. Chronic bronchitis is defined as cough and sputum for at least 3 consecutive months in each of 2 consecutive years. Emphysema is an abnormal permanent enlargement of the airspaces distal to the terminal bronchiole accompanied by destruction of there wall. Cigarette smoking represents the most significant risk factor for COPD and the risk of developing the condition relates to both the amount and duration of smoking. COPD It is unusual to develop COPD with less than 10 pack years (1 pack year=20 cigarettes daily per year) and not all smokers develop the condition, suggesting that individual susceptibility factors are important. COPD prevalence is directly related to the prevalence of risk factors in the community, such as tobacco smoking, coal dust exposure or the use of biomass fuels. Protease _antiprotease imbalance..congenital alph1 antitrypsin deficiency. COPD Exacerbations and comorbidities contribute to the overall severity in individual patients. Extrapulmonary effects include weight loss and skeletal muscle dysfunction.  Noxious or Airflow limitation Alpha1 antitrypsin with premature deficiency. airway closure Gas trapping and hyperinflation Affecting Diaphragmatic pulmonary Mechanical muscles disadvantage of and chest wall flattening. respiratory muscles compliance. Shortening of expiration Increase work of breathing  Emphysema may classified by the pattern of the enlarged airspace: Centriacinar. Panacinar. Paraseptal. Some individuals develop bullae; permanent air-filled spaces within the lung that are more than 1 cm in diameter. Clinical features: COPD should be suspected in any patient over 40 years old who presents with symptoms of chronic bronchitis and/or breathlessness. Cough and associated sputum production are usually the first symptoms, and are often referred to as a ‘smoker’s cough’. The level of breathlessness should be quantified for future reference, often by documenting what the patient can manage before stopping. Clinical features: ❖ Symptoms: Chronic cough. Sputum production. Breathlessness. ❖ Physical signs: Decrease intensity of breathing sounds. Rhonchi. Pitting edema due to salt and water and retention. Pursing lip. Barrel chest. Two classical phenotypes have been described: ‘pink puffers’ and ‘blue bloaters’. Investigations: Spirometry. (FEV1% or FEV1/FVC ratio) Lung volume measurement. (RV) (TLC) and RV/TLC ratio Diffusing capacity for carbon monoxide (Dlco). Exercise tests. 6-minutes walk test. CXR. Chest CT scan. All patients should be tested for alpha-1-antitrypsin deficiency. The diagnosis requires objective demonstration of airflow obstruction by spirometry and is established when the post- bronchodilator FEV1/FVC is