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Chronic Obstructive Pulmonary Disease

A presentation to understand this deadly and progressive disease.

Pallas Chan

on 26 September 2013

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Transcript of Chronic Obstructive Pulmonary Disease

Chronic Obstructive
Pulmonary Disease

By: Pallas Chan
(Canadian Lung Association Representative)

What's COPD?
Causes of COPD
COPD is a lung disease that is basically the constant blocking of airflow within the lungs. This is mainly due to smoking or second hand smoking. Countries/people who are most affected are the ones with low to middle class income, although it can affect high class people as well because of their usage of tobacco. This incurable disease is very dangerous, and along with diagnoses for bronchitis, emphysema and other respiratory diseases an individual could be diagnosed for COPD as well.
This symptom of COPD is when a person basically has mucus stuck within their airways and they find the need to expel it so they cough and wheeze to try and get it out. Although there is a technique recommended by the Lung Association of Canada that may help: First they should take in a slow and steady breath and hold it for 2 seconds, after the person should cough softly through a small slit of their mouth (can be repeated) and this will hopefully get the mucus slightly away from your airway lining and the second cough should expel it, after sniff softly, but do not take a deep breath because mucus may come back and the last thing to do is take a rest.
AAT Deficiency
This respiratory disease could be because of one of many things, although smoking is the main cause.
a lung disease that is reversible, but affects more than 100 million people all over the world, although this disease can be reversed, it can also become more fatal. There are specific triggers to make people swell in airways which make it harder to breathe. This happens because people may be, people may cough trying to get mucus out of their system or sometimes people wheeze when trying to get air into the infected airways. Some causes for this to happen may be because of dust, animal fur, feathers or scales, smoking, acid reflux, strong odours, exercise, respiratory infections, etc. Typically when people have asthma it can be treated with proper medication and the attacks tend to be episodic which means that they could be here during one period of time and be gone for a long period of time.
A condition that is diagnosed in smokers or ex-smokers (50-75 years of age), they suffer from fatigue, shortness of breath (usually first noticed in heavy exercise). As this disease progresses, breathlessness begins to occur even in the lightest of the activities, this triggers depression and the inclination to do less and less in order to prevent being breathless, this causes the individual to become physically less conditioned and more fatigued (when ironically they really should be doing more to prevent this). In this disease the alveoli become more damaged and then rupture and are destroyed, this makes large holes in the lungs that trap air, making it difficult for the lungs to perform the exchange of oxygen and carbon dioxide. Having lost their elasticity, the air sacs can't expel carbon dioxide during expiration, so breathing is more difficult, stagnant air in alveoli can’t supply adequate oxygen to the capillaries to service the rest of the body. It also creates a place for bacteria to grow, at the same time, carbon dioxide levels increase in the blood, causing fatigue, headaches and a sense of lethargy, the most common cause for this disease is smoking, other factors would be air pollution, cooking in non-ventilated areas, genetics, etc.
Bronchitis is when your bronchi are inflamed because they have been infected, this condition is not considered chronic until you have a cough that brings up sputum and has to have been continuous for 3 straight months to 2 consecutive years, you may not have trouble breathing (called non-obstructive bronchitis- no shortness of breath). Typically happens to people over the age of 40 who are or were moderate or heavy smokers, with the years of built up cigarette smoke, your airways in your lungs become more narrow because of the scarring, they also become clogged with a lot of excessive mucus that you’ve been trying to cough up, this makes it hard to breathe
AAT (alpha-1-antitrypsin deficiency) is needed to create a protective layering to protect the lungs’ elastic fibers. AAT is produced by the liver, people with this deficiency basically have a fast pacing type of emphysema, and this disease usually starts around the age of 40, and if a person smokes, this disease may start much earlier.
-by the time that you realize that you have this serious disease, it’ll have already done serious lung damage
When you realize that you are coughing, losing weight without trying, have lung infections, feel weak, always tired, wheezing , when you find yourself breathless while doing simple activities or if you feel depressed, you should find help immediately, these could be signs of COPD.
Smoking: 80%-90% of patients infected with COPD were smokers. This is a major factor for all respiratory diseases and many other serious conditions within the body. In terms of COPD, smoking will cause the cilia (microscopic, hair-like, wave-like moving hairs in your bronchial tubes to basically be paralyzed). The cilia’s natural use is to take out foreign matter from the lungs. Although when the cilia cannot function, the foreign matter will stay within the lungs and clog them, eventually clogging the airway passages.
Bad Environment: We all know that, in the current generation although people have been trying to change and try to become environmentally friendly, our environment is still very bad and there is a lot of pollution. On Earth, 75% of people currently live in areas with a dangerous amount of ozone air pollution which is basically known as smog. This may be caused by cars, excessive forestry, big air polluting companies and people just throwing garbage all over the place. In addition to a dirty environment that can cause COPD, people could be working with bad chemical fumes, dampness, or dust. These jobs could include working with aerosol, paints or wood; people with these jobs could be at risk.
Genetics: Sometimes it is not just external factors and other things that cause COPD; it could be because of a person’s genetics. At an early age a child could have AAT deficiency or later on in life if a past or current member of a individual’s family has had COPD, that person could also end up with the same disease. So it is a good idea to have a physician to check for family medical records and if possible diagnosis this disease early before it starts to progress.
Physical Examinations:
Diagnosing COPD
Vital Signs Check- Up:
Temperature Check, Blood Pressure, Breathing Patterns
Air Density Check by percussing (tapping) your back
using a stethoscope to check your heart and lungs to check for irregular beats, while doing this the doctor may observe your neck to see if you need it to inhale and exhale, if so you may have weak respiratory muscles
a check on the legs and ankles for swelling (peripheral edema), which means that you may have fluid retention which could lead to heart problems
also sometimes looking at a person’s skin colour or fingernails can be helpful because a person could have cyanosis, which basically means that you are not getting enough oxygen in your body
Diagnostic Testing:
Pulmonary Function Test (PFT):
One of the best ways to detect COPD is the spirometry. What you do in this test is basically take a deep breath and blow out as hard and fast as you can in the spirometer. This tool will measure the amount of volume of air in your lungs and will also measure your air flow which is the speed of air you just blew at. At times, before this test you may be asked to inhale medications to check your reaction to them. If you feel dizzy or experience any pain from this tell your doctor immediately. After this test, your doctor will tell you the forced vital capacity (FVC) and your forced expiratory volume in one second (FEV1).
A Chest X-ray:
When taking an x-ray your doctor may take a front and side picture of your chest to see you heart and lungs to see what may cause any respiratory condition. During this x-ray you may be asked to hold your breath. If the results of the x-ray may not show anything, your doctor may run other tests to be certain that there is nothing wrong.
Electrocardiogram (EKG):
During much progressed stages of COPD, a doctor can see any abnormal straining of the right side of your heart when pumping blood back through the lungs to take in oxygen and expel carbon dioxide.
Computerized Tomography (CT) Scan-non-invasive:
This scan uses really thin X-ray beams to take computer generated pictures to show your doctor 2D views of your organs. This test is used to check for emphysema and much progressed stages of COPD, it may take between 30-60 minutes and all you have to do is keep still while strapped on an X-ray bench/table.
Analyzing Sputum:
This is a basic check of the cells in your sputum (spit)
Exercise Stress Test:
This test is to basically test your heart rate and use of oxygen while you’re on a treadmill wearing the average athletic equipment and you will be strapped to some special tools to measure your heart’s rate and your breathing while you run at different speeds and levels on the treadmill. On the treadmill, you do not have to worry about overexerting because a doctor will be monitoring your progress.
Arterial Blood Gas Test (ABG) - very invasive:

