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COPD

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Nicole Madden

on 27 August 2015

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Transcript of COPD

C
hronic
O
bstructive

P
ulmonary
D
isease

What is COPD?
Chronic obstructive pulmonary disease is a preventable and treatable, slowly progressive
respiratory disease of airflow obstruction involving the airways, pulmonary parenchyma, or both.
There are two types of COPD:
Emphysema
Chronic Bronchitis
Although it is treatable, the airflow or obstruction in COPD is not fully reversible.
Emphysema
Emphysema results from the destruction of alveoli walls due to over distention, causing impaired oxygen and carbon dioxide exchange.
Inflammatory response disrupts lung tissue increasing in dead space, lung area where no gas exchange can occur.
Hypercapnia, decreased pulmonary bed size, right ventricular hypertrophy, and hypoxia result.
Two types of Emphysema
In panlobular type, the respiratory bronchiole, alveolar duct, and alveolus are destroyed and air spaces within the lobule are enlarged.
In centrilobular, the pathological changes occur in the lobule, whereas the peripheral portions of the acinus are preserved, leading to central cyanosis secondary to chronic hypoxemia and hypercapnia, respiratory failure, right sided heart failure, in which the patient develops peripheral edema.
Chronic Bronchitis
Chronic bronchitis is defined as the presence of cough and sputum production for at least three months in each of two consecutive years.
Smoke or other environmental pollutions irritate the airways causing:
Inflammation and hypersecretion of mucus.
Over production of mucus
All the mucus impedes ciliary function.
Bronchial walls become congested with mucus
Patient becomes susceptible to respiratory infections due to altered function in the alveolar macrophages, which help play a role in destroying bacteria and foreign particles.
What causes Chronic Bronchitis?
Risk Factors
exposure to tobacco smoke accounts for 80% to 90% of cases
exposure to second hand smoke
increased age
environmental/occupational exposure- dust, chemicals, or air pollution,
Genetic abnormalities- deficiency of alpha1-antitrypsin.
Symptoms
Three primary symptoms
Chronic cough
Sputum
Production
Dyspnea
As symptoms worsen...
Dyspnea worsens.
Increase in the use of accessory muscles to aid in the work of breathing.
Depletion of energy results.
Weight loss results in many patients.
Chronic hyperinflation and loss of lung elasticity leads to a barrel chest configuration of the thorax.
With advanced emphysema, the abdominal muscles
may also contract on inspiration.
Arterial blood gas is used to measure a baseline oxygenation and gas exchange.
CT and chest x-ray is used to exclude alternative diagnoses.
Alpha1-antitrypsin deficiency may be performed for patients over 45 or those with family history of COPD.
Diagnostic Process for COPD
Spirometry is used to evaluate airflow obstruction.
Managing COPD
Smoking cessation is the single most cost effective intervention to reduce the risk of developing COPD.
Bronchodilators relieve bronchospams by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation
There are many classes of bronchodilators, which can be short or long acting, including:
Beta-adrenergic agonist (albuterol -Proventil).
Anticholinergic agents (ipratropium bromide- Atrovent).
Methylxanthines (theophylline -TheoDur).
Combination agents (salbutamol/ipratropium -Combivent).
Other medications used in the treatment of COPD include:
Corticosteroids
Antibiotic agents
Antitussive agents
Vasodilators
Narcotics
Alpha1-antitrypsin augmentation therapy.
Vaccines, such as the influenza and pneumococcal vaccines, are recommended to help prevent exacerbations by preventing respiratory infections.
Oxygen therapy can be administered for long-term continuous therapy, during exercise, or to prevent acute dyspnea during an exacerbation.
The goal of oxygen therapy is to give sufficient oxygen to improve oxygenation and decrease hypoxemia and hypercapnia.
Surgical management:
Bullectomy
Lung volume reduction
Lung transplantation.
Long Term Goal Care Plan
American Lung Association
The American Lung Association is the leading organization working to
save lives by improving lung health and preventing lung disease through education, advocacy and research.
88 cents out of every dollar donated to the American Lung Association goes to program services offered nationwide.
Funding is used for fighting:
Lung disease
Childhood Asthma
Lung cancer
First & second hand smoking
Healthy air
Flu
Finding a cure
Contact the American Lung Association:
www.lung.org
1-800-LUNG-USA
Or in local offices.
The Lung Help Line connects you to a nurse or a respiratory therapist who will provide education and information on local resources.
The American Lung Associations Helpline also provides translating services that support 200 different languages.
Information provided via phone:
How to take prescribed medications.
Physicians list
Related educational materials
Information on disease
List of FDA approved treatments
List of clinical trials from ClinicalTrials.gov
Confidentiality for clients
References
Lipsi, Roberto, Rogliani, Paola, Calzetta Luigino, Segreti, Andrea, Cazzola, Mario (2013). The Clinical use of Regenerative Therapy in COPD.

The International Journal of COPD. http://www.dovepress.com/the-clinical-use-of-regenerative-therapy-in-copd-peer-reviewed-article-COPD. Retrieved 8/22/15 @ 1900

Schöler, Hans R. (2007).
"The Potential of Stem Cells: An Inventory". In Nikolaus Knoepffler, Dagmar Schipanski, and Stefan Lorenz Sorgner. Humanbiotechnology as Social Challenge. Publishing. p. 28.

Studies on animals and humans have demonstrated that tissue specific
stem cells and bone marrow (BM) derived cells contribute to lung
tissue regeneration and protection (Lipsi et al, 2013).

Administration of exogenous stem cells or the humoral factors
responsible for the activation of endogenous stem cells may be a potent
next-generation therapy for COPD.

Stem Cell Therapy
There is some lung
regeneration in humans like
the spontaneous formation of
new lung acini after a partial
pneumonectomy (PPN).
Unfortunately it only occurs
in children younger than 3
years old and not adults.

PPN
The basic concept behind stem cell
therapy when it comes to
regenerating lung tissue is
epimorphosis (Lipsi et al, 2013).
Epimorphosis is the phenomenon
seen in salamanders when they
regrow tails, deers re-growing
antlers and rodents re-growing digit tips.

Regeneration

Engraftment of BM-derived stem cells into the lungs could allow us to
repair and regenerate damaged tissue present in the COPD patient.


Another approach being looked at is the possibility of in-vitro
stimulation of stem cells that would be subsequently introduced into the
body by means of photobiostimulation (laser therapy).


Stem Cell Therapy
Stem cell therapy is the use of stem
cells to treat or prevent a disease or
condition (Scholer, 2007). The most
widely used stem cell therapy is
bone marrow transplant but some
therapies involve umbilical cord
blood. In view of the current
disappointing status of available
pharmaceutical agents there is a
urgent need for alternative
approaches to the treatment of
COPD.

Stem Cells
And to possibly replace
malfunctioning or damaged tissue

Regenerative or stem cell therapy
is an emerging field of treatment
based on stimulation of
endogenous resident stem cells or
administration of exogenous stem
cells to treat disease or injury

Regenerative/ Stem cell therapy



Maurice Madison


The Clinical use of Regenerative Therapy in COPD

Short Term Goal Care Plan
Full transcript