COPD

OBSTRUCTIVE AIR WAY DISORDERS
DEFINITION
In this Condition there is chronic obstruction to the alveolar in flow of air either due to chronic Bronchitis and / or emphysema and / or Bronchial Asthma.
Chronic Bronchitis may be complicated with emphysema but there may be predominance of any of them. Bronchial asthma also causes generalized airway obstruction and is dealt with separately. There may be considerable over lapping of these three diseases.
CHRONIC BRONCHITIS
DEFINITION
Ch. Bronchitis may be defined as a disease characterized by cough and sputum for at least 3 consecutive months in a year for more than 2 successive Years.
AETIOLOGY
 Smoking
 Atmospheric Pollution
 Infection
 Occupation (Coal miners)
 Familial and genetic abnormalities associated with alpha1 , antitrypsin deficiency -may also be present.
Pathology
Develops airway wall inflammation

Hypertrophy of mucus secreting Glands and increases in the number of Goblet cells in bronchi and bronchioles with consequent
Decrease in ciliated cells,

Obstruction of air flow.
Pathology for Cyanosis
Due to uneven distribution of the inspired air

There may be diminished diffusing capacity

Airway obstruction gives rise to ventilation perfusion in equality.

Resulting in increased paco2 and decreased pao2 with severe ventilatory failure there is falling pH together with compensatory decrease in plasma bicarbonate and respiratory acidosis.

Cyanosis

Clinical Features
 Gradual onset
 Cough with expectoration: It is usually starts as attacks of “winter cough” and “Smoker’s cough”. Gradually increasing in severity and duration, the expectoration is mucoid (or) mucopurulent depending on the presence of infection.
 Some time there may be haemoptysis.
 Shortness of breath due to airway obstruction.

SIGNS
 Respiratory rate is hurried
 Central cyanosis may be present.
 Chest may show no signs on examinations (or) there may be prolonged expiration with transient rhonchi present.
INVESTIGATION
 Blood Count: May show leucocytosis in presence of acute infection.
 Polycythaemia may develop in long standing cases.
 X Ray Chest
Does not show any characteristics change.
 Bronchography
May show irregularities of Bronchial lumen,
 Pulmonary function test: May chow some impairment due to development of emphysema, simple measurement of ventilatory capacity and arterial Paco2 may help to determine the severity of airway obstruction.


Complication
- Emphysema
- Bronchiolar Spasm
- Bronchiectasis
- Rt heart failure (ch. Cor pulmonale).
EMPHYSEMA
Def:
It is a condition of generalized over distension of the lung alveoli with Rupture of interalveolar septae, over aeration of the alveoli, loss of alveolar elasticity, impairment of pulmonary function and increased lung volume due to various causes.
Aetiology:
- Chronic Bronchitis and chronic Bronchial asthma are common predisposing causes.
- In association with fibrotic pulmonary disease such as silicosis.
C/F:
- Breathlessness (exertional dyspnoea)
- Cough with expectoration are due to associated chronic bronchitis, they usually develop before the onset of breathlessness.
- Wheezing sound present.
Sign:
- Pink buffer cyanosis is present
- Clubbing of finger present
- Respiration rate hurried.
Examination:
Inspection : Barrel shaped chest
Palpation : Vocal fermitus is diminished
Percussion : Hyper Resonant note present
Auscultation : Rhonchi present
- X Ray Chest:
- Marked radio translucent lung fields with the fine vascular striations particularly at the periphery.
- Low and flat diaphragm.

Lung Function Tests:
Blood gas analysis shows Pao2 less than 50 torr and Paco2 more than 50 torr indicative of Respiratory failure.

Complication:
- Rt heart failure
- Spontaneous pneumothorax

BRONCHIAL ASTHMA
Def:
Asthma is defined as a chronic inflammatory disorder of the airways, characterized by Reversible airflow obstruction causing cough, wheeze, chest tightness and shortness of Breath.
Types:
- Early onset asthma (or) atopic
- Late onset asthma (or) Non-atopic

1. Early Onset Asthma:
- Commonly encountered in child hood.
- Family History of this disorder present.
- These individuals are usually atopic.
- Allergic skin tests positive
- IgE level raised
- H/o Allergy present

2. Late Onset Asthma:
- It occurs in any age.
- No family history disorders.
- Non-atopic individuals
- Extrinsic allergens play no part.
- Skin Hyper sensitivity test negative
- IgE level normal.