This somewhat painful this is basically to check how well your lungs can take oxygen to the blood and expel carbon dioxide. Instead of taking your blood from a vein, the doctor will be taking it from an artery which is why this test is a painful even with anesthetics (ex. Lidocaine) because arteries are deeper than veins are. Before taking this test inform your doctor on any blood thinning medications.
Pulse Oximetry- non-invasive:
In this test you are tested to see if you need extra oxygen when you exercise or sleep, and you are just attached to a little clothespin clip on your finger or earlobe and the oximeter will measure the amounts of oxygen.
The Progressing COPD
What can you expect to happen?
-over time COPD causes your lungs to become swollen and as well, mucus starts to build up
Other issues that could possibly happen due to the progression of COPD.
Additional Conditions:
frequent chest infections (Ex. Pneumonia)
pulmonary hypertension (increase of blood pressure in the arteries within the lungs)
heart conditions
osteoporosis or osteopenia (thinning of the bones)
eye problems (Ex. Glaucoma)
cachexia (losing body mass, muscle, losing your appetite, feeling weak)
lung cancer
Depression and Anxiety- As this disease progresses, a person will find themselves trying to conserve as much energy as possible by doing as little as possible even if it means that they have to stop doing what they love the most. Former smokers will feel guilty and feel as if others are less sympathetic because smoking is what caused this. In addition, doing household chores and other simple tasks may be get harder and a person will need more help from their friends and family and the person suffering from this disease will feel like a burden. A person will also fear that they may not be able to control their fate and they don’t know what will happen to their family. Fear and anxiety is only natural, but to get rid of these emotions you could talk about them.
Weak Muscles- This is due to the lack of nutrients (mal-nutrition) which means the lack of oxygen and calories around the body will cause weak muscles and a person will also lose their motivation for exercising. Although ironically a person with COPD should really be doing aerobic exercise (exercise without using more air than your body can supply) and this will improve their lungs and heart and after exercising a person will be happier and will feel less helpless and isolated.
Less Energy- When having COPD, your lungs lose their elasticity and you need more energy to breathe. In a normal person’s lungs, they only need a bit of energy to inhale, but people with COPD, they have to use energy to exhale. Typically people with COPD use more calories therefore there are less nutrients going to your muscles and the rest of the body, which will make a COPD patient weaker and want to do less and less especially in terms of eating and cooking. They will take a more convenient route and just eat precooked or prepackaged foods which are really bad for a person’s health in general.
What are some way to prevent this life-threatening disease?
Prevention Techniques:
keep the environment clean (stop pollution)
keep a healthy diet and stay active
take the flu shot, and the shot against pneumonia when you are young
stay away from smokers and people who may seem to have symptoms of contagious respiratory diseases
wash your hands (scrub for 25 seconds), use hand sanitizer, have good hygiene (most respiratory diseases begin with the hands), don't excessively wash or use hand sanitizer, you will kill off healthy bacteria
create new laws about smoking in many public places (no smoking near malls, offices, hospitals, schools), smoking should only be legal on designated private property that is owned by the smoker (in buildings where there are lots of people; smoking shouldn’t be tolerated)
When diagnosed with a serious disease like COPD, a close helping hand is sometimes the best medicine.
Someone who can help...
Healthy Lungs V.S. Unhealthy Lungs
What's the difference?
Healthy: They are pink and spongy, and similar to a balloon they will expand and return to their original shape, this is during inhalation and exhalation. Healthy lungs have a great elasticity and e a great reserve capacity, typically a person will not completely fill their lungs with air because the diaphragm puts enough air in the body. In the lungs there are also cells that are called stretch receptors that line the lungs and the chest; these cells keep an individual from over inflating their lungs and stretching their lungs enough to damage them, when taken enough air these cells will tell you to exhale.
Unhealthy: They will lose the ability to exchange gases and will make a person feel as if they don’t ever have enough air, they lose elasticity, airways are more narrow and clogged and air sacs may stay inflated making it harder to exhale, meaning that when breathing quickly you can get air out before you take in another breath. Also within the lungs air sacs (alveoli) are damaged, leaving only bigger air sacs (bullae) to exchange gases which will make a person feel a short of breath.
