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Definition of COPD

Definition of COPD. COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible.

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Definition of COPD

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  1. Definition of COPD • COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. • Its pulmonary component is characterized by airflow limitation that is not fully reversible. • The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.

  2. Inflammation in COPD

  3. Pathogenesis of COPD

  4. Diagnosis of COPD EXPOSURE TO RISK FACTORS SYMPTOMS tobacco cough occupation sputum indoor/outdoor pollution dyspnea  SPIROMETRY

  5. Spirometry: Normal and Patients with COPD

  6. Spirometry “How-To” Resources from GOLD • Spirometry Guide • Spirometry Quick Guide • Spirometry Teaching Slide Set • To help health care professionals understand how to perform & evaluate spirometry. • All resources available at www.goldcopd.org.

  7. Classification of COPD Severity by Spirometry Stage I: Mild FEV1/FVC < 0.70 FEV1> 80% predicted Stage II: Moderate FEV1/FVC < 0.70 50% < FEV1 < 80% predicted Stage III: Severe FEV1/FVC < 0.70 30% < FEV1 < 50% predicted Stage IV: Very Severe FEV1/FVC < 0.70 FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure

  8. Active reduction of risk factor(s); influenza vaccination Addshort-acting bronchodilator (when needed) I: Mild II: Moderate III: Severe IV: Very Severe Addregular treatment with one or more long-acting bronchodilators (when needed); Addrehabilitation Addinhaled glucocorticosteroids if repeated exacerbations Addlong term oxygenif chronic respiratory failure. Considersurgical treatments

  9. Differential Diagnosis: COPD and Asthma COPD ASTHMA • Onset in mid-life • Symptoms slowly progressive • Long smoking history • Dyspnea during exercise • Largely irreversible airflow limitation • Onset early in life (often childhood) • Symptoms vary from day to day • Symptoms at night/early morning • Allergy, rhinitis, and/or eczema also present • Family history of asthma • Largely reversible airflow limitation

  10. COPD and Co-morbid Conditions • Common co-morbid conditions in COPD patients: • Cardiovascular disease • Lung cancer • Osteoporosis • Musculoskeletal disorders • Depression/anxiety • Obesity/type II diabetes • Physicians should identify and treat co-morbid conditions that impact on the clinical course of COPD. • Smoking prevention and cessation, weight control, exercise, and rehabilitation have the potential to beneficially affect COPD and co-morbid conditions.

  11. Preventing COPD Exacerbations • Prevent respiratory infections: pneumococcal vaccine, annual influenza vaccine. • Avoid air pollution: remain indoors and close windows on bad air pollution days. • Quit smoking and avoid exposure to secondhand smoke. • Understand medication regimen and proper inhaler use. • Patients with severe COPD and repeated exacerbations (3 or more in a year): use inhaled glucocorticosteroids. • Recognize and respond to early signs of exacerbations to minimize impact when exacerbations do occur.

  12. Risk Factors for COPD Genes Exposure to particles • Tobacco smoke • Occupational dusts, organic and inorganic • Indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings • Outdoor air pollution Lung growth and development Oxidative stress Gender Age Respiratory infections Socioeconomic status Nutrition Comorbidities

  13. Brief Strategies to Help the Patient Willing to Quit Smoking • ASKSystematically identify all tobacco users at every visit. • ADVISEStrongly urge all tobacco users to quit. • ASSESSDetermine willingness to make a quit attempt. • ASSIST Aid the patient in quitting. • ARRANGESchedule follow-up contact.

  14. Anatomy of the Lower Respiratory System Trachea Main bronchi Left Right Bronchioles Acinus Bronchus rigid because ofC-shapedcartilage rings Alveolus Acinus Capillary Alveolus Attenuatedepithelium Alveolarspace Capillaries

  15. Anatomy of the Airways Trachea and major bronchi Bronchioles Smooth muscle Connective tissue Cartilage Mucous membrane Airway mucous membrane Mucus Cilia Secretory cells Epithelium Ciliated cells Basal membrane Submucosa

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