2. OBJECTIVES
 What is COPD
 Related diagnoses
 Risk factors
 Pathophysiology
 Clinical features
 Investigation
 Management
 Prescription
 Smoking cessation
methods

3. COPD
Preventable and treatable lung disease
with some significant extrapulmonary
effects that may contribute to severity in
individual patient
 Pulmonary component Airflow limitation
(not fully reversible)
 Limitation is progressive and associated with
an abnormal inflammatory response of the
lung to noxious particles or gases.

4. RELATED DIAGNOSES
 Chronic Bronchitis
Cough
Sputum
 Emphysema
Enlargement of airspaces distal
to terminal bronchioles with destruction
of their walls (no fibrosis)

5. RISK FACTORS
Exposures
 Tobacco smoke
 Occupation
 Lung growth
 Infections
 Low SES
 Nutrition (unclear)
 Cannabis smoking
Host factors
 Genetic factors
 Airway hyper-reactivity

6. PATHOPHYSIOLOGY
 Airway inflammation
 Loss of elastic recoil-
Airway collapse

7. CLINICAL FEATURES
 Cough
 Sputum production
 Haemoptysis
 Breathlessness
 Pink puffers
 Blue bloaters
 Cor pulmonale

8. BREATHLESSNESS
Modified MRC dyspnoea scale
Grade Degree of breathlessness related to activities
0 No breathlessness except with strenuous exercise
1 Breathlessness when hurrying on the level or walking up a
slight hill
2 Walks slower than contemporaries on level ground because
of breathlessness or has to stop for breath when walking at
own pace
3 Stops for breath after walking about 100 m or after a few
minutes on level ground
4 Too breathless to leave the house, or breathless when
dressing or undressing

9. SIGNS OF COPD
Pathological
conditions
COPD
Shape and
deformity of chest
Barrel shaped chest
Movement of chest
wall
Diminished all over
Mediastinal
displacement
None
Percussion note Normal or hyper-resonant
Breath sounds Diminished vesicular with
prolonged expiration
Vocal resonance Normal or reduced
Added sounds Ronchi (may be both
inspiratory or expiratory)

10. INVESTIGATION
 Chest x-ray:
Cardiac failure
Lung cancer
Bullae
 Complete Blood Count:
 Alpha1 antiproteinase
 Pulmonary Function Test:
Hallmark of COPD is airway obstruction.
(reduction in FEV1 and FEV1/FVC)

11. Spirometric classification of
COPD severity based on
post-bronchodilator FEV1
Stage Severity FEV1
1 Mild FEV1/FVC < 0.70
FEV1 ≥ 80% predicted
2 Moderate FEV1/FVC < 0.70
50% ≤ FEV1< 80% predicted
3 Severe FEV1/FVC < 0.70
30% ≤ FEV1 < 50% predicted
4 Very severe FEV1/FVC < 0.70
FEV1 < 30% predicted or FEV1 < 50% predicted
plus chronic pulmonary failure

12.  Health status questionnaires:
 Arterial blood Gases:
Demonstrate mild reduction
in blood oxygen levels,
and normal carbon dioxide
levels
 Heart Function Tests: Echocardiogram shows the
function of the heart, and ECG will demonstrate changes of
right heart strain or heart failure (cor pulmonale)

13. MANAGEMENT
 Smoking cessation
 Bronchodilators
 Corticosteroids
 Oxygen therapy
 Pulmonary rehabilitation
 Surgical intervention
 Palliative care

14. BRONCHODILATORS
ROUTE:
 Inhaled in preferred
 Oral bronchodilators
For the management of
Breathlessness
Drugs Used:
 Short acting beta 2 agonist(mild
disease)
Salbutamol
Terbutaline
 Anticholinergic
Ipratropium
 Long acting beta 2 agonist(moderate
to severe)
Salmeterol
Formeterol
 Anticholinergic
Tiotropium bromide

15. CORTICOSTEROIDS
 ICS: frequency and severity of exacerbation
Patient with sever disease (FEV1 <50%)
 Oral corticosteroids: Exacerbations
Maintenance therapy
Impaired skeletal muscle function
and Osteoporosis

16. OXYGEN THERAPY
 Long term domiciliary oxygen therapy (LTOT):
Provided by oxygen concentrator
Minimum of 15 hours/day
AIM:
The paO2 to at least 8 kPa (60 mmHg) or SaO2
to at least 90%.
 Ambulatory oxygen therapy:
In patients who desaturate on exercise & show
objective improvement in exercise capacity &/or
dyspnoea with oxygen.

