CHRONIC
OBSTRUCTIVE
PULMONARY
DISEASE
PGI Johayra H.A Taher
DEFINITION
Chronic Obstructive Pulmonary Disease (COPD)
is a common, preventable and treatable disease that is characterized 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 gases. (GOLD, 2020)
EPIDEMIOLOGY
COPD is currently the fourth leading cause of death in the world.
COPD is projected to be the 3rd leading cause of death by 2020.
More than 3 million people died of COPD in 2012 accounting for 6%
of all deaths globally.
Globally, the COPD burden is projected to increase in coming
decades because of continued exposure to COPD risk factors and
aging of the population
EMPHYSEMA
Anatomically defined condition characterized by destruction
and enlargement of lung alveoli
CHRONIC BRONCHITIS
Clinically defined condition with chronic cough and phlegm
SMALL AIRWAY DISEASE
Small bronchioles are narrowed
PATHOPHYSIOLOGY
DIAGNOSIS
• FVC is the maximum amount of air a person can expel from the lungs after a
maximum inhalation
• FEV1 is the volume of air that can be expired in first second of a forced maximal
expiration
• FEV1 is normally 80% of FVC
DIAGNOSIS
© 2019 Global Initiative for Chronic Obstructive Lung Disease
ASSESSMENT
ASSESSMENT OF
EXACERBATION RISK
COPD exacerbations are defined as an acute worsening of respiratory
symptoms that result in additional therapy.
Classified as:
Mild (treated with SABDs only)
Moderate (treated with SABDs plus antibiotics and/or oral
corticosteroids) or
Severe (patient requires hospitalization or visits the emergency
room). Severe exacerbations may also be associated with acute
respiratory failure.
MANAGEMENT
© 2019 Global Initiative for Chronic Obstructive Lung Disease
© 2020 Global Initiative for Chronic Obstructive Lung Disease
MANAGEMENT
NON PHARMACLOGIC
Education and self-management
Physical activity
Pulmonary rehabilitation programs
Exercise training
Self-management education
End of life and palliative care
Nutritional support
Vaccination
Oxygen therapy
MONITORING AND FOLLOW
UP
Monitoring disease progression and development of complications
and/or comorbidities
Measurements
Decline in FEV1 can be tracked by spirometry performed at least
once a year.
Symptoms
At each visit, information on symptoms since the last visit should be
collected, including cough and sputum, breathlessness, fatigue,
activity limitation, and sleep disturbances.
MONITORING AND FOLLOW
UP
Exacerbations.
The frequency, severity, type and likely causes of all exacerbations
should be monitored.
Imaging
If there is a clear worsening of symptoms, imaging may be indicated.
Smoking status
At each visit, the current smoking status and smoke exposure should
be determined followed by appropriate action.
EXACERBATIONS
COPD exacerbations are defined as an acute worsening of respiratory
symptoms that result in additional therapy.
They are classified as:
Mild (treated with short acting bronchodilators only, SABDs)
Moderate (treated with SABDs plus antibiotics and/or oral
corticosteroids) or
Severe (patient requires hospitalization or visits the emergency room).
Severe exacerbations may also be associated with acute respiratory
failure.
Classification of hospitalized
patients
No respiratory failure:
respiratory rate: 20-30 breaths per minute;
no use of accessory respiratory muscles;
no changes in mental status;
hypoxemia improved with supplemental oxygen given via Venturi
mask 28-35% inspired oxygen (FiO2);
no increase in PaCO2.
Classification of hospitalized
patients
Acute respiratory failure — non-life-threatening:
Respiratory rate: > 30 breaths per minute;
using accessory respiratory muscles;
no change in mental status;
hypoxemia improved with supplemental oxygen via Venturi mask
25-30% FiO2;
hypercarbia i.e., PaCO2 increased compared with baseline or
elevated 50-60 mmHg.
Classification of hospitalized
patients
Acute respiratory failure — life-threatening:
Respiratory rate: > 30 breaths per minute;
using accessory respiratory muscles;
acute changes in mental status;
hypoxemia not improved with supplemental oxygen via Venturi
mask or requiring FiO2 > 40%;
hypercarbia i.e., PaCO2 increased compared with baseline or
elevated > 60 mmHg or the presence of acidosis (pH < 7.25).
© 2019 Global Initiative for Chronic Obstructive Lung Disease
THANK YOU!
