Andriy Lepyavko, MD, PhDDepartment of Internal Medicine № 2

1. Etiology, pathogenesis of COPD2. Diagnostic criteria3. Principles of treatment4. Step-by-step treatment

COPD and Bronchial Asthma are the most common diseases of lungs

4-10 % of adult people are ill with COPD

In Europe 7,4 % of people have COPD

Mortality of such patients is 10 %

According GOLD 2006 COPD – this is disease which is

characterized by combination of clinical signs of chronic obstructive bronchitis (inflammation and narrowing of bronchi) and emphysema (changes of lung tissue structure).

Permanent hyperactivity of parasympathetic Permanent hyperactivity of parasympathetic nervous system nervous system with hyperproduction of with hyperproduction of acetylcholine, bronchial spasm and hypersecretion acetylcholine, bronchial spasm and hypersecretion of mucusof mucus

Insufficiency of adrenal receptors in bronchial Insufficiency of adrenal receptors in bronchial wallswalls as the result of deep morphological changes as the result of deep morphological changes with bronchial hypersecretion, bronchial spasm and with bronchial hypersecretion, bronchial spasm and coughcough

Bronchial hyperreactivity Bronchial hyperreactivity which is characterized which is characterized by immune inflammation of bronchioles walls by immune inflammation of bronchioles walls

All that lead to:All that lead to: 1) 1) narrowing of bronchiolesnarrowing of bronchioles; ; 2) 2) development of emphysemadevelopment of emphysema

1.Hypersecretion of mucus2.Dysfunction of ciliary epithelium 3.Decreasing of air flow in bronchi 4.Hyperpneumatization of lungs 5.Disturbances of gases-exchange 6.Pulmonary hypertension 7.cor pulmonale

Severe smokingOccupational diseasesFamily anamnesis

Chronic cough is the earliest sign of COPD and arise earlier then dyspnea

Sputum – as a rool in small amount, after cough

Dyspnea – persistent, progressive, becomes worse during physical activity and in severe cases – even if patient is calm

Central cyanosis, emphysematous chest, additional breathing muscles are necessary for breathing

Increasing of breathing rate, decreasing of its deepness, prolongation of expiration

Percussion: decreasing of heart dullness Auscultation: wheezing, dry rales, heart tones are

dull

Investigation of external breathing (spyrometry);

Bronchodilatation test; Cytology of sputum; Blood analysis; X-ray; ECG; Blood gases;

FVC – max air volume which is expired during forced expiration after max inspiration;

FEV1 (<80 %) FEV1/FVC (<70 %) Peak flow (of expiration)

Lungs are enlargedDyaphragm is located lower than

normallyNarrow heart shadowSometimes – emphysematous bullas

Is necessary to find bronchial reversibility

Spyrometry has to be provided before and 15 min after inhalation of 400 mkg of Salbutamol (or 30-45 min – 80 mkg of Ipratropium)

Increasing of FEV1 more than 15 % tells us about reversibility

Stage and severity  Signs

І, mild 

- FEVІ < 80% , FEV1/FVC < 70% - As a rule chronic cough with sputum

II, moderate 

- 50%< FEVІ < 80% - FEV1/FVC < 70% - Symptoms are more significant, presence of dyspnea during physical activity and exacerbation

III, severe 

30%< FEVІ < 50% FEV1/FVC < 70% - Symptoms cause worsening of life quality

IV, very severe - FEVІ < 30% FEV1/FVC < 70% and CRF

Increasing of intensivity of treatment in correlation with COPD severity;

Permanent basis therapy; Individual sensitivity of patients to

different medicines leads to necessarity of permanent control;

Inhaled medicines are useful.

Short action – (Ipratropium bromid, Berodual Н) has more slowly beginning but longer action than β2-agonists

Prolonged action – (Thyotropium bromid, Spiriva ) is active for 24 hours

agonists of short action (Salbutamol, Fenoterol) – fast beginning of action, but duration – 4-6 hours

2-agonists of prolonged action (Salmeterol, Formoterol ) are active for 12 hours.

Theophyllines of prolonged action are useful – Teopec, Teotard.

Are useful for permanent basis therapy for patients with COPD III-IV st.

Inhaled GCS are used. Prednisone may be used only during

exacerbation and is not recommended for basis therapy

Inhaled GCS (Beclomethasone, Budesonid, Fluticasone).

Seretid (GCS+Salmeterol) is used in patients with III-IV st. of COPD and oftern exacerbations in anamnesis.

Thanks for your attention!