87. REHABILITATION For the lungs to get more air PURSED-LIP BREATHING (like breathing out slowly into a straw) INHALE EXHALE
88. REHABILITATION For the lungs to get more air DIAPHRAGMATIC BREATHING Sit comfortably and relax your shoulders Put one hand on your abdomen. Now inhale slowly through your nose. (Push your abdomen out while you breathe in) Then push in your abdominal muscles and breathe out using the pursed-lip technique Note: • Repeat the above maneuver three times and then take a little rest. • This exercise can be done many times a day. 3. Then push in your abdominal muscles and breathe out using the pursed-lip technique. (You should feel your abdomen go down) 2. Put one hand on your abdomen. Now inhale slowly through your nose. (Push your abdomen out while you breathe in) 1. Sit comfortably and relax your shoulders.
103. Do you know what COPD is ? This chronic lung disease is a major cause of illness. Many people have it and yet don’t know it. If you answer these questions, it will help you find out if you could have COPD. 1. Do you cough several times most days? Yes ___ No ___ 2. Do you bring up phlegm or mucus most days? Yes ___ No ___ 3. Do you get out of breath more easily than others your age? Yes ___ No ___ 4. Are you older than 40 years? Yes ___ No ___ 5. Are you a current smoker or an ex-smoker? Yes ___ No ___ If you answered yes to three or more of these questions, ask your doctor if you might have COPD and should have a simple breathing test. If COPD is found early, there are steps you can take to prevent further lung damage and make you feel better. Take time to think about your lungs……Learn about COPD ! Could it be COPD?
105. ASTHMA V/s COPD ETIOLOGICAL BASIS Smoking is the noxious ag. No noxious external agent Any body may be effected Innate Atopy is essential Chronic exposure -Noxious Sensitizing trigger needed COPD ASTHMA
106. ASTHMA V/s COPD PATHOLOGY Disease of alveloli, bronchi Small airways - bronchioles Alveolar destruc. Br fibrosis No destruction or fibrosis Primary ↑ in bronchial tone Secondary bronchospasm Destructive Inflammation Primarily Allergic Inflamm. COPD ASTHMA
107. ASTHMA V/s COPD PATHOGENESIS CD 8 T, MF, Neutrophils CD4 T, Mast cells, Eosino LT B4, IL 8, TNF- α LT D4, IL 4, IL 5, - Th2 ↑ Proteases, ↓ in antiprote. ↑↑ IgE + other atopic disea. Emphysema, Bronchial fibr. Airway remodeling occurs Progressive destr. inflamm. Recurrent allergic inflamm. COPD ASTHMA
108. ASTHMA V/s COPD CLINICAL FEATURES Progressive dyspn, Hr. Gr. Episodic dyspnea – moder. Perennial symptoms Seasonal symptoms Sputum purulent & copious Sputum mucoid or none Chronic, progressive, Exaca Episodic, recurrent, normal Age always > 35 yrs, smoke Young subjects, any age COPD ASTHMA
109. ASTHMA V/s COPD SPIROMETRY Irreversible - < 15 % ↑ Reversible - > 15 % ↑ Resp. failure,Corpulmonale Resp. failure rare FEV 1 ÷ FVC < 60% FEV 1 ÷ FVC < 70% FEV 1 < 70% may be < 40% FEV 1 < 80% but > 60% Always obstructive pattern Normal or obstructive COPD ASTHMA
110. Treatment ASTHMA V/s COPD. - Rx. LTA have no role at all LTA are very useful Cromolyn, Ketotifen no use Mast cell stabilizers useful LTOT must in stage III and IV LTOT not needed mostly Ipatrop., Tiotrop. are first line Ipatropium add on only SR Theophylline contraindic. SR Theophylline?? some role Oral steroids in stage III & IV Oral steroids have little role SABA not much, ICS useful SABA for acute attacks LABA + Antibiotics – Ac. exa ICS are the main stay Quitting of smoking crucial Relievers and Preventers COPD ASTHMA
111. “ The old order changeth yielding place to new; Lest, one good custom should corrupt the world.” This is most pertinent today to Asthma and COPD Tennyson Sir Lord, Alfred Holm and Harris & NEJM
117. Most of these effects have dose-response relationship. Most of them are reversible if smoking is stopped early. Reducing the # reduces the risk – inverse response. If we are a smoker, let us quit smoking – set an example. Let us motivate every month at least one person to quit. What right we have, to make others passive smokers? The Onus here is on us
123. Om Asatho maa sad gamaya Om Tamaso maa jyothir gamaya Om Mrityor maa amritam gamaya Om Sarveshaam swasthir bhavathu Om Sarveshaam shaantir bhavathu Om Shaantihi Shaantihi Shaantihi ||
124. A CD format of today’s presentation is ready 1. COPD, Asthma and basics of spirometry In addition it, also contains 2. ECG workshop presented earlier 3. Guidelines on Hypertension treatment This can be used in Computer & DVD player Important Announcement
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126. Dr.Sarma RVSN, M.D., M.Sc (Canada) JN Road, Jayanagar, Tiruvallur, TN +91 98940 60593, (4116) 260593 PLEASE CONTACT US Dr. Kumaran.M, B.Sc., M.B.B.S., 10 North Raja St, Tiruvallur, TN +91 98941 10450, (4116) 260288 WE WILL MEET AGAIN SOON
