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Chronic obstructive pulmonary disease (copd)
also known
as
COAD or COLD
Asthma
is reversibl Copd is irreversible
COPC
is chronic obstruction to airflow due to chronic bronchitisor
emphysema.
Obstruction is
not
relived
with bronchodilators
Chronic
bronchitis:
obstruction
happens
in the smaller
airways
defined as:excessive tracheobronchial
mucus production -> cause cough
thatexacerbat
for at least 3
month of the
year,
for more than 2 consecutive
years.
incidence: Middle-late adult life (70-
yr) Cough
and sputum.
Aetiology:
Cigarette
smoking
· Slugish
ciliary
movement
·
Smooth Ms Constriction broncho constriction
·
hypertrophy
of
secreting gland-
Mucus
·
proteolytic
enzyme
· inhibition of
the function of alveolar
macrophages
air
pollution
with
dust, smoke
and flames
ocupational hazards
Family
and genetic
factors
infection
exposure
to dampness,
fog
and Sudden
Change
in temp
Clinical
features:
Cough
with sputumnproduction
for
many years
late onsetof breathlessues
dyspnea
Some with
climat (winter season:withter
cough
or smoker
Cough, Morning Cough), cough
increases presentall round
the
year.
Sputure (mucoid and mucopurulent
more
in
morning
↓
mansp
secret
outerwther
or
green
secretions
sputum: blood Slaine
Chemophysis)
airways
fever
wheezing, tightness
inchest
vasoconstriction
of Ms.
Emphysema:
a distension of the
airspaces
distal
to
terminal
bronchiole (alveolar destruction)
gas
exchange
as space between alveoli and
capillary
dyspnea
inflamation -
proteas ->
elastic
fibers
damage
->
alveoli
enlarge
and
don'trecoil.
Ateiology:
·
smoking
alveolar
macrophages
accumulate around
terminal bronchioles and release
proteolytic
enzyme
(proteases
(infection -> proteas)
-these
enzymes
cause enzymatic
digestion
and destruction
of alveolar walls
·occupational exposure
·lack
of Alphal
antitrypsin
deficiency -
Genetic Common
babies don't
have
anti protease
3
types
of
emphysma:
Centrilobular (centriacinal
emphysma:
Central involument of
the acines
with
sparing
of
the
perionary
Panacinar
emphysema:
both central and
periphral portion
of aucinus involved
Paraseptal
emphysema:
where distension involves
only
the distal acinus
Clinical features:
·progressive
exertional breathlessnes
with minimal
cough
and mucoid sputum
·breathlessnes is insidious onset,
intially only
exertional,
gradually progressive
weakness,
weight
loss,
anorexia,
lethargy-stired
first
noenergy
.
bed
ridden-dyspnea,
can't exercise
kyphotic-flat
diaphragm
physical signs
(inspection, palpation)
-use of
accessory
Ms-
hands on
bed
Chronic bronchitis
usually
patient
is
overweight, jugular
distention to stablize
Arterial blood
gas analysis:
↓ Paoz
(hypoxemia)
and &
pacoc
(hypercarbial
Complication:
Treatment:
Mucoputulant relapses
-> Chronic bronchitis
therapy
Respiratory
faliure- ancord
types
lacka
MCoz -ventilation -
bronchodialalo
us
pulmonary
hypertension
and Rufaliure - Antibiotics
pulmonary
bullae ->
emphysma
-> pneumothorax secondary
Chronic bronchitis
Stimulans
Noninvasis the
airwaypress
ventilation
invasive
ventilation
Cessation of
smoking
avoidance
of
occupational exposure
- Lots
of vesicular
Markings
No shift
-lung
volume
to
surgery
flatdiaphragm S.RA
and
Dr
enlarg
-> cardio
megaly
hyperinflation
lung
transplanation
emphysema:
copd
alwayse
bilateral
Bullae
- tubular heart
Iflat diaphragm
So no markings vesicular
palpation:
trached Center
tective ferritus
t
hyper
resonance dair
vesicular breath
sounds
wheet, crackles
bronchophony
dimmed
Chest expansion
t
symetrical
clubbing
hy
poventilation
d
Resp
acidosis
