3.CHRONIC OBSTRUCTIVE PULMONARY DISEASE(COPD) MKU PPT (1)

3.CHRONIC OBSTRUCTIVE PULMONARY DISEASE(COPD) MKU PPT (1) Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / IMED 4.1 / NGUGI -- Slide 1 CHRONIC OBSTRUCTIVE PULMONARY DISEASE(COPD) DR. ROSSLYN NGUGI MBChB (UON),MMED IMED (UON),Pg Dip DIABETES(NSW) Slide 2 INTRODUCTION: Defined as a preventable and treatable lung disease with some significant extrapulmonary effects.\n •Pulmonary component is characterised by airflow limitation\n–not fully reversible.\n–progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. Slide 3 INTRODUCTION: It consists of\n•Chronic bronchitis\n–cough and sputum on most days\n–For at least 3 consecutive months for at least 2 successive years\n •Emphysema\n–abnormal permanent enlargement of the airspaces distal to the terminal bronchioles. –accompanied by destruction of their walls and without obvious fibrosis.\n •Extra pulmonary manifestations: impaired nutrition, weight loss and skeletal muscle dysfunction Slide 4 © 2020 Global Initiative for Chronic Obstructive Lung Disease Slide 5 EPIDEMIOLOGY: Prevalence is directly related to the prevalence of tobacco smoking\nLow- and middle-income countries, the use of biomass fuels.\n80 million people world-wide suffer from moderate to severe disease.\nIn 2005, more than 3 million deaths (5% of deaths globally),\n2020 it is forecast to represent the 3rd most important cause of death world-wide.\nGreatest in Asian and African countries - increasing tobacco consumption. Slide 6 © 2020 Global Initiative for Chronic Obstructive Lung Disease Slide 7 © 2020 Global Initiative for Chronic Obstructive Lung Disease Slide 8 © 2020 Global Initiative for Chronic Obstructive Lung Disease Slide 9 © 2020 Global Initiative for Chronic Obstructive Lung Disease Slide 10 © 2020 Global Initiative for Chronic Obstructive Lung Disease Slide 11 © 2020 Global Initiative for Chronic Obstructive Lung Disease Slide 12 PULMONARY AND SYSTEMIC FEATURES OF COPD: Slide 13 AETIOLOGY: Cigarette smoking represents the most significant cause.\n Relates to both the amount and the duration of smoking.\n It is unusual to develop COPD with less than 10 pack years (1 pack year = 20 cigarettes /day/year)\n Not all smokers develop the condition - individual susceptibility factors are important. Slide 14 RISK FACTORS: Exposures\nTobacco smoke\nBiomass solid fuel fires: wood, animal dung, crop residues and coal lead to high levels of indoor air pollution\nOccupation: coal miners and those who work with cadmium\nOutdoor and indoor air pollution\nLow birth weight: may reduce maximally attained lung function in young adult life Slide 15 RISK FACTORS: Lung growth\nchildhood infections.\nmaternal smoking.\nInfections\nrecurrent infection may accelerate decline in FEV 1;\npersistence of adenovirus in lung tissue may alter local inflammatory response predisposing to lung damage;\n•HIV infection is associated with emphysema.\nLow socioeconomic status.\nNutrition: role as independent risk factor unclear.\nCannabis smoking\nHost factors\nGenetic factors: α 1-antiproteinase deficiency.\nAirway hyper-reactivity. Slide 16 CLINICAL FEATURES: Suspected in any patient over the age of 40 years with symptoms - chronic bronchitis and/or breathlessness.\nCough and associated sputum: first symptoms, often referred to as a ‘smoker’s cough’.\nHaemoptysis: complicate exacerbations of COPD but should not be attributed to COPD without thorough investigation.\nBreathlessness: first presentation to medical attention.\nIn advanced disease, oedema and morning headaches may suggest hypercapnia Slide 17 Medical Research Council (MRC) Dyspnoea Scale Slide 18 CLINICAL FEATURES: Physical Sign: Non-specific, correlate poorly with lung function,\n•Present only in advance disease.\n •Breath sounds are typically quiet;\n •Crackles may accompany infection but if persistent raise the possibility of bronchiectasis.\n •Oedema usually relates to failure of salt and water excretion by the hypoxic, hypercapnic kidney. Slide 19 CLINICAL FEATURES: Body mass index (BMI) - prognostic significance and should be recorded.\n•Two classical phenotypes:\n•Pink puffers\n–Typically thin and breathless.\n–Maintain a normal PaCO2 until the late stage of disease.\n•Blue bloaters\n–develop (or tolerate) hypercapnia earlier.\n–may develop oedema and secondary polycythaemia.\n•In practice, these phenotypes often overlap. Slide 20 CLINICAL FEATURES: Slide 21 INVESTIGATIONS: No reliable radiographic signs that correlate with the severity of airflow limitation,\nCXR - essential to identify alternative diagnoses such as cardiac failure, other complications of smoking such as lung cancer, and the presence of bullae.\nCBC: exclude anaemia or document polycythaemia,\nYounger patients with predominantly basal emphysema, α1-antiproteinase should be assayed.\nThe diagnosis is confirmed by demonstrating airflow obstruction by spirometry Slide 22 © 2020 Global Initiative for Chronic Obstructive Lun