What is copd
Chronic obstructive pulmonary disease
What is the cause of copd
Copd is caused due to abnormal inflammatory response of the lungs to noxious particles are gases
What causes airflow limitation
Mixture of small airway disease and parenchymal destruction - bronchitis and emphysema
What are risk factors
-age 35+
-smoking
Environmental pollution
Genetic
occupaton exposure
frequent infection of airway
what are the symptoms of copd
- Progressive and exertional and breathless
- Chronic cough
- Sputum production
- Chest tightness and wheezing
- Frequent winter bronchitis
- Upper respiratory infection
- Pulmonary hyper tension
what are severe symptoms
- weight loss
ankle swelling
depression
anxiety
diagnosis
- Age is considered- patient is older than 35
- Risk factors - smoking
- Respiratory symptoms
Test airflow obstruction - spirometry test with bronchodilators
what is chronic bronchitis + bronchiolitis
what occurs?
Chronic bronchitis and bronchiolitis: inflammation of central airways (trachea/bronchi) and smaller airways (bronchioles)
- Hypertrophy and hyperplasia occur to the mucus-secreting glands and smooth muscle in smaller airways
- Small airways become obstructed by intraluminal mucus, mucosal oedema and airways wall fibrosis.
The obstruction and the mucus increase resistance to airflow and cause chronic viral and bacterial colonisation in the retained mucus.
- Small airways become obstructed by intraluminal mucus, mucosal oedema and airways wall fibrosis.
what is emphysema
- Persistent inflammation destroys alveoli at the end of small airway.
- Permanent enlargement of the air spaces distal to the terminal bronchiole accompanied by destruction of their walls.
- Destruction of the parenchyma decreases the area for gas exchange and lung elasticity
Hypertrophy of capillaries reduces ability to absorb oxygen and may increase blood pressure.
what is the pathogenesis of copd
- Inflammatory cell and mediators
○ Chronic inflammation
○ Neutrophils - producing proteinases and leukotrienes
○ Macrophages - producing cytokines and chemokines- Oxidative stress
- Reactive oxygen and nitrogen species
- Protease-antiprotease imbalance
Alpha 1 -antitrypsin deficit - enzyme increases activity and causes damage In the lungs
- Oxidative stress
non-pharmacological treatment
- offer treatment and help to Stop smoking
- Pneumococcal and influenza vaccinations
- Pulmonary rehabilitation
- personalised Self management plan
Treatment for comorbidities
what does m3 receptor do
m3 on airway smooth muscle cells and glands: mediate bronchoconstriction and mucus secretion
what does m1 receptor do?
- M1 receptors may mediate bronchodilation, by the release of a relaxing agent from respiratory epithelia or pulmonary nerves
what does m2 receptor do?
M2 autoreceptors, on post-ganglionic cholinergic nerves: provide negative feedback to reduce acetylcholine release
what does inhaled anticholingeric drugs do : mechanism
Blocks muscarinic acetylcholine receptors (M3) to cause bronchodilation and reduce mucus secretion
what are the side effects of Inhaled Anticholinergic drugs
- Common: Dry mouth, arrhythmias, cough, dizziness, headache, nausea
Uncommon: constipation, dysphonia, glaucoma, palpitation, skin reactions, stomatitis, urinary disorder, vision blurred.
what are the treatments
no asthmatic
LABA + LAMA
LABA+ LABA+ ICS
no improvement revert back
asthmatic features : LABA + ICS
LABA + LAMA + ICS
what are further treatment options
mucolytics - cough
phosphodiesterase - 4 - inhibitor
