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1、CHRONIC OBSTRUCTIVE PULMONARY DISEASE,Vanessa Zhou 18/6/2020,Based on Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease -2020 REPORT,Diagnosis,Treatment,Symptoms,3,Definition,Epidemio-,Anatomy,Pathophysiology,Contents,Definition,Definition,Chronic
2、 obstructive pulmonary disease (COPD),COPD is a common, preventable and treatable disease that is characterized by presistent respiratory symptoms and airflow limitation that is due to airway and/oralveolar abnormalities.usually caused by significant exposure to noxious particles or gases and influe
3、nced by host factors including abnormal lung development. significant comorbidities may have an ipact on morbidity and mortality.,Definition,Epidemiology,Epidemiology,In 2016, more than 8.9M Americans were diagnosed with chronic bronchitis,Meanwhile, about 3.5M Americans were diagnosed with emphysem
4、a,Chronic Bronchitis=8.9M,Emphysema=3.5M,COPD was the Third-leading cause of death in the United States in 2016, following heart disease, cancer, and unintentional injuries.,Source centers for disease control and prevention (CDC),Epidemiology,Leading cause of death,Diagnositic rate,Men and Women,Ris
5、k factors,In China, COPD ranked among the top four leading causes of death in China,The diagnostic rate of COPD patients in China varied from 23.61% to 30.00%.,The prevalence rate of COPD was higher among men (7.76%) than women (4.07%).,Tobacco exposure and biomass fuel/solid fuel usage were documen
6、ted as two important risk factors of COPD.,Anatomy,Respiratory system,When a person inhales, air flows from the nose and mouth to alveoli. oxygen from air passes through the walls of the inflated alveoli and is taken up by the red blood cells for delivery to rest of the body,Alveoli,What are Alveoli
7、?,Alveoli are small, thin-walled,air sacs located in clusters at the end of the bronchial tubes There are about 300 million alveoli in normal lungs. As breathing in air, the alveoli stretch, drawing oxygen in and transporting it to the blood. When exhaling, the alveoli shrink, forcing carbon dioxide
8、 out of the body.,The airway,Epithelium,Goblet cell (produce mucus),Ciliated pseudostratified columnar epithelial cells(it has cilia),Cilia,Loose connective tissue,lamina propria,Basement membrane,Smooth muscle,Connective tissue,Bronchial mucinous glands,Submucosa,Mucosa,Thin the presence of a post-
9、bronchodilator FEV1/FVC 0.70 confirms the presence of persistent airflow limitation.,Chronic Obstructive Lung Disease (GOLD): https:/goldcopd.org/,-GOLD 2020,Assessment of airflow limitation,FEV1/FVC Ration,Forced Vital Capacity(FVC): the maximum amount of air people can breath out in a single breat
10、h.,Forced Expiratory Volume in one second (FEV1):the first second of air breath.,The result of this ratio is expressed as FEV1%.Normal values are approximately 80%.,Spirometry-Normal trace,FEV1/FVC,This reduction is especially noticeable in the first second of air (FEV1),FEV1/FVC,The airway is obstr
11、ucted,The lungs dont empty properly, that leaves air trapped inside the lungs.,FVC,FEV1,FEV1=2.1L FVC=3.0L 1.2/3.0=40%,Spirometry-Obstructive disease,modified Medical Research Council Dyspnea Scale(mMRC ),Assessment dyspnea,Please choose the one best response to describe your shortness of breath,Ass
12、essment symptoms,For each item below, place a mark in the box that best describes you currently. be sure to only select one response for each question,Assessment symptoms,Spirometry,Blood tests,Other Diagnosis Tests,CT scan,Sputum testing,Chest X-ray,Chest X-ray,For chronic bronchitis,For emphysema,
13、Horizontal ribs,No apparent abnormality, or thickened and increased lung markings are noted,Marked over inflation is noted with flatten and low diaphragm Intercostal space becomes widen A horizontal pattern of ribs A long thin heart shadow Decreased markings of lung peripheral,CT,CT is currently the
14、 modality of choice for detecting emphysema,Centrilobular emphysema is the most frequently encountered type and affects the proximal respiratory bronchioles, particularly of the upper zones.,Laboratory Examination,Blood test,Sputum test,In exacerbation or acute infection in airway, leukocytosis may
15、be detected Arterial blood gas meaurements:Pao26.7kpa when breathing room air indicates respiratory failure,Streptococcus pneumonia Haemophilus influenzae Moraxella catarrhalis Kiebsiella pneumonia,Treatment,Treatments,Self-management education and smoking cessation,Bronchodilators,Inhaled Corticost
16、eroids,Pulmonary Rehabilitation,Oxygen,Surgery,Increasing severity,Management of COPD,INITIAL ASSESSMENT FEV1 GOLD 1-4 Symptoms(CAT OT mMRC) Exacerbation history Smoking status 1-antitrypsin Comorbidities,DIAGNOSIS Symptoms Risk factors Spirometry(repeat if borderline),ADJUST Pharmacotherapy Non-phamacological,INITIAL MANAGEMENT Smoking cessation Vaccination Active lifestyle and exercise initial pharmacotherapy inhaler techique br