Your family doctor/physician (first to see when you realize that you are having difficulties with your health)
A pulmonologist recommended by your physician (what does a pulmonologist do?)
Family and friends (can help with anxiety and medications)
What's a pulmonologist?
Treatment Techniques:
Having this disease what can you do?
When seeing a physician for COPD, they may refer the patient to go see a pulmonologist which is basically a doctor with specialized training in the functions of lungs and the diagnosis and treatment of lung diseases. When seeing a pulmonologist, they will want to know how you breathe and how much gas exchange occurs within your body. They will also test your ability to do simple tasks such as walking up the stairs, in addition to these tests, they will run a spirometry test, maybe some x-rays, echocardiograms (heart ultrasounds) and maybe a bronchoscopy (looking inside, maybe removing fluid/tissue within the bronchial)
Although COPD is not a curable disease, it can be treated. A doctor can help you create a plan to improve your lifestyle while living with this disease. This treatment plan will help you improve your lungs’ abilities; it’ll help you lessen your disability to do things and prevents you from dying earlier. Also before you let your doctor treat you, tell them your philosophy of treatments.
Some Treatments Options:
-these are used when the bronchial are constricted and/or full of mucus
3 Types:
Beta-agonists- tells your muscles in your smaller airways to relax (making them open up), side effects include: faster heartbeat, cramps, shaking, anxiety
Anticholinergics-not letting larger airways tighten side effects are usually just a cough and a dry mouth
Theophylline- helps diaphragm work better and reduces swelling within the lungs, has serious side effects (headaches, heartaches, stomach pain, loss of appetite, troubles when sleeping, vomiting, sezures)
Short Acting Bronchodilators:
Beta-agonists- to relieve breathlessness within 3-5 minutes, to be taken to prevent breathlessness in the near future, take them with you wherever you go, some brands include: Proventil, Alupen, Bronkosol, etc.,
Anticholinergics- 15 minutes, not good for immediate relief, less side effects, some examples of brands include: Atrovent (inhaler/liquid) and Oxivent (inhaler)
Theophylline- lasts 6-12 hours, usually in tablet, liquid or IV form, this medicine when taken needs a doctor monitoring constantly with blood tests
Long Acting Bronchodilators:
Beta-agonists- lasts 12+ hours (newer), cannot be of any use when in need of it, overdoses can cause death, to be taken twice a day, one type is called Formoterol (sold under the name Oxis and Foradil).
Anticholinergics- only one type called tiotopium (sold under the name Spirvia), it is a powder type of inhaler, works within 20 minutes, take only once a day
Theophylines- taken once a day,capsule/liquid forms, can be taken with an empty stomach or with food (if having nausea or an upset stomach)
When describing treatments for COPD while using steroids, a person is not referring to the anabolic sports illegal substances, a person will be talking about the corticosteroids...
What is cortisol? A substance made by your adrenal gland that protects the body when stressed.
reduces swelling, mucus, breathlessness attacks when triggered by an infection
usually prescribed during severe stages (prevents inflammation), works well with other medications
once you make a habit of using corticosteroids do not suddenly withdrawal, your body has to get used to producing cortisol again because you could experience fatigue, muscle/joint pains and depression and maybe breathlessness will come bacl
inhalers (fewer side effects), pills, liquids, shots, intravenous solutions (liquids going into the veins)- these are the most common
inhaled types includeL Flovent, Pulmicort, Qvar, Advair
Oral Steroids- one type is called prednisone, it helps with worsening symptoms
Side Effects:
Oral Steroids- bruising, ankle/feet swelling, weight gain, higher sugar levels
Inhaled Steroids- thrush (yeast infection within the mouth or throat), happens if medicine stays within your mouth instead of being inhaled, this side effect can be prevented by rinsing your mouth after inhalation
Steroids in general can cause osteoporosis, high blood pressure and cataracts
This is typically the last treatment option for patients because surgery comes with many challenges later on. This is when medicine and rehabilitation methods are not working and when a case is severe.
There are 3 types of procedures that could be done, although the following 3 are to treat patients with extreme emphysema rather than a COPD patient with chronic bronchitis.
#1- Bullectomy:
This is surgically removing bullae within the lungs, a bulla is usually classified as huge when it is more than 1cm large but less than 1/2 a inch. If a bulla is really that big, it could destroy lung tissues and reduce gas exchange and blood flow within the lungs. Side effects may include being stuck on a ventilator, long hospital stays and heart diseases.

