Chronic Obstructive Pulmonary Disease – Diagnosis And Treatment

Chronic Obstructive Pulmonary Disease – Diagnosis And Treatment

Describe etiology, clinical features, diagnosis, complications and treatment of chronic obstructive pulmonary disease.
Or
Write etiology, clinical features, diagnosis, and management of chronic obstructive pulmonary disease.

Answer. Chronic obstructive pulmonary disease is characterized by irreversible obstruction to the airflw throughout lungs. It consists of two important disorders of lungs, i.e. chronic bronchitis and emphysema.

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These both diseases coexist in a single patient.

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Etiology chronic obstructive pulmonary disease or Etiology of COPD

1.COPD Localized Causes

1. Congenital
2. Compensatory due to lung collapse, scarring or resection
3. Partial bronchial obstruction due to neoplasm or foreign body
4. MacLeod’syndrome

2. COPD Generalized Causes :

1. Idiopathic
2. Senile
3. Familial, i.e. due to alpha-l-anti-trypsin defiiency
4. Associated with chronic bronchitis, asthma or
   pneumoconiosis.

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Clinical Features chronic obstructive pulmonary disease

Lung Disease Emphysema

In most of the patients, chronic bronchitis is associated with emphysema so two types clinical syndromes of chronic obstructive pulmonary disease are present i.e.

1. Predominant chronic bronchitis with emphysema, i.e. Bluebloater type
2. Predominant emphysema with some degree of chronic bronchitis, i.e. pink-puffers type

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 Chronic Obstructive Pulmonary Disease Diagnosis

1. History of chronic progressive symptoms, i.e. cough orwheeze or breathlessness.

2. General condition: Patient can be emaciated, cyanosed and edematous. Jugular venous pressure may show giant a­waves.

3. Chest fidings:

1. Chest wall process is barrel­shaped.
2. Movement of chest is decreased.
3. Centrally placed mediastinum
4. Percussion is hyper­resonant.
5. Breath is diminished vesicular with prolong expiration.
6. Rhonchi are heared.
7. Vocal resonance sounds are diminished.

4. Heart:

1. Apex beat may not be visible or palpable.
2. Right ventricular heave can be present.
3. Heart sounds can be diminished. Second sound can be loud.
4. Gallop rhythm can be heared.
5. Functional tricuspid regurgitation murmur can be present.
6. Hyperkinetic state with warm limb and water hammer pulse is present.

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Lung Disease Emphysema

5. Miscellaneous:

1. Hepatomegaly can be present.
2. Optic disc can show papilliedema

6. Investigations:

1. There is presence of post-bronchodilator FEV1/FVC less than 0.7 which confims the presence of persistent airflw limitation and thus is diagnostic of chronic obstructive pulmonary disease.
2. Arterial blood gas show retention of carbon dioxide in emphysema.
3. Serum alpha­1­anti­trypsin levels to diagnose alpha­1 anti-trypsin defiiency.
4. X-ray chest: Presence of hypertranslucency of lung filds, wide intercoastal spaces, diaphragm is low and flt, heart is tubular shaped, presence of large hilar shadows, diminished peripheral vascular pattrn, rounded areas of hypertranslucency with thin hairline shadow forming margins.

Complications chronic obstructive pulmonary disease

In emphysema

1. Pneumothorax due to rupture of bullae in pleural space.
2. Cor pulmonale, i.e. right­sided heart failure or right ventricular hypertrophy secondary to lung disease.
3. Type II respiratory failure.

Lung Disease Emphysema

In chronic Bronchitis

1. Type I and type II respiratory failure
2. Cor pulmonale
3. Pulmonary arterial hypertension
4. Secondary infections
5. Secondary polycythemia

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Chronic Obstructive Pulmonary Disease Treatment

• Bronchial irritants should be avoided, i.e.
  • Smoking should be strictly stopped.
  • Passive smoking is stopped.
  • Gas smoke is avoided by housemakers.
  • Aerosols such as hair spray, insecticide spray and aerosols should be avoided.
  • Polluted atmosphere should be strictly avoided.
• Treatment ofan infection:
  • Ampicillin 250 to 500 mg every 6 hourly is given for 5–7 days.
  • Cotrimazole 960 mg can be given as BD dose.
  • Antibiotics should be given till purulent mucous become mucoid.
  • If necessary modify antibiotics as per culture and sensitivity test.
• Bronchodilators:
  • In mild­to­moderate chronic bronchitis oral theophylline 150 mg
  • BD or inhaled salbutamol 200 μg 6 hourly can be given.
  • In severe bronchitis, ipratropium bromide 40 to 80 μg 6 hourly is added.

Mucolytic agents: Bromhexine and carbocysteine are to be given.

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• Corticosteroids: Prednisolone 30mg/day for 2 weeks is given.
• If improvement occur by oral steroids they are replaced by inhalational steroids.
• Domiciliary oxygen therapy: Long­term oxygen therapy in low concentration, i.e. 2L/min by nasal cannula is given to reverse or to delay development of pulmonary hypertension.
• If cor pulmonale is present diuretics such as furosemide,
  digitalis and potassium salts might be given.
• Chest physiotherapy should be done, and proper exercises should be taught to the patient.
• Patients with COPD should receive influenza and pneumococcal vaccines.
• Non­invasive ventilation is useful in those with pronounced daytime hypercapnia.
• Lung volume reduction surgery can be done. In this parts of lungs are resected to reduce hyperinfltion.