COPD (Chronic Obstructive Pulmonary Disease)

COPD(Chronic Obstructive Pulmonary Disease) is a broad classification of disorders that includes chronic bronchitis, bronchiectasis, emphysema and asthma, which is an irreversible condition associated with dyspnea on exertion and decreased air flow in and out of the lungs.
Chronic obstructive pulmonary disease is a disease that causes airway obstruction, including therein is asthma, chronic bronchitis and emphysema Pulmonum.
Chronic obstructive pulmonary disease is a lung disorder characterized by impaired lung function in the form of prolonged expiratory period caused by the narrowing of the airways and not much changed in the period of observation for some time.
Disease chronic obstructive lung is a term used for a group of lung diseases that last long and is characterized by increased resistance to air flow as the main pathophysiological picture.

Classification
Diseases included in chronic obstructive pulmonary disease group are as follows:
1. Chronic Bronchitis
Bronchitis is a clinical definition to cough almost every day accompanied by sputum expenditure, at the lack of 3 months in a year and occurred at least 2 consecutive years.
2. Pulmonary emphysema
Pulmonary emphysema is an anatomic definition, namely a change of anatomic lung characterized by abnormal widening of the distal bronchial airways terminalis, which is accompanied by alveolar wall destruction.
3. Asthma
Asthma is a disease characterized by hypersensitivity tracheobronchial branches of various types of stimuli. This condition manifests as narrowing the channels of periodic breathing due to bronchospasm and reversible.
4. Bronchiectasis
Bronchiectasis is a chronic dilatation of bronchi and bronchioles yan may be caused by various conditions, including pulmonary infections and bronchial obstruction, foreign body aspiration, vomit, or the objects of the upper respiratory tract, and the pressure of the tumor, which dilates blood vessels and lymph node enlargement.

Etiology
The etiology of this disease is unknown. The disease is associated with the risk factors contained in people include:
1. Cigarette smoking is a long
2. Air Pollution
3. Peru recurrent infections
4. Age
5. Gender
6. Race
7. Alpha-1 antitrypsin deficiency
8. Deficiency of anti-oxidants
The effect of each risk factor for COPD is the occurrence of mutually reinforcing factors and smoking are considered the most dominant.

Pathophysiology
Lung function decline with the advent of old age are caused by elasticity of lung tissue and chest wall dwindle. In a more advanced age, the strength of respiratory muscle contraction can be reduced making it difficult to breathe.
Lung function to determine a person's oxygen consumption, ie the amount of oxygen bound by blood in the lungs to the body uses. Oxygen consumption is closely related to blood flow to the lungs. Reduced lung function is also caused by reduced function of the respiratory system such as pulmonary ventilation function.
Risk factors mentioned above will bring the process of bronchial inflammation and bronchial wall damage apda terminalis. Damage will occur as a result of the small bronchial obstruction (terminal bronchioles), which experienced early closure or obstruction of expiratory phase. The air that easily fit into the alveoli during inspiration, during expiration many trapped in the alveoli and there was a buildup of air (air trapping). This has led to complaints of shortness of breath with all its consequences. Obstruction in the early expiration will cause trouble and cause a lengthening expiratory expiratory phase. Pulmonary functions: ventilation, gas distribution, gas diffusion, and perfusion of blood will have the disorder (Brannon, et al, 1993)

Examination Support
Investigations required are as follows:
A. Radiological Examination
In chronic bronchitis radiological there are some things to note:

1. Tubular shadows or farm lines visible shadow lines are parallel, out from the hilum toward the lung apex. The shadow is the shadow of a thickened bronchus.
2. Pattern of increased lung

In pulmonary emphysema there are two forms of abnormal chest images are:

1. Picture of arterial deficiency, occurs overinflasi, pulmonary oligoemia and bullae. This situation is more often found in panlobular emphysema and pink puffer.
2. Pattern lung is increased.

B. Examination of Lung Physiology
In chronic bronchitis there is a KV VEP1 and declining, VR is growing and a normal ID card. In pulmonary emphysema there is a decrease VEP1, KV, and KAEM (arum expiratory maximum speed) or MEFR (maximal expiratory flow rate), KRF and VR increases, whereas KTP increased or normal. The situation above is more clearly at an advanced stage, being at an early stage changes only to the small airways (small Airways). In emphysema decreased diffusion capacity of the alveoli due to surface diffusion is reduced.

C. Blood Gas Analysis
In bronchitis PaCO2 increased, decreased hemoglobin saturation, arise cyanosis, pulmonary vascular vasoconstriction occurs and the addition eritropoesis. That chronic hypoxia stimulate erythropoietin formation, giving rise to polycythemia. At the age of 55-60 years polycythemia conditions causing right heart must work harder and is one of the causes of right heart trouble.

D. ECG
Abnormalities of the earliest was a clock wise rotation of the heart. If there is a cor pulmonale was found to right axis deviation and P pulmonale on delivery II, III, and aVF. Low QRS voltage ratio in V1 R / S is more than 1 and V6 ratio R / S is less than 1. There are often incomplete RBBB.

E. Cultures of sputum, to determine the cause of infection petogen.


F. Complete blood laboratory


Management of COPD


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