Copd introduction and pft
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Transcript of Copd introduction and pft
ANAESTHESIA AND COPD
ANAESTHESIA AND COPD
Dr PRASHANTHDr GANESHDr KARAN Dr KIRAN
DEFINITIONPATHOPHYSIOLOGYDIAGNOSISPRE OPERATIVE OPTIMISATION
www.goldcopd.com, Updated 2006INTRODUCTION
A common preventable and treatable disease characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases3rd Leading cause of morbidity & mortality
3
COPD INCLUDES..CHRONIC BRONCHITIS: (clinical definition) Chronic productive cough for 3 months in each of 2 successive years
EMPHYSEMA: (anatomical definition) Permanent enlargement of the airspaces distal to the terminal bronchioles
SMALL AIRWAY DISEASE: Narrowing of small bronchioles due to hyperplasia, mucus and fibrosis
Comparative features of COPDFeatureChronic BronchitisEmphysemaMech of Airway ObstructionDecreased Lumen d/t mucus & inflammationLoss of elastic recoilDyspnoeaModerateSevereFEV1 DecreasedDecreasedPaO2 Marked Decrease (Blue Bloater)Moderate Decrease (Pink Puffer)PaCO2 IncreasedNormal or DecreasedDiffusing capacityNormalDecreasedHematocritIncreasedNormalCor PulmonaleMarkedMildPrognosisPoorGood
Differences Between COPD and AsthmaParameters COPD Asthma Onset Middle ageEarly in life (often childhood) SymptomsSlowly progressive Diurnal and seasonal variationHistory Long smoking history or exposure to smoking and bio-mass fuel History of allergy, rhinitis and/or eczema. Inflammatory cells Neutrophils Eosinophils Airway hyperresponsiveness ++++++Airflow limitation Largely irreversible usually < 15% or 200 ml change Largely reversible usually > 15% or 200 ml change. (irreversible in later stages)
Risk factorsSMOKE: CIGARETTE smoking passive smoking environmental occupational Genetic factors: 1 anti trypsin deficiency
PATHOGENESIS
PATOGENESIS contd..Elastase & antielastase hypothesis Imbalance between elastin and elastase Deficiency of 1 antitrypsin which is elastase inhibitor Autoimmune contributionCigarette smoke induced loss of cilia & impaired macrophage phagocytosis
PATOGENESIS contd..
PATHOLOGY contd..
Types of emphysema
PATHOPHYSILOGY :PULMONARY
PULMONARYAIRWAY OBSTUCTIONHYPERRESPONSIVENESSALVEOLAR DESTRUCTIONSECRETIONSHYPERINFATION
PATHOPHYSIOLOGY contd..:EXTRA PULMONARY
IL6,TNF a, CRP, OXIDANTS, HYPOXEMIART HEART DISEASE,IHDSKELETAL MUSCLE WEAKNESSOSTEOPOROSISDM, DEPRESSION
PATHOPHYSIOLOGY contd..:EXTRA PULMONARY
PRE OPERATIVE OPTMISATION
Pre-operative assessment:History:SmokingCough: Type, Progression, Recent RTISputum: Quantity, color, bloodDyspneaExercise intoleranceOccupation, AllergiesSymptoms of cardiac or respiratory failure
Physical findingsEarly stage: signs of smokingAdvanced stage: prolonged expiratory phase with wheezeSigns of hyperinflation: barrel chestUse of accessory musclesTripod positionCyanosisCachexia, bitemporal wasting & diffuse loss of subcutaneous adipose tissueClubbing : ?? carcinoma
PHYSICAL FINDINGS contd..Pink puffers emphysema Thin patients Non cyanotic at rest Use of accessory muscles Good prognosisBlue bloaters Chronic bronchitis Heavy patients Cyanotic at rest Bad prognosis
Investigations:Routine blood investigations Chest Radiograph: To exclude other diseasesEmphysematous changesSpirometryDiagnosisAssessment of severityFollowing progressBronchodilator ReversibilityExclude Bronchial Asthma 70 years
Bed side PFTSabrasez breath holding test:>25 sec- normal cardio pulmonary reserve (CPR)15-25 sec- limited CPR150L/min 6 >60 L/min 3 >40L/min
Match blowing test
Bed side PFT contd..Cough test: deep breath followed by cough Ability to cough Strength Effectiveness Inadequate cough : FVC 2Age >70 yearsNeck, thoracic, upper abdominal, aortic, or neurologic surgeryAnticipated prolonged procedures (>2 hours) General anesthesia (especially with endotracheal intubationAlbumin less than 3g/dLExercise capacity of less than two blocks or one flight of stairsBMI greater than 30Arozullah AM, Ann Surg 232:242-253,2000.
Risk factors for post op pulmonary complications
To be contd.....
Thank you