1. Chronic obstructive
pulmonary disease
(( COPD
Dr. gehan younis
Lecturer of critical care Nursing

2. COPD
 Out lines
 What is the COPD?
 Overview
 Causes of COPD
 Symptoms of COPD
 What's the difference between COPD and
asthma?
 Diagnostic tests needed for COPD
 Medical management of COPD
 Preventive measures
 Nursing intervention

3. COPD
Definition
COPD , or chronic
obstructive pulmonary
disease, is a progressive
disease that makes it hard
to breathe. "Progressive"
means the disease gets
worse over time.

4.  COPD is a collective name for
chronic bronchitis and emphysema,
two diseases that are almost always
caused by smoking. Many of the
symptoms of COPD are similar to
those of asthma (e.g.
breathlessness, wheezing,
production of too much mucus,
coughing).

5.  COPD is a more serious disease
than asthma, because the changes
in the airways are much more
difficult to treat, and it usually has a
worse outcome. COPD can cause
greater long-term disability and
have a greater effect on the heart
and other organ systems than
asthma.

6.  COPD: disease due to
emphysema or chronic bronchitis
characterized by airflow limitation
that is not fully reversible

7. COPD
Overview

8. COPD
Overview
 In COPD, less air flows in and out of
the airways because of one or more of
the following:
 The airways and air sacs lose their
elastic quality.
 The walls between many of the air
sacs are destroyed.
 The walls of the airways become thick
and inflamed.
 The airways make more mucus than
usual, which tends to clog them.

9. Emphysema
Description
 Abnormal permanent enlargement
of the air space distal to the
terminal bronchioles
 Accompanied by destruction of
bronchioles

10. Chronic Bronchitis
Description
 Presence of chronic productive
cough for 3 or more months in each
of 2 successive years in a patient
whom other causes of chronic
cough have been excluded

11. COPD
Causes
 Exposure to pipe, cigar, tobacco
smoke
 Exposure to second hand smoke
 Exposure to heavy air pollution
 Exposure to heavy dust
 Exposure to chemical/toxic fumes
 Genetic conditions

12.  Infection
 Major contributing factor to the aggravation
and progression of COPD
 Heredity
 α -Antitrypsin (AAT) deficiency (produced by
liver and found in lungs).this protien protect
lung tissue from ensymz of inflamatory cells
Normal from 1.5-3.5 gL
 Emphysema results from lysis of lung tissues
by proteolytic enzymes from neutrophils and
macrophages

13. Pathogenesis of COPD
NOXIOUS AGENT
(tobacco smoke, pollutants, occupational
agent)
Genetic factors
Respiratory
infection
Other
COPD

14. Pathophysiology of Chronic
(Bronchitis and Emphysema(COPD
Fig. 28-7

15. COPD
Symptoms
 Productive cough
 Breathlessness
 Chest infection
 Other symptoms of COPD
weight loss, tiredness and ankle
swelling.

16. Signs and symptoms
 Wheezing
 Coughing
 Sputum production
 Shortness of breath
 Chest tightness

17. Difference between COPD and
Asthma
 In COPD there is permanent damage to the
airways. The narrowed airways are fixed, and
so symptoms are chronic (persistent).
Treatment to open up the airways, is therefore
limited.
 In asthma there is inflammation in the airways
which makes the muscles in the airways
constrict. This causes the airways to narrow.
The symptoms tend to come and go, and vary
in severity from time to time. Treatment to
reduce inflammation and to open up the
airways usually works well.
 COPD is more likely than asthma to cause a
chronic (ongoing) cough with sputum.

18. Difference between COPD and asthma
…((cont
 Night time waking with breathlessness
or wheeze is common in asthma and
uncommon in COPD.
 COPD is rare before the age of 35
whilst asthma is common in under-35.

