CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary          disease (copd)

It is a combination of clinical signs of chronic obstructive bronchitis(inflammation of narrowing of bronchi) and emphysema(changes of lung tissue structure).COPD is irreversible disease increasing worldwide because of the increase in smoking in developing countries, the reduction in mortality due to infectious diseases and the widespread use of biomass fuels. Prevalence, incidence and mortality rates increase with age. Prevalence is higher in men, but total mortality is similar in both sexes.

ETIOLOGY

•       Cigarette smoking

•       Genetic factors (alpha1-antitrypsin deficiency)

•   Air pollution, airway infections

PATHOPHYSIOLOGY

*Inflammation –It generally occurs in our body due to foreign particle irritation after getting in contact with our epithelium, in this disease COPD inflammatory response is triggered by increase in activity of protease activity and decrease in anti protease activity which thus cause break down of elastin and connective tissue in our lungs and this causes problems in normal repair processes of tissues. In patients with COPD activated neutrophils and other inflammatory cells release proteases as a part of inflammatory process; protease activity exceeds anti protease activity and tissue destruction and mucous hyper secretion starts.

* Infection – Smoking and airflow obstruction may lead to impaired mucus clearance in lower airways, which predisposes to infection.

* Airflow limitation – due to mucus hyper secretion, mucus plugging, mucosal edema, bronchi spasm all these mechanism occur due to airway obstruction. As alveolar wall destroy due to loss of elastic recoil and lung hyperinflation.

CLINICAL SIGNS

- Productive cough

- Dyspnea

- Wheezing

- Lung hyperinflation

- Decreased heart and lung sounds

- Increased anteroposterior diameter of the thorax

- Cyanosis of skin and lips

DIAGNOSIS

+ Pulmonary function tests- that is forced expiratory volume test (FEV1), Forced vital capacity test (FVC).

+ Instrumental and laboratory tests-chest x-rays, CT scan.

+Adjunctive tests –alpha1-antitrypsin levels, ECG, CBC, Sputum analysis.

TREATMENT

·     Inhaled bronchodilators –these includes beta agonists like Fenoterol , salbutamol and anti cholinergic; tiotropium bromide is used over ipratropium as powder formulation , corticosteroids; fluticasone and beclamethasone are used

·     Supportive care(stopping smoking, oxygen therapy, pulmonary rehabilitation)

·     Metered dose inhalers (MTIs) or dry powder inhaler is preferred over nebulizer home treatment.

·     Theophylline, oxygen therapy, vaccinations and pulmonary rehabilitations are widely used.

·     Expectorants and mucosolvents lasolvan ,acetylcysteine are used in order to dissolve the drainage function of bronchi

·     Antibiotics are recommended for exacerbation in patients with purulent sputum. If the infectious organism is resistant, amoxicillin, fluoroquinolones, cephalosporin’s of 2^nd generation and extended spectrum macrolides are indicated.

  

                                                                                                             

                                                                                                             -by Dr. Ravi Ranjan