17. SURGICAL
INTERVENTION:
 Bullectomy
 Lung Volume Reduction Surgery (LVRS)
 Lung Transplantation
PULMONARY REHABILITATION
 Treatment program that incorporate education and
cardiovascular conditions

18. PALLIATIVE CARE
 Addressing end-of-life needs is an important, yet
often ignored aspect of care in advanced disease.
 Morphine preparations: Breathlessness
 Benzodiazepines (low dose): Anxiety

19. Rx For Mild COPD
Name of the patient: (-)
Date:
Gender: (-)
Age : (-)
Address : (-)
Rx:
Short acting bronchodilators
Salbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S
Follow up:
Name of physician:
Signature:

20. Rx For Moderate COPD
Name of the patient: (-) Date:
Gender: (-)
Age : (-)
Address : (-)
Rx:
Short acting bronchodilators
Salbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S
Long acting bronchodilators
Salmeterol ( 25mcg) 2-4 puffs twice daily
Long acting anticholinergics
Tiotropium (9mcg) inhaler 2 puffs once daily
Ipratropium Bromide (Atrovent) 2-3 puffs
Follow up:
Name of physician:
Signature

21. Rx For Severe COPD
Name of the patient: (-) Date:
Gender: (-)
Age : (-)
Address : (-)
Rx:
Short acting bronchodilators
Salbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S
Long acting bronchodilators
Salmeterol ( 25mcg) 2-4 puffs twice daily
Inhaled Corticosteroids
Prednisone 60 mg qd for 7 days
Prednisone tapered off over additional 2 weeks
Follow up:
Name of physician:
Signature

22. Rx For very Severe COPD
Name of the patient: (-) Date:
Gender: (-)
Age : (-)
Address : (-)
Rx:
Short acting bronchodilators
Salbutamol (100mcg) inhaler 1-2 times every 6hrs or S.O.S
Long acting bronchodilators
Salmeterol ( 25mcg) 2-4 puffs twice daily
Inhaled Corticosteroids
Prednisone 60 mg qd for 7 days
Prednisone tapered off over additional 2 weeks
Follow up:
Name of physician:
Signature

23. SMOKING CESSATION
METHODS
Smokers who are not motivated to try to stop smoking
- Record smoking status at regular intervals
- Anti-smoking advice
- Encourage change in attitude towards smoking to improve motivation
Motivated light smokers (<10/day)
- Anti-smoking advice
- Anti-smoking support programme
Motivated heavy smokers (10-15/day)
- As above plus nicotine replacement therapy (NRT) (minimum 8 weeks)
Motivated heavy smokers (>15/day)
- As above plus bupropion if NRT and behavioural support are
unsuccessful and patient remains motivated

25. HEALTH BENEFITS OF
SMOKING CESSATION

26. PHARMACOLOGICAL
TREATMENTo Nicotine Replacement Therapy (NRT)
o Gum
o Patch
o Inhaler
o Nasal Spray
o Lozenge
o Bupropion
o Combination Therapy

27. SUMMARY
 COPD : Disease state characterized by airflow limitation that
is not fully reversible
 It includes: Emphysema and Chronic bronchitis
 Risk factors: Exposure and Host factors
 C/F: Cough, Haemoptysis, Sputum, Breathlessness, Pink
puffers, Blue bloater.
 Investigation: Radiograph, CBC, Pulmonary function test,
Health status questionnaire, Arterial blood gases, Heart
function test.
 Management: Bronchodilators, corticosteroids, Pulmonary
rehabilitation, Oxygen therapy, Surgical interventions, Palliative
care.
 Smoking cessation methods

28. REFERRENCES
 DAVIDSON
 Bedside Techniques (Shabbir)
 GOOGLE
 WIKIPEDIA

29. THANK YOU