Chronic obstructive pulmonary disease (COPD)

Notes
  • This is a type of obstructive lung disease characterized by long-term poor airflow
  • COPD encompasses chronic bronchitis and emphysema (which is the destruction of lung parenchyma that results in the loss of elastic recoil, alveolar septa and radial airway traction hence increasing the probability of the collapse of airways).
  • Causes of COPD are tobacco smoking (most important), genetic factors (mainly of α1-Antitrypsin deficiency), infections (especially Haemophilus influenza) and air pollution among others.
  • Tobacco smoking (and other irritants) causes an inflammatory response leading to narrowing of the small airways and breakdown of lung tissue
  • The major differentiating factor between COPD and asthma is that the symptoms of COPD are partially relieved by bronchodilators while those of asthma are better relieved by the same.
  • Statistics: number of people affected by COPD globally - 329 million (about 5% of global population); global annual mortality rate from COPD - 2.9 million; age that is mostly affected by COPD - ≥ 40 yrs; about 50% of patients with severe COPD die within 10 yr of diagnosis.
Symptoms
  • Symptoms worsen with time
  • Shortness of breath
  • Productive cough
  • Sometimes wheezing
  • Chest hyper-resonance
  • Occasionally Cor pulmonale (COPD at advanced stage causes high pressure on the lung arteries that affect right ventricle leading to the swelling of the legs and bulging of the neck veins, among other symptoms)
  • Weight loss
  • Pneumothorax (as a complication of the disease)
  • Cyanosis
Diagnosis

##Pulmonary function tests (PFTs)

  • Done mainly by use of spirometry
  • A spirometer measures the forced expiratory volume in one second, FEV1 and the forced vital capacity, FVC (the greatest volume of air that can be breathed out in a single large breath
  • A person is defined as having COPD if the ratio FEV1/FVC ≤ 70% in the presence of other symptoms of COPD

##Chest X-ray

  • Overexpanded lungs
  • A flattened diaphragm
  • Increased retrosternal airspace
  • Bullae

##Full Blood Count (FBC)

##A high-resolution CT scan

##An analysis of arterial blood (to determine the need for oxygen)

Differential
  • Asthma
  • Bronchiectasis
  • Pneumonia
  • Pulmonary edema
  • Pulmonary embolism
  • Pneumothorax
  • Congestive Heart Failure (CHF)
  • TB
Prevention
  • Cessation of smoking

 

Management

##Bronchodilators (both beta-agonists and anticholinergic)

  • Tab Salbutamol 4mg TID or
  • Salbutamol inhaler 2 puffs QID or TID Or
  • Tabs Theophylline 250mg BD or TID or
  • IV Aminophylline 9mg/ kg/ hr or
  • Albuterol nebulizer 5 – 2mg QID
  • Terbutaline Nebulizer 1 – 0.2mg QID
  • Ipratropium bromide inhaler 5mg QID
  • Salmeterol
  • Formoterol
  • Tiotropium

##Corticosteroids

  • Tabs prednisolone 30-60mg daily  5-10 days
  • Fluticasone
  • Beclomethasone

##Antibiotics

  • Caps Amoxicillin 250 -500mg TID x 5/7 or
  • Caps Tetracycline 250-500mg QID x 5/7

## Others

  • Oxygen, when require
  • Theophylline
  • Surgery in some cases
  • Chest physiotherapy
Drug Index 2.0 is here
Our new update features a more powerful search feature and easier login. Having any issues? Contact us today. Contact Us