19. COPD
Diagnostic tests
 Symptoms
 Physical examination
 Sample of sputum
 Chest x-ray
 High-resolution CT (HRCT scan)
 Pulmonary function test
(spirometery)
 Arterial blood gases test
 Pulse oximeter

21. Objectives of COPD
Management
 Prevent disease progression
 Relieve symptoms
 Improve exercise tolerance
 Improve health status
 Prevent and treat exacerbations
 Prevent and treat complications
 Reduce mortality
 Minimize side effects from

22. COPD
Medical management
 Give antibiotics to treat infection
 Give bronchodilators to relieve
bronchospasm, reduce airway obstruction,
mucosal edema and liquefy secretions.
 Chest physiotherapy and postural drainage to
improve pulmonary ventilation.
 Proper hydration helps to cough up secretions
or tracheal suctioning when the patient is
unable to cough.
 Steroid therapy if the patient fails to respond
to more conservative treatment.

23. COPD
…( Medical management (cont
 S top smoking
 O xygenation with low concentration during the acute episodes
 In asthma adrenaline ( epinephrine) SC if the bronchospasm
not relieved.
 A minophylins IV if the above treatment does not help.
 IV corticosteroids for patients with chronic asthma or frequent
attack.
 S edative or tranquilizers to calm the patient.
 I ncrease fluids intake to correct loss of diaphoresis and
inaccessible loss of hyperventilation.
 I ntubations and mechanical ventilation if there is respiratory
failure .

24. COPD
Preventive measures
 To prevent irritation and infection of the
airways, instruct the patient to:
 Avoid exposure to cigarette, pipe, and cigar
smoke as well as to dusts and powders.
 Avoid use of aerosol sprays.
 Stay indoors when the pollen count is high.
 Stay indoors when temperature and
humidity are both high

25. COPD
…(Preventive measures (cont
 Use air conditioning to help decrease
pollutants and control temperature
 Avoid exposure to persons known to have
colds or other respiratory tract infection
 Avoid enclosed, crowded areas during cold
and flu season.
 Obtain immunization against influenza and
streptococcal pneumonia.

26. COPD
…(Preventive measures (cont
 To ensure prompt, effective treatment
of a developing respiratory infection,
instruct the patient to do the
following:-
 Report any change in sputum color
character, increased tightness of the
chest, increased dyspnea, or fatigue.
 Call the physician if ordered antibiotics
do not relieve symptoms within 24

27. COPD
Nursing intervention
 Assessment
 History
 Patient's environment
 Work history, exercise pattern,
smoking habits
 The onset & development of
symptoms
 Sleeping positions

28. COPD
…(Nursing intervention (cont
 Physical examination
Signs of heavy smokers
 Observe for clubbing
 Distended neck vein on expiration
 The presence of barrel chest
 Observe for abdominal breathing
 The use of pursed lips breathing and
chest movement
 Auscultate the chest& listen for
musical wheezes characteristics of
chronic bronchitis

29. COPD
…(Nursing intervention (cont
 review the results of diagnostic procedure:
 Arterial blood gases
 Pulmonary function tests
 X-ray films
 Nursing diagnosis
 Ineffective breathing pattern related to increase
need of O2
 Ineffective airway clearance related to excessive
accumulation of secretions
 Impaired gas exchange related to impaired
expiration &co2 retention

30. COPD
…(Nursing intervention (cont
 Activity intolerance related to inadequate
oxygenation
 High risk for ineffective individual coping
related to chronic disease, its effects& its
treatment
 High risk for altered health maintenance
related to insufficient knowledge of
prevention, identification and treatment of
respiratory complication of COPD

31. Warning symptoms
 Increasing shortness of breath
 Increasing coughing and wheezing
 History of fever

32. Warning signs*
 Increased wheezing
 Decreased pulse ox
 Fever ( greater than 101 degrees
Fahrenheit)
 Increased pulse (greater than 100)
 Decreased pulse (less than 60)
 Increased respiratory rate
*ALL vital parameters are determined by
RN supervisor and are patient specific

33. COPD
Complications
 Pulmonary hypertension (pulmonary
vessel constriction d/t alveolar hypoxia
& acidosis)
 Cor pulmonale (Rt heart hypertrophy +
RV failure)
 Pneumonia
 Acute Respiratory Failure