How is it done? 4 different ways, depends on the condition.
Thorasoscopy- used when there is only one bullae in a side of a lung, and a surgeon would basically make a small incision on the side of the chest and use a flexible tubed camera to find the bullae

Muscle-Sparing Thoracotomy- a large incision on the side underneath a armpit, and this puts less pressure onto the muscles

Median Sternotomy- this is when an incision is made on the sternum, giving the surgeon the ability to see the heart and the lungs and this is used when there are bullae on both lungs

Wedge resection/lobectomy- during a wedge resection, the surgeon will remove a "wedge" or a part of the lung that is infected, during a lobectomy the surgeon is removing an entire lobe
Lung Volume Reduction:
This is basically removing small parts of the lungs, allowing the diaphragm to work better and this surgery may be used while a patient waits for a lung donor. This is only used when you have extreme emphysema, you're not responding to medicine to rehabilitation methods, have no had this procedure done before, has quit smoking 4 months in advance and has not had heart bypass surgery (surgery to help treat blockage of coronary arteries). The one side effect is a high death rate between 6%-10%.

How is it done?
A surgeon will perform a open-chest operation and the destroyed lung tissue will be removed with a tiny camera and lasers and when it is removed to repair and mend remaining healthy tissue, the surgeon could use dissolving sutures (needle and thread application) or staples.
Lung Transplant:
This procedure is only done when both of your lungs have been completely damaged. Find a matching donor is also very hard because the donor has to match the size, blood and tissue types. Prior to the surgery you will also go through pulmonary rehab and after the surgery even more rehab while taking drugs called immunosuppressants to prevent your body from rejecting the new lung. The chances of survival are low, and after receiving them, you may only live for 5 more years. To be a candidate for a lung transplant you have to 65 years old or younger, given up smoking, cannot be underweight or overweight and you have to be able to walk.
Overall, COPD is a very serious disease and if you can prevent it from a early point on (don't smoke), please do because you won't have to go through as much later on in life and you can continue to be healthy.
Shimberg, Elaine Fantle. Coping with Chronic Obstructive Pulmonary Disease.
New York: St. Martin's Griffin, 2003. Print.
Felner, Kevin, and Meg Schneider. COPD for Dummies. Hoboken, NJ: Wiley
Pub., 2008. Print.
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Canadian Lung Association. N.p., n.d. Web. 01 Oct. 2012. <http://www.lung.ca/diseases-maladies/copd-mpoc/signs-signes/index_e.php>.
"Chronic Obstructive Pulmonary Disease (COPD)." WHO. N.p., n.d. Web. 01 Oct.
2012. <http://www.who.int/mediacentre/factsheets/fs315/en/index.html>.
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TopHospital. "Armin Ernst, MD Explains COPD." YouTube. YouTube, 25 July 2008. Web. 01 Oct. 2012.
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