COPD (Chronic Obstructive Pulmonary Disease)

Definition COPD (Chronic Obstructive Pulmonary Disease) is:

1. Clinical syndrome of chronic dyspnea with expiratory airflow obstruction due to bronchitis and or emphysema
2. Chronic lung disease characterized by airflow resistance of the airways due to chronic bronchitis or emphysema and pulmonary
3. Chronic Obstructive Pulmonary Disease [COPD] is a lung disease with obstruction of lung airflow that lasts long.

Diagnosis of COPD

A common complaint in COPD :

• Shortness of breath
• Chronic Cough
• Productive sputum

Confirmed by spirometry test:

• VEP1 (FEV 1) post bronkhodilator = <80%, and VEP1/KVP (FEV1/FVC) = <70% 

Types of COPD:
Chronic Bronchitis and Emphysema.
Inchronic bronchitis there is inflammation in the airway wall so as to produce too much mucus. As a result of airway narrowing that affected the air exchange in the lungs. In chronic bronchitis there is also damage to the cilia that function to clear excess mucus in the airways.
In emphysema, there was enlargement and extensive damage to the alveoli, resulting in disruption of air exchange in the lung.

Chronic bronchitis
Syndrome a chronic productive cough (at least 3 consecutive months and at least for 2 years) with no other identifiable cause.
Emphysema
Pathological diagnosis characterized by enlargement of airspaces distal to bronchioli terminal (terminal bronchi) is accompanied by alveolar wall destruction.

History and physical examination

• Chronic productive cough
• Shortness of breath (Tachypnea)
• Breathing with the lips contract
• History of smoking which means
• Alpha-1 antitrypsin deficiency in non-smokers
• On chest percussion hiperesonansi
• Respiratory sound may be weakened

Chest X-ray photographs

• Low and flat diaphragm -->Useful for acute exacerbations to exclude complications such as pneumonia or pneumothorak

ECG changes

• Low QRS voltage
• If there is cor pulmonale occur deviations in delivery II, III and aVF

Examination of lung function

• FEV1 and all measurements of expiratory air is reduced Residual volume (RV) and total lung capacity increases
• Vital Capacity (KV) is reduced

Examination AGD

• Pa CO2 increased
• Hemoglobin saturation decreased
• Respiratory acidosis

Factors that influence the incidence of chronic bronchitis and emphysema
1. Smoking

• Hyperplasia of mucous glands bronchi
• Respiratory tract epithelial metaplasia skuamus
• Inhibition activity of the hair cells vibrate, alveolar macrophages, surfactant

2. Infection
Most bacteria are Haemophilus influenzae and Streptococcus pneumonia

3. Pollution
Chemicals that can cause bronchitis are: N2O, Hydrocarbons, Aldehydes, Ozone, O2
4. Offspring
Not known except dipengaruhnya deficiency of alpha-1 anti-trypsin is a disorder inherited in an autosomal recessive ang
5. Social and Economy
Patients with chronic bronchitis mortality more in lower socioeconomic groups

Pathophysiology

• In the lung there is a balance between proteolytic enzymes elastase and anti-elastase to prevent tissue damage
• Sources elastase: PMN cells, alveolar macrophages
• Sources elastase influenced by: cigarette smoke, infection
• Anti-elastase in the form of the enzyme alpha-1 anti-trypsin
• When anti-elastase elastase increases, decreases
• Because there is an imbalance between elastase and anti-elastase is elastin lung tissue damage and emphysema occur
• Refinement sal. respiration occurs PPOM
• In chronic bronchitis airway constriction occurs in small and large because the process of hypertrophy, hyperplasia of mucous glands
• In emphysema narrowing due to reduced lung elastisistas
• In the lung there is an interesting balance between the pressure of lung tissue with a pull out into the
• Exit by intra-pleural pressure and chest wall muscles
• Into the lung elasticity B
• Balance they form a functional residual capacity

Management COPD

There are four components of the management of COPD according to WHO 1998

• Assessment and monitoring of disease
• Reduce risk factors
• Stable COPD Therapy
• Therapy of acute exacerbations

When described then management of these become:

1. Stop smoking
2. Pharmacologic Therapy
3. Oxygen therapy
4. Mechanical ventilation
5. Rehabilitation
6. Nutrition
7. Surgery
8. Vaccination
9. Education

The objectives of the management of COPD are:

1. Prevent disease progression
2. Eliminate complaints
3. Increase activity tolerance
4. Improve health status
5. Prevent and treat exacerbations
6. Prevent and treat complications
7. Reduce mortality