Andriy Lepyavko, MD, PhD Department of Internal Medicine № 2

1. Etiology, pathogenesis of COPD 2. Diagnostic criteria 3. Principles of treatment 4. 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 nervous system with hyperproduction of acetylcholine, bronchial spasm and hypersecretion of mucus  Insufficiency of adrenal receptors in bronchial walls as the result of deep morphological changes with bronchial hypersecretion, bronchial spasm and cough  Bronchial hyperreactivity which is characterized by immune inflammation of bronchioles walls All that lead to:  1) narrowing of bronchioles;  2) development of emphysema

 1.Hypersecretion of mucus  2.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 smoking  Occupational diseases  Family 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 enlarged  Dyaphragm is located lower than normally  Narrow heart shadow  Sometimes – 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 min – 80 mkg of Ipratropium)  Increasing of FEV1 more than 15 % tells us about reversibility

Stage and severity Signs І, mild - FEV І < 80%, FEV1/FVC < 70% - As a rule chronic cough with sputum II, moderate - 50%< FEV І < 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.

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