A summary about COPD (chronic obstructive pulmonary disease). It includes broken down information on bronchitis, bronchiectasis and emphysema. This includes epidemiology, pathophysiology, clinical manifestations, risk factors, medical management and nursing management
Chronic Obstructive Pulmonary Disease (COPD)
Definition - a group of disorders which cause irreversible damage to the lung
parenchyma and obstruction to airflow
Included in this group are: Chronic bronchitis, Bronchiectasis and Emphysema
Characteristics
Chronic bronchitis - inflammation and constant productive cough obstructs air
flow
Bronchiectasis - damage to bronchial walls resulting in irreversible dilation of
the bronchi and bronchioles with accumulation of thick secretions leading to
respiratory failure
Emphysema - overdistention of alveoli with reduced permeability results in
impaired gaseous exchange
Epidemiology
One of the leading causes of morbidity and mortality in the world
Estimated currently over 280 million cases in the world, a significant proportion
of whom are undiagnosed
Prevalence of COPD is projected to rise owing to increased exposure to risk
factors and population ageing
A study that investigated the prevalence of COPD in various countries showed
that COPD prevalence varied considerably in different countries, with a range of
6 - 19% for stage >2 COPD (clinically significant disease) and 12 - 26% for stage
>1 COPD
South Africa had the highest prevalence of stage >2 COPD (19% overall, 22%
male and 17% female)
- Greater than the general South African prevalence - higher incidence of
smoking, occupational dust exposure, indoor pollution and prior tuberculosis
in the area studied
- Unlike other chronic diseases, COPD mortality for both men and women are
increasing
The Global Burden of Disease Study has projected that COPD, which was ranked
6th as the cause of death in 1990, will become the third leading cause of death
by 2020.
, Chronic Bronchitis
Definition – the presence of a persistent productive cough for at least 2 months
over two consecutive years
Can occur in any age group but is common in:
- Middle aged men
- Cigarette smokers
- People exposed to high levels of environmental pollution
Pathophysiology
Chronic inflammation of tracheo-bronchial tree
Hyperplasia of mucus-secreting glands in trachea and bronchi and goblet cells
Excessive mucus production → plugging of airways, obstructing airflow
Chronic inflammatory changes and narrowing of small airways
Disappearance of cilia
Imbalance between ventilation and perfusion → hypoxia and hypercapnia
Chronic, ineffective coughing → irritation of airways → production of excessive
and thick sputum
Infection risk because of
- ↑mucus secretion
- ↓ciliary action
- Frequent colonizing of airways with micro-organisms
Clinical Manifestations
History of cough and/or sputum production for many years
Clinical picture progress over a number of years
Dyspnoea on exertion (later in disease)
Cyanosis
Hypoxia and hypercapnia
Crepitations / rhonchi on auscultation
Onset 20-30 years
Tendency towards obesity
Recurrent respiratory tract infections
Known as the “Blue Bloater” (blue-ish red colour of the skin)
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