C.O.P.D.

Charles Williams RRT, AE-C

 What is C.O.P.D.?
COPD is an acronym for Chronic Obstructive
Pulmonary Disease.

It is generally applied to patients who show

persistent airway obstruction and decreased
expiratory flow rates.
 What is C.O.P.D.?
‒ COPD is the 4th leading cause of death in
the United States.
‒ Approximately 14-16 million people in the
U.S. are currently diagnosed with COPD.
‒ COPD is the second leading cause of
disability.
‒ Men are 7x more likely to be diagnosed
with COPD than women.
Source: http://www.copd-international.com/library/statistics.htm
 What is C.O.P.D.?
Physical Appearance of COPD patients:
‒ Anxious
‒ Increased WOB/ use of accessory muscles
‒ Barrel-chested (result of air-trapping)
‒ Pursed-lip breathing
‒ Prolonged expiratory time
‒ Clubbing
‒ Cyanosis
‒ Diminished and/or adventitious breath sounds
 What is C.O.P.D.?
There are two main types of COPD:
‒ Chronic Bronchitis
‒ Emphysema
*Some patients have characteristics of both

Other obstructive lung diseases:

‒ Asthma
‒ Bronchiectasis
‒ Cystic Fibrosis
 What is C.O.P.D.?
Chronic Bronchitis:

‒ Chronic cough with excessive sputum

production for 3 months per year for 2 or
more consecutive years.
 What is C.O.P.D.?
Chronic Bronchitis:

‒ The lining of the airways are constantly

irritated and inflamed, becoming
permanently thickened.
‒ Mucous secreting glands increase in size
and number, producing excess mucous.
What is C.O.P.D.?
 What is C.O.P.D.?
Chronic Bronchitis
Causes:
‒ Cigarette smoking (leading cause)
‒ Air pollution
‒ Occupational exposure
‒ Chronic infections
 What is C.O.P.D.?
Chronic Bronchitis
Clinical manifestations:
Smoker’s cough
Morning cough
Chronic cough
‒ Sputum production gradually increases until it is
abnormally continuous.
‒ Is usually thick, grey, and mucoid until chronic infections
develop. Then becomes mucopurulent.
 What is C.O.P.D.?
Emphysema:

‒ Alveolar septal walls become damaged or

destroyed, along with loss of elastic tissue.
 What is C.O.P.D.?
Emphysema:

‒ Damaged alveoli lose their shape and

become “floppy”.
‒ This leads to air-trapping, increased WOB,
and impaired oxygenation/ventilation.
What is C.O.P.D.?
 What is C.O.P.D.?
Emphysema
Causes:
‒ Cigarette smoking (leading cause)
‒ Air pollution
‒ Occupational exposure
‒ Heredity (Alpha 1-antitrypsin deficiency)
 What is C.O.P.D.?
Emphysema
Alpha 1-antitrypsin deficiency:

‒ Genetic disorder
‒ Alpha 1-antitrypsin is produced in the liver, protects the
lungs from the neutrophil elastase enzyme.
‒ Causes emphysematous changes to the lungs. (young age;
no smoking history).
‒ Also characterized by liver disease and elevated liver
enzymes.
 What is C.O.P.D.?
Emphysema
Clinical manifestations:

‒ Usually have a dry, non-productive cough.

‒ Patients sometimes appear malnourished
(anorexic) secondary to loss of appetite.
 COPD and Ventilatory Drive
‒ Ventilatory drive is controlled by the peripheral
and central chemoreceptors.
‒ Located in the aorta and carotid arteries, and also
the medulla.
‒ Sensitive to oxygen concentration (O2), carbon
dioxide (CO2), and pH of the blood and CSF.
‒ Under normal conditions, breathing is regulated
by CO2 levels.
 COPD and Ventilatory Drive
‒ Because of the disease process, some COPD patients
become “CO2 retainers”. They maintain continuously high
levels of CO2.
‒ They become less sensitive to CO2, and more sensitive to
O2.
‒ O2 then becomes the primary stimulus for breathing.
‒ If O2 if given in sufficient amounts or too much is given,
breathing may be suppressed to the point of apnea.
‒ These patients require a small amount of hypoxia as their
stimulus to breath.
‒ This is known as the “hypoxic drive”.
 COPD and Ventilatory Drive
Key points:

‒ COPD patients that are on a “hypoxic

drive” are rare.
‒ Not all COPD patients are “CO2 retainers”.
‒ Not all CO2 retainers are on a hypoxic
drive.
 Managing COPD

‒Acute exacerbations
‒Long-Term maintenance
 Managing COPD
Acute Exacerbations:
‒ Treat comorbid conditions
(pneumonia, CHF)
‒ Oxygen Therapy
(Titrated to maintain pO2 60 mm , SpO2 90%)
‒ Medications
(bronchodilators, corticosteroids, antibiotics, etc.)
‒ Ventilatory Support
BiPAP, mechanical ventilation
 Managing COPD
Long-Term maintenence:
‒ Prevent progression of disease
(Smoking cessation, etc.)
‒ Improve exercise tolerance
‒ Prevent and treat complications
(CHF, Cor Pulmonale)
 Managing COPD
Nursing tips:
‒ Titrate oxygen to keep O2 sat 90%
‒ Encourage pursed-lip breathing for
shortness of breath
 Managing COPD
Pursed-lip breathing
‒ Sit in a comfortable position and relax.
‒ Slowly take a deep breath in through your nose.
‒ Draw your lips together as if you were going to whistle
and blow out through pursed lips slowly and evenly.
‒ Try to make the time blowing out longer than when you
took a breath in. (inhale 2 sec/exhale 4 sec)
‒ Repeat this several times until your shortness of breath
disappears.
 Sources:
‒ The Essentials of Respiratory Care;
Kacmarek, Dimas, Mack
‒ Respiratory Care: Principles & Practice;
Hess, MacIntyre
‒ National Heart, Lung, and Blood Institute
Website:
(http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/)