Oleh dr.

Edi Hidayat

Definition
COPD

a preventable and treatable condition, which is

characterised by chronic slowly progressive airway
obstruction.
It is a major cause of morbidity and the 4th leading cause
of death worldwide;
it is expected to be the 3rd leading cause of death by
2020.

 Studies in Europe estimate the prevalence of COPD to

be approximately 10%.
European studies in people aged >70 years showed a
prevalence of COPD of 20% in men and 15% in women.
COPDGOLD 2013
COPDNational Institute for Health and Care Excellence
(NICE).

PATHOPHYSIOLOGY
Inhaled cigarette smoke and other noxious particles

cause an inflammatory response which induces

parenchymal tissue destruction and narrowing of the
peripheral airways leading to progressive airflow
obstruction.
Exacerbations of COPD, defined as increased cough,
dyspnoea or sputum production, are triggered by factors
including infection (bacterial and/or viral) and
environmental pollutants
Pulmonary hypertension may develop late in the course
of COPD due to hypoxic constriction of small pulmonary
arteries; this may progress to right ventricular
hypertrophy and cor pulmonale

 The prevalence of COPD is directly related to the

prevalence of cigarette smoking

Other risk factors for COPD include older age,

occupational exposure to noxious particles, passive

exposure to cigarette smoke, early childhood lung
infections and alpha-1 antitrypsin deficiency.

DIAGNOSIS and ASSESSMENT

A clinical diagnosis of COPD should be considered in any

patient > 35 years with risk factors for COPD, and

symptoms that include dyspnoea, chronic cough or
sputum production
The diagnosis of COPD is based on a combination of
history and physical examination with confirmation of the
diagnosis using spirometry.
The presence of a post-bronchodilator FEV1/FVC < 0.70
confirms the presence of persistent airflow limitation of
COPD.

 In addition to spirometry, patients require a chest x-ray to

exclude other conditions such as lung cancer and

tuberculosis.
ECG and echocardiography (to assess cardiac status if

there are clinical features of cor pulmonale.

MANAGEMENT
The main goals in the management of COPD
1.reducing symptoms
2.reducing the rate of lung function decline
3.preventing exacerbations
4.reducing mortality.
multidisciplinary approach involving non-pharmacological

and pharmacological treatment is recommended.

Non-pharmacological treatment
Smoking cessation is the intervention which has the

greatest capacity to influence the natural history of COPD

and is the key intervention for people who continue to
smoke.
Patient education is an essential aspect of COPD
Long-term administration of oxygen therapy (LTOT) (> 15
hours per day) in patients with chronic respiratory failure
has been shown to increase survival in patients with
severe resting hypoxaemia.

Pharmacological Management

Management of exacerbations:
Exacerbations of COPD can be precipitated by several

factors including respiratory tract infections (viral or

bacterial)
Bronchodilators, corticosteroids and antibiotics
SABAs, with or without SAMAs are usually the preferred
bronchodilators for treatment of an exacerbation
A recent RCT supports the use of 5 days treatment with
oral corticosteroids for exacerbation of COPD, but most
guidelines recommend 30-40mg prednisolone for 7-14
days.

 The choice of antibiotic therapy to use in COPD should

be based on the local bacterial resistance pattern

Irish guidelines recommend first line primary care
treatment with amoxicillin or doxycycline or
clarithromycin; combinations of antibiotics are not
required for COPD
Hospital management includes respiratory support with
oxygen therapy and ventilatory support

THANKS