Aetiology:
- Infections
- Cigarette Smoking
- Temperature and Humidity
- Psychological factors
- Exercise
- Allergy
Triggers of the Asthmatic Response:
- Cold Air, Tobacco, Smoking, Dust, Acid Fumes, Resp. Viral infection and emotional stress.
- In children and young adults exposure to cold air and excretion.
- Previous exposure to antigents stimulate the formation of IgE antibody in the brochi, further on exposing in the allergens.
C/F:
- Episodic Asthma
- Chronic Asthma
- Severe Acute Asthma
1. Episodic:
- Paroxysms of wheeze and breathlessness may occur at any time and can be of sudden onset.
- Episodic asthma may be triggered by Allergens, exercise and Viral infections.
- The attacks may be mild (or) severe lasting for few hours, days (or) weeks.
- Atopic individuals with episodic asthma are worse in summer, when they are heavily exposed to allergens.
2. Chronic Asthma:
- Symptoms of chest tightness, wheeze and Breathlessness on exertion together with spontaneous cough and wheeze during night.
- Cough with mucoid sputum with recurrent episodes of Resp. infection is common.
- Chronic asthma pt. Are worse in winter due to increased exposure to viral infection.

3. Severe Acute Asthma (or) “Status Asthmaticus”
This term has replaced status asthmaticus which in life threatening at time of asthma.
- The patient often has an unproductive cough.
- Respiratory symptoms such as chest tightness and breadthlessness are accompanied by tachycardia, Pulsus Paradoxis, Sweating, and Central Cyanosis.
- The Pt adopts an upright position fixing the shoulder muscle to assist the accessory muscles of respiration.
Signs:
- During an attack when the chest is held in full inspiration, the percussion note is hyper resonance.
- Broncho vesicular Breath sound present.
- Added sounds – Rhonchi, High pitched polyphonic inspiratory and expiratory Rhonchi.
- In severe asthma airflow may be insufficiency of produce a Rhonchi and chest remains silent – it is a “Ominous Sign”.

INVESTIGATION
X ray chest
 In an acute attack the lungs appears hyper inflated.
 In between the episodes the chest x ray is normal.
 Pigeon shaped deformity can be demonstrated on a lateral view x ray.
 In severe acute asthma pneumothorax may be seen.
 X ray may show mediastinal (or) subcutaneous emphysema.

Pulmonary Function Test:
- Measurement of force expiratory volume in one second, vital capacity and peak expiratory volume with given indication to the degree of airflow obstruction.
Arterial Blood Gas Analysis:
Measurement of partial pressure of PO2 and PCO2 is required in the management sever acute asthma.

Skin hypersensitivity test: It is depends upon the individuals.

Complications:
- Status asthmaticus
- Secondary infection – Bronchitis, Tuberculosis.
- Emphysema of lung
- Rt. Heart failure
- Bronchiectasis.
Homoeopathic Management (Murphy repertory)
Bronchitis. Chronic
Ant.tart hep
Am.carb hydr
ant .s ipecac
ars.alb kali bic
ars.iod kaliod
bac lyco
bar.m nit.ac
calc puls
canth seneg
carb. v stann
cop sulph
Emphysema
Am.carb calc.s
Ant.ars camph
Ant.Tart carb.veg
Hepar chlor
Lachesis dig
Loblia ip
Sil lyc
Ars merc
aur.m Nat.m
bell phos
brom stry
calc.p


From, smoking
am.c
calad

Bronchial asthma
Ambr lobil
Arg. Nit Nat.s
Ars puls
Ars.iod samb
Baltta sil
Carci spong
Cupr stram
Ip sulph
Kali ars visc
Kali carb Grindilia
Kali Nit