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COPD AS Systemic disease

COPD AS Systemic disease. BY Dr/Sami EL-Dahdouh (MD) Lecturer of Pulmonary & Critical care Faculty of Medicine, Menofia University. PATHOGENSIS. Release of mediators & cytokines e.g. IL6, TNF alpha. hypoxemia and its effect on tissues. oxidative stress.

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COPD AS Systemic disease

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  1. COPD AS Systemic disease BY Dr/Sami EL-Dahdouh (MD) Lecturer of Pulmonary & Critical care Faculty of Medicine, Menofia University

  2. PATHOGENSIS Release of mediators & cytokines e.g. IL6, TNF alpha. hypoxemia and its effect on tissues. oxidative stress. increase acute phase proteins.

  3. Manifestations Wt loss and muscle wasting. Endocrinal manifestations. Effect on other systems as heart, GIT, Neuro- psychiatry, sleep disorders, kidney.

  4. Wt loss & Muscle Weakness Is due to 1-imbalance between increase catabolism (TNF alpha, IL1&6) and decrease anabolic hormones( GH, Insulin & Testerone). 2-Decrease caloric intake due to dyspnea, anorexia and GIT disturbances. Wt loss & muscle weakness lead to impaired excises intolerance & poor outcome of the patients . This is demonstrated by BODE index.

  5. The BODE Index Predicts survival based on Body mass index (< 21 is associated with greater mortality) FEV1 (airflow obstruction) Degree of dyspnea (MRC grade) Capacity for exercise (6-minute walk distance) Can Fam Physician 2008;54:706-11

  6. The BODE Index ScorePoints Used To Calculate Can Fam Physician 2008;54:706-11

  7. Medical Research Council dyspnoea scale GradeDegree of breathlessness related to activities 0 Not troubled by breathlessness except on strenuous exercise 1Short of breath when hurrying or walking up a slight hill 2 Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace 3Stops for breath after walking about 100m or after a few minutes on level ground 4Too breathless to leave the house, or breathless when dressing or undressing

  8. If score more than 7 associated with 30% mortality in 2 years. If score 5-6 associated with 15% mortality in 2 years. If less than 5 associated with less than 10% mortality in 2 years.

  9. Endocrinal manifestations 1- Hypogonadism & impotence due to hypoxemia, steroid used, increase s. leptin & decrease s. testerone. 2- Salt &water retention is due to increase renin –angiotensin system. vasopressin. increase ADH. Hypercapnia ++CAE salt and water retention.

  10. 3- Osteoporosis is due to: mal nutrition, Steroid use, Hypoxemia increase renal exertion of ca+2 and Acidosis decrease absorption of ca +2.

  11. Other system affections CVS: cor pulomnale, lt sided dystolic dysfunction, IHD. GIT: -Reflux oesphgitis due tohypoxemia. Hypercapnia, hyperinflation, also coughing lead to increase in intra abdominal pressure. - Peptic ulcer effect of hypoxia and hypercapnia and effect of drugs.

  12. Sleep disturbances is due to Hypoxemia, Nocturnal bronchospasm, Drugs as theophylline, Anxiety , depression & Sleep apnea syndromes may be associated with COPD (overlap syndrome), or complication of sever air flow obstruction.

  13. Neuro- psychiatric disorders in the form of depression psychosis anxiety panic disorders.

  14. Treatment Nutritional problems - high fat diet ( increase caloric intake) - decrease CHO intake. - give anabolic hormone. - give appetizer e.g. megastrol.

  15. O2 therapy. Antioxidants. Anti mediators asTNF alpha antagonist. Rehabilitation. All COPD patients benefit from exercise training programs, improving with respect to both exercisetolerance and symptoms of dyspnea and fatigue.

  16. Thank you

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