A 52-year old man present to your office for an accute visit because of coughing and shortness of breath.

He is well-known to because of multiple office visit in the past few years for similar reason. He has chronic smokers caugh,but reports in the past 2 days his cough has increased,his sputum has changed from white to green in color and he has had to increase the frequency with which he uses his albuterol inhaler. He denies having fever, chest pain, peripheral edema, or other symptoms. His medical history is significant for hypertensio, pheripheral vascular disease, and 2 hospitalization pneumonia in the past 5 years. He has a 60-packhistory of smoking and continuous to smoke 2 packs of cigarettes a day. On examination, he is in moderate respiratory distress. His temperature is 98.4F degree, his blood pressure is 152/95 mm Hg, his pulse is 98 beats/min, his repiratory rate is 24 breaths/min, and he has an oxygen saturation of 94% on room air. His lung is significant for diffuse expiratory wheezing and a prolonged expiratory phase of respiration. There are no sign of cyanosis. The remindeer of his examination is normal. Chest x-ray done in your office shows an increased anteroposterior (AP) diameter and flattened diaphragms, otherwise clear lung fields.

INTRODUCTION In this time,there are a lot of problem about pulmonary dissease which increased the precentage of mortality. In this case we will talk about the obstruction of respiratory way. Respiratory way can sufferer of an acute obstruction which is happen in superior of respiratory way (supraglotic), middle of respiratory way (intraglotic),or under of respiratory way(infraglotic). If the obstruction happen in the under of the respiratory way so it maybe cause by an asthma or COPD. Yeah we will concern about the COPD it self. In the past few years chronic obstructive pulmonary disease(COPD) or sometimes we call PPOK in bahasa is an interesting topic in this world, because there are an increases of precentage of mortality cause by COPD. As cause of the death COPD has stay as the fourth grade after the heart attack and cerebrovascular disease.

MAIN IDEA What is COPD mean? COPD is a chronic obstructive pulmonary disease that marked by the blocked of respiratory way that not reversible at all. This inhibitation of the respiratory way is always progressive and related to the lungs inflamation cause by particle, or even dangerous gas.

DEFINITION

COPD
AIRFLOW AIRFLOW LIMITATION LIMITATION IN SMALL AIRWAYS IN SMALL AIRWAYS PROGRESSIVE

CHRONIC INFLAMMATION

PARTIAL REVERSIBLE

IRREVERSIBLE

ALVEOLER STRUCTURE DAMAGED ALVEOLER STRUCTURE DAMAGED DECREASED ELASTIC RECOIL DECREASED ELASTIC RECOIL

1 CHRONIC BRONCHITIS CHRONIC BRONCHITIS 2 EMPHYSEMATOUS LUNG EMPHYSEMATOUS LUNG

MIXED

GOLD [ [NHLBI WHO ] ] GOLD NHLBI WHO GUIDELINES MANAGEMENT STRATEGY GUIDELINES MANAGEMENT STRATEGY OF COPD OF COPD WHO 2020 MORTALITY 3 million/year

MORBIDITY & MORTALITY IV in USA

HOSPITAL MORTALITY 10 %

INCREASING PROBLEMS OF COPD

WORSEN HEALTH STATUS

INCREASE OF 51 % ACUTE EXACERBATION INCREASE OF 51 % ACUTE EXACERBATION IN HOSPITAL ADMISSION BETWEEN 1991 - -2000 IN HOSPITAL ADMISSION BETWEEN 1991 2000 PREMATURE DEATH

Trigger factors: -smoke of ciggarete An active smoker A passive smoker Why COPD can happened? -chronic bronchitis -emphisema -both of them -air polution Indoor polution Smoke of stove Outdoor polution smoke of vehicle Iritation particle, chemicle stuff, dangerous gasoline. -infection of under of respiratory way

PATOGENESIS of CHRONIC BRONCHITIS

PHATOGENESIS OF EMPHYSEMA

SIGN AND SYMPTOMS

Increases of sputums volume A progressive dyspnea chest tightness A purulent sputum Increases of broncodilator indeeed Weakness,tired

Physical examination -fever -wheezing