Medical PG Entrance – COPD Diagnosis and Management

Dear students

I will be discussing here with you very important topic for PG medical entrance examinations like NEET, AIIMS, PGI etc. Listen above lecture and read the following important points for revision. and then read the standard textbook. You will find it very easy to remember this topic.

Definition: COPD is characterized by

  • Chronic Disorder of lungs characterized by pulmonary and extra-pulmonary manifestations
  • Not fully reversible airflow limitation
  • Progressive limitation of airflow occurs in COPD
  • Abnormal inflammatory response to External particles and antigens

Patterns of COPD:

  • Chronic Bronchitis: Cough and sputum for most days on 3 consecutive months for more than 2 years
  • Emphysema: Abnormal permanent enlargement of airspaces distal to terminal bronchioles with destruction of their walls
  • Extra-pulmonary– Muscular weakness, weight loss, peripheral edema

Etiology:

  • Tobacco smoking
  • Environment air pollution
  • Biomass fuel use like wood, cow dung, coal
  • Recurrent infections in childhood

Pathophysiology:

  • Loss of elastic tissues in airways
  • Inflammatory exudate in airways –premature airways closure and gas trapping
  • Enlargement of Mucus secreting glands , increase in number and size of goblet cells, increased mucus production
  • Remodeling of pulmonary vasculature
  • Destruction of alveoli due to action of proteases leads to Emphysema
  • Peripheral edema due to impaired salt and water excretion
  • Weight loss due to alteration in fat metabolism
  • Muscular weakness
  • Increased incidence of Osteoporosis

Clinical Features:

  • Peripheral edema due to impaired salt and water excretion
  • Weight loss due to alteration in fat metabolism
  • Muscular weakness
  • Increased incidence of Osteoporosis

Grading of breathlessness: ( MMRC grading)

  • Grade 0: No breathlessness except with strenuous exercise
  • Grade 1 :Breathlessness when hurrying on level ground or walking up a slight hill
  • Grade 2:Walks slower than contemporaries on level ground or has to stop in between when walking at own pace
  • Grade 3:Stops for breath after walking for 100m or after a few minutes on level ground
  • Grade 4:Too breathless to leave the house or breathless when dressing or undressing

Two phenotypes:

  • Pink puffers and Blue bloaters
  • Pink puffers are thin individuals, who have symptoms of breathlessness and they maintain PCo2 level till late stages of disease.
  • Blue bloaters develop hypercapnea in earlier stage of disease and they develop oedema an secondary polycythemia

Diagnosis:

  • Chest x-ray:

        -No specific radiological signs

        – Helps to rule out cardiac failure, lung cancer

  • CBC- Hb,TLC,DLC
  • Alpha-1 antiprotease
  • HRCT
  • Spirometery –

      – FEV1/FVC ratio < 70%

      – Post bronchodilator FEV1 < 80 %

Treatment:

  • Smoking Cessation
  • Use of non smoking cooking devices
  • Bronchodilators

          – Mainstay of treatment

          – Inhaled route is preferred

          – Mild cases- Short acting Beta 2 agonists like Salbutamol, Terbutaline , Anticholinergic like Ipratropium bromide preferred.

  • Moderate –severe cases- Long acting bronchodilators like Salmeterol or Formoterol or anticholinergic like Tiotropium bromide preferred
  • Corticosteroids:

       – Inhaled corticosteroids recommended

       – Severe disease with FEV1< 50%, with two or more exacerbations per year requiring antibiotics or oral corticosteoids

  • Regular physical exercise helps to improve FEV1 over longer periods
  • Long term Oxygen therapy

        – improves survival in patients who have low Pao2< 55 mm of Hg

        – given by oxygen concentrator

        – Flow rate should be adjusted to keep Spo2>90%

Use at rate of 2-4litre/min to keep PaO2> 60 mm of Hg

  • Annual Influenza and Pneumococcal vaccination
  • Treatment for Obesity, poor nutrition, depression and social isolation

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