Define COPD.
COPD is a common, treatable and preventable disease that is characterised 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 gas.
OR; “Chronic obstructive pulmonary disease (COPD) is a general term which covers many previously used clinical labels that are now recognised as being different aspects of the same problem.”
Describe the pathology COPD.
Inflammation (in response to inhalation of an irritant) of the;
- airways
- lung parenchyma
- pulmonary vasculature
What are the 3 pathologies that are classed under COPD?
- Chronic bronchitis
- Emphysema
- Asthma
What is Chronic Bronchitis?
- Inflammation of the Bronchi.
- The presence of a cough productive of sputum for 3 months or more in at least 2 consecutive years.
What is Emphysema?
- The abnormal and permanent enlargement of gas exchange airways, with destruction of the alveolar walls.
Airflow obstruction is a key feature of COPD, it is usually progressive and not fully reversible.
What is the Pathophysiology?
- Airflow obstruction (reduced FEV1) leading to hyperinflation.
- Mucus hypersecretion
- Reduced lung recoil
- Reduced gas exchange interface.
What leads to Airflow obstruction?
Due to inflammation, presence of secretions and reduced lung recoil.
What is Hyperinflation?
- Reduced length of the diaphragm.
- Reduced force generating capacity of the diaphragm.
- flattened diaphragm
- increased use of accessory muscles.
What causes a reduction in gas exchange interface.
V/Q mismatch; Hypoxia
- polycythaemia (making more red blood cells = blood becomes thicker); in response to hypoxia.
- increased pulmonary vascular resistance
Cor pulmonale; (R) heart failure to pulmonary disease
- loss of capillary bed (emphysema in late disease)
what is a V/Q mismatch?
What a V/Q mismatch means. A V/Q mismatch happens when part of your lung receives oxygen without blood flow or blood flow without oxygen. This happens if you have an obstructed airway, such as when you’re choking, or if you have an obstructed blood vessel, such as a blood clot in your lung.
What are the aetiologies of COPD?
- Cigarette smoking
- Bronchial hyperresponsiveness
- Pollution
- alpha 1 antitrypsin deficiency.
What are the effects of smoking on the lungs?
There’s a lot of answers :(
- Inflammation of terminal and respiratory bronchioles
- Inflammation of the bronchial & bronchiolar epithelium
- Submucosal gland hypertrophy
- Goblet cell hyperplasia
- Airway narrowing
- Phagocytic cells and debris in mucus, so viscosity of sputum increases
- Depressed cilia action.
- Sputum retention.
- Destruction of alveolar wall due to loss of elastic tissue
- Loss of elastic recoil
- Bullae & Dead space.
- Depresses immunity
- Inhibition of alveolar macrophage activity
- Reduced cilia action
- Greater risk of infection
What population and symptoms should make you consider diagnosing someone of COPD?
“A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with one or more of the following symptoms;
- Exertional breathlessness
- Chronic cough
- Regular sputum production
- Frequent winter ‘bronchitis’
- Wheeze”
How would you measure to diagnose a person with COPD
- FEV1
- FEV1/FVC
Outline the COPD assessment test (CAT)
- Patient completed quality of life instrument
Developed as HRQL measures time consuming and sometimes require licences - 8 questions covering impact of symptoms
- CAT scores 0-10 (mild clinical impact), 11-20 (moderate CI), 21-30 (severe CI), 31-40 (very severe CI).
Outline the Mild, Moderate and Severe symptoms of COPD.
- Mild; Asymptomatic, morning cough, SOB on minimal exertion, Unknown to GP.
- Moderate; Cough, Discoloured sputum, SOB +/- wheeze, Known to GP.
- Severe; SOB on minimal exertion, Wheeze, Cough, Peripheral oedema, Cyanosis, Well known to GP & hospital.
What are the clinical features of COPD?
- Chronic cough and/or increased sputum production.
- Accessory muscle activity
- Hyperinflation (increased a-p diameter)
- Breathlessness on exertion
- Exercise limitation
- Hypoxia
- Hypercapnia
What are the aims of treatment for COPD?
- Prevent disease progression
- Reduce symptoms
Improve exercise tolerance - Improve health status
- Prevent and treat exacerbations
- Prevent mortality
- Improve quality of life
AND MVP QUIT SMOKING
As it’s the only intervention which will reduce the accelerated decline in FEV1 at all stages of the disease.
What pharmacological therapy is available for COPD?
- Bronchodilators
- Corticosteroids
- Vaccination?
- Long term oxygen therapy (15 hours a day)
What things can help COPD patients?
- Nutrition (for obese or malnutrition patients)
- Surgery (Lung transplant, Lung volume reduction)
- Pulmonary rehabilitation
A multidisciplinary programme of care for patients with chronic respiratory impairment that it is individually tailored and designed to optimise each patient’s physical and social performance and autonomy.
Involves; exercise, education and psychosocial support. - Other (Psychologist, support groups, referral to respiratory specialist physician).
What treatment options are there for COPD
- Oxygen therapy
- Bronchodilators
- Antibiotics
- Steroids
- Diuretics
- Physiotherapy
- NIV
What can physio’s do for COPD patients (treatment)
- Sputum clearance
- Maintenance or increase of exercise tolerance
- Positioning
- Re-educate breathing pattern
- Education
- Managing of breathlessness.
What are the discharge plans for COPD patients?
- Aim to maximise independence
- Avoid readmissions
- Medication review
- Social set up
- Outpatient FU
- Early discharge schemes – management at home
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Induction25
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COPD23
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Assesment of COPD patients27
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Lung volumes, Dead space and pulmonary pressures31
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Lung Mechanics38
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Diffusion and Carriage of Gases pt133
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Diffusion and Carriage of Gases pt241
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Factors contributing to breathlessness and it's management24
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Ventilation - Perfusion mismatching, factors affecting blood gases31
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Control of Breathing34
