يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه، 2015/10/11يکشنبه،...
TRANSCRIPT
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الرحمن الله بسمالرحیم
سالم با
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Chronic Obstructive Pulmonary Disease
Dr A. Asadian
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Occupational Respiratory Diseases
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تعریف
COPD is defined as a disease state characterized by the presence of airflow obstruction due to chronic
bronchitis or emphysema.
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airflow limitation that is not fully reversible Accessed September 19, 2008, at http://www.goldcopd.com/.)
N Engl J Med Volume 359:1616-1618 October 9, 2008
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Key Indicators for COPD DiagnosisChronic cough Present intermittently or every
day often present throughout the day; seldom only nocturnal
Chronic sputum production Present for many years, worst in winters. Initially mucoid – becomes purulent with exacerbation
Dyspnoea that is Progressive (worsens over time)Persistent (present every day)Worse on exerciseWorse during respiratory infections
Acute bronchitis Repeated episodes
History of exposure to risk factors
Tobacco smoke occupational dusts and chemical smoke from home cooking and heating fuel
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Disease Trajectory of a Patients with COPD
Symptoms
Exacerbations
Exacerbations
ExacerbationsDeterioration
End of Life
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Physical signs
Large barrel shaped chest (hyperinflation)
Prominent accessory respiratory muscles in
neck and use of accessory muscle in
respirationLow, flat diaphragmDiminished breath
sound
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Emphysema
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Normal versus Diseased Bronchi
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COPD classification based on spirometry GOLD 2003
.
Severity Postbronchodilator FEV1/FVC
Postbronchodilator FEV1% predicted
At risk >0.7 >80
Mild COPD <0.7 >80
Moderate COPD
<0.7 50-80
Severe COPD <0.7 30-50
Very severe COPD
<0.7 <30
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Cardiac Disease in Chronic Obstructive Pulmonary Disease
The cardiac manifestations of chronic obstructive pulmonary disease (COPD)
are numerous. right ventricular
dysfunction and pulmonary vascular disease are well known to complicate
the clinical course of COPD and correlate inversely with survival.
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Spirometry
Diagnosis
Assessing
severity
Assessing
prognosis
Monitoring
progression
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Spirometry
FEV1 – Forced expired volume in the first second
FVC – Total volume of air that can be exhaled from maximal inhalation
to maximal exhalationFEV1/FVC% - The ratio of FEV1 to
FVC, expressed as a percentage .
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COPD :
Beyond FEV1
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Systemic Effects
weight loss
,
Circulating concentrations of interleukin-6
acute-phase proteins, such CRP
levels of leptin
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CXY in COPDCXY in COPDDIAGNOSIS OF A R F IN COAD …
1} X-RAY CHEST
• Hyper - inflation• Flattened diaphragm• Less lung markings• Increased hilum / pulm.Art.Size• RA / RV dilated • Existing pathology
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DIAGNOSIS OF A R F IN COAD ….
2} E C G
- NORMAL- RT AXIS DEVIATION- RAH ( ‘P’ PULMONALE)- RVH WITH RV – STRAIN- RBBB
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comorbidities of COPDThe most common that are possibly related
to the systemic effects of smoking are CHF, arrhythmias, hypertension, peripheral and
coronary artery diseases, diabetes and metabolic syndrome, osteoporosis, cancer
(particularly lung cancer), pulmonary vascular abnormalities, psychiatric
disorders, cachexia, skeletal muscle abnormalities, and infections
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Airflow Limitation in Smokers Is Associated with Subclinical Atherosclerosis
Conclusions: Smokers with airflow limitation had exaggerated subclinical atherosclerosis.. American Journal of Respiratory
and Critical Care Medicine Vol 179. pp. 35-40, 2009
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Copyright restrictions may apply.
Lynch, J. InnovAiT 2008 1:222-232; doi:10.1093/innovait/inn019
(a) Normal and (b) barrel chest
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Post-bronchodilator
FEV1(% predicted)
Management based on GOLD
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What medications are used to prevent complications?
Annual flu vaccine Reduces risk of flu and its complications
Pneumonia vaccineReduces risk of common cause of
pneumonia
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Algorithm for the management of COPD
Short acting bronchodilator – as required
Tiotropium
Tiotropium+LABA
Long acting beta agonist
LABA + tiotropium
Add-Inhaled steroids-Theophylline
Mild
Severe
asse
ss w
ith s
ympt
oms
and
spiro
met
ry
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Chicken or egg: physical activity in COPD
Eur Respir J 2009; 33:227-229Copyright ©ERS Journals Ltd 2009
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نباشید خسته
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QUESTIONS?