Chronic Obstructive Pulmonary Diseases (COPD)

It involves damage to the airways and alveoli , narrowing of airways is IRREVERSIBLE,unlike in BA

Chronic bronchitis (always forget the definition yet it’s important): it’s characterized by chronic productive cough for successive 3 months for at least 2 successive years

Emphysema is abnormally dilated alveoli due to the loss of its elastic recoil it’s characterized by increasing compliance of alveoli,

Both of them are directly related to Smoking, though consider alpha-1 antitrypsin deficiency (elastase gone Wild!) in children who develop emphysema

CXR: hyper translucency due to hyperinflation, 
 ABG would show  respiratory Acidosis , alkalosis would develop in acute exacerbation !

Spirometry would show increase RV and decreased FEV and FEV1/ FVC ratio

Complications: CHRONIC HYPOXIA would lead to chronic Hypoxaemia ! Pulmonary HTN and eventually Cor-pulmonale

Hypoxaemia is drop in Pa

Management of COPD

O2 O2O2O2O2, can’t stress on myself more than that and yet imagine it or not I always forget it
 

In fact in home managed COPD : O2 is essential to be administered at home, particularly in patients who develop hypoxemia with O2 saturation below 88% because Pa O2 tension would be nearly fifties,, revise Oxy-Hb dissociation curve!

Ipratropium bromide (inhaled anticholinergics) is superior to short acting B agonists because in most cases of COPD would present to you with heart failure or even associated with a coronary artery disease (SMOKERS why do you do that for yourselves ?!!), so you have to consider that B agonists may exacerbate the condition
  !

Theophylline would carry also the same risk particularly if their toxicities increased with consequent use of Cipro or Macrolides commonly used in these conditions (remember cyt p450 inhibitors : ))

Corticosteroids:

Unlike asthma inhaled corticosteroids have not a significant contribution in management of these cases,

What I understood about its rule that it may be beneficial during acute exacerbations that it _as mentioned_ reduces period of admission and speeds up recovery

Always add antibiotics !!!