15. giáo trình COPD tiếng anh
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (3.87 MB, 66 trang )
Chronic Obstructive
Pulmonary Disease
DEFINITION OF COPD
Normal
COPD
Chronic Obstructive Pulmonary Disease
(COPD) is characterized by persistent
airflow limitation that is usually progressive
and associated with an enhanced chronic
inflammatory response in the airways and
the lung to noxious particles or gases
COPD is preventable and treatable. The
patients with COPD have comorbidities
DEFINITION OF COPD
Mortality of COPD in The World
Trevor Hansel, Peter Barne (2004)
THE RICK FACTORS OF COPD
Environmental factors
Cigarette smoking
Exposures to indoor and
outdoor air pollutants
Occupational exposures
Respiratory infections
Socioeconomic Status
Local factor
Genetic
Airway
hyperresponsiveness
Age
Gender
The inflammation in the lung
Oxidative
stress
Proteinases
Tissue
reconstruction
Anti-proteinases
Anti-oxidants
Local factors
Exposure to Particles
Pathogenesis of COPD
Pathology of COPD
Nguồn
: Peter J. Barnes, MD
Hypoxic
Vasoconstriction of small
pulmonary arteries
• Smooth muscle
hypertrophy
• Intimal
hyperplasia
• Fibrosis
• Embolism
Pulmonary hypertension
Right-side cardiac
failure
Mortality
Edema
Pulmonary Hypertension in copd
Peter J. Barnes, MD
Clinical Course of COPD
Air Trapping
Expiratory Flow Limitation
Breathlessness
Inactivity
Poor Health-Related Quality of Life
Hyperinflation
Deconditioning
COPD
Disability Disease progression Death
Reduced Exercise
Capacity
COPD
Exacerbations
1. Chronic bronchitis
2. Obstructive bronchiolitis
3. Emphysema
4. Pulmonary vascular disease
5. Systemic Features
Pathology
1. Chronic bronchitis
Dyspnea, chronic
cough or sputum
production
Pathology
Exertional dyspnea
Acute dyspnea
( FEV1 < 50%)
Pathology
2. Obtructive bronchiolitis
Exertional dyspnea
Pathology
3. Emphysema
4. Pulmonary vascular disease
Pulmonary
hypertension
Right-side cardiac
failure
Pathology
Mechanisms of Airflow Limitation in COPD
Barnes PJ. N Engl J Med. 2000;343:269-280.
Emphysema
CHRONIC SYSTEMIC INFLAMMATORY SYNDROME
Skeletal muscle
wasting and
cachexia
Heart disease
Metabolic
syndrome/diabetes
Osteoporosis
Depression
Fabbry et al. ERJ : 31;204-212,
2008
Symptoms suggestive of COPD
1. History with exposure of risk factor
2. Dyspnea, chronic cough or sputum production
3. Dyspnea that is: Progressive (worsens over time)
4. Physical examination:
Barrel shaped chest
Decreased breath sounds
wheezing sounds or crackles in the lungs heard
Signs of Right-side cardiac failure
Module D - 17
Barrel shaped chest
Systemic features
Skeletal muscle wasting and cachexia
Incresing the risk of heart disease
Metabolic syndrome/diabetes
Osteoporosis
Depression
Decreased quality of life
1. Blood count, arterial blood gas
2. Spirometry
3. Chest X-ray: exclude other lung diseases
excluding alternative diagnoses as Cancer lung,
Bronchiectasis, Tuberculosis
4. ECG (signs of pulmonary hypertention and cor
pulmonale): P pulmonale, right axis deviation, right
venticular hypertrophy/strain
TESTS
Radiology
Normal
Images courtesy of Denis O’Donnell, Queen’s University, Kingston, Canada
COPD
Male, 69T - COPD
Radiology
Mild
Severe
Radiology
Spirometry
Spirometry is critical for
screening, diagnosis and
management!
Symptoms do not correlate
well with spirometry
Symptoms do not predict
prognosis
Symptoms may not detect all
responses to therapy
Spirometry
--> 
