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Chronic Obstructive Pulmonary Disease | Detailed | QuadBloggers

ByDanish syed

Jan 4, 2022 , ,
Chronic Obstructive Pulmonary Diseases

Chronic obstructive pulmonary disease is a syndrome characterized by increased or chronic obstruction of lung airways that results in difficulty in breathing.

  • Furthermore divided into two different parts:
    • A) Emphysema- Destruction of small airways that obstruct the airflow and hence leads to excess tissue deposition
    • B) Chronic bronchitis- Condition that causes phlegm production and cough all in all

Determination of airflow obstruction in Chronic Obstructive Pulmonary Disease:

  • Airway obstruction, determined by the ratio of forced expiratory volume ( How much a person can exhale during a forced breath)
  • And additionally forced vital capacity ( Capacity at which a person can forcibly exhale air from the lungs).
  • Furthermore, Reduced forced expiratory volume is a parameter to assess severe COPD.
  • COPD divided into 4 stages:
    • A) Stage 1- Accounts for > 80%
    • B) Stage 2- 50-80%
    • C) Stage 3- 30-50%
    • D) Stage 4- <30%
Chronic Obstructive Pulmonary Disease

Risk factors of Chronic Obstructive Pulmonary Disease:

  • Cigarette smoking- A major factor leads to increased incidence of COPD ( 1 pack of cigarettes per day for 1 year)
  • Occupational exposures such as bagassosis disease of the lung, gold mining and cotton textiles.
  • Subsequently, Burning of organic material affects women in general
  • Sedentary lifestyle all in all
  • Additionally, Symptoms usually occur in advanced stages of COPD
  • Spirometry test is indeed crucial in early detection of COPD
  • Subsequently, COPD involves increased respiratory symptoms like phlegm production, cough and shortness of breath, collectively known as exacerbation.
  • Exacerbations, triggered by bacterial and viral infections

GOLD, grading criteria for Chronic Obstructive Pulmonary Disease:

GOLD STAGESEVERITYSPIROMETRY
1MILD>80%
2MODERATE>50-<80%
3SEVERE>30-<50%
4VERY SEVERE<30%

Clinical manifestations of Chronic Obstructive Pulmonary Disease:

History of Chronic Obstructive Pulmonary Disease:

  • COPD patients complain of increased phlegm production simultaneously with increased cough.
  • Patients who have severe and productive cough simultaneously for > 3 months for 2 consecutive years suffer from chronic bronchitis.
  • Weight loss and weakness in additionally seen in advanced stages.
  • Furthermore, upper body exercises are considered to be difficult in COPD cases.
  • Additionally, history of severe exacerbations need to be assessed.

Physical findings:

  • Physical findings, usually are normal but progress with COPD
  • Respiratory distress
  • Tachycardia or increased heart rate
  • Additionally, Tachypnea or abnormal breathing
  • Furthermore, Cyanosis or bluish discoloration of tongue
  • Wheezing all in all
  • Barrel shaped chest
  • Use of accessory muscles of respiration

Scans:

  • Chest x-ray:
    • To detect hyperinflation( Trapping of air in the lungs that leads to over inflation)
    • Emphysema( shortness of breath)
    • Furthermore, Pulmonary hypertension ( increased blood pressure in vessels from the heart to the lungs)
    • Additionally, to exclude other lung conditions like pneumonia and pneumothorax.
  • Chest CT:
    • It is simultaneously used in severe and advanced cases
    • To evaluate for emphysema
    • Lung cancer in smokers
  • Pulmonary function tests:
    • Most important test in detection of COPD
    • Spirometry method is employed in this regard
  • Laboratory tests:
    • Oxygen saturation using a pulse oximeter
    • Alpha 1 antitrypsin test to exclude alpha 1 antitrypsin deficiency( Treated by slow IV therapy weekly)
    • Arterial blood gas method- To assess the PH and amount of carbon dioxide and oxygen in blood
    • CBC or complete blood count to simultaneously assess for increased blood cells.

Treatment:

Stop smoking:

  • Smoking, considered to be a major health hazard in reducing lungs capacity to breathe.
  • Nicotine replacement therapy needs to be started:
    • Transdermal patch ( A patch simultaneously applied to the skin, which then absorbs the medication in it)
    • Nasal spray
    • Chewing gum
    • Additionally Lozenges
    • Oral inhalers all in all
  • Oral bupripion ( antidepressant used for seasonal affective disorders)
  • Varenicline ( used for adults in order to stop smoking gradually)

Non-medicated:

  • Influenza vaccinations can be taken once a year
  • Pneumococcal and pertusis vaccinations

Bronchodilators:

  • Oral: Cetrizine, Theophyline and other anticholinergics
  • Inhalation: Ipratropium bromide, Tiotropium bromide and albuterol

Corticosteroids:

  • These are not really recommended in cases of COPD due to its severe symptoms.

PDE4 inhibitors:

  • Roflumilast reduces the incidence of severe exacerbations in COPD cases.

Antibiotics:

  • Patients suffering simultaneously from extreme or severe exacerbations have shown improvement in reduction of COPD with azithromycin.

Oxygen:

  • Oxygen therapy is crucial in reducing the incidence of COPD.
  • Due to breathing difficulty, airway blockages reduce the saturation levels, as a result maintenance oxygen therapy should be started.

Surgical interventions for COPD:

  • Lung volume reduction surgery improves lung function
  • Additionally, Lung transplantation method in final stages for chronic airflow obstruction

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