• Chronic Obstructive Pulmonary Disease (COPD) should be suspected in any patient who has chronic cough, sputum production or dyspnea with or without history of risk factors for the disease

• A preventable & treatable disease with overall severity contributed by exacerbations & comorbidities
• The persistent airflow limitation is usually progressive & associated with an enhanced chronic inflammatory response in the airways & the lung to noxious particles or gases
• The chronic airflow limitation is caused by a mixture of small airways disease & parenchymal destruction

A diagnosis of COPD should be considered in patients over 40 years of age who have a suggestive medical history (ie presence of risk factors) & who present with any of the following:

• Chronic cough (present intermittently or daily) & sputum production of ≥3 months in each of 2 consecutive years
  • Does not reflect the major impact of airflow limitation on the morbidity & mortality in patients with COPD
  • Cough may be unproductive

• Exertional breathlessness, wheezing, pursed-lip breathing, dyspnea with or without wheezing
• Rhonchi, prolonged expiratory phase of respiration, chest hyperinflation, use of accessory muscles for respiration, decreased breath sounds
• Signs of cor pulmonale: neck vein distention, increased pulmonic component of 2nd heart sound, lower extremity edema, hepatomegaly
• The absence of wheezing or chest tightness does not rule out a diagnosis of COPD

Host Factors

• Hereditary deficiency of alpha-1 antitrypsin
• Airway hyper-responsiveness
  • Includes asthma
  • May also develop after exposure to tobacco smoke or other environmental insults

• Lung growth & development
  • Individuals may have reduced maximal attained lung function due to processes during gestation & childhood

• Infections
  • Reduced lung function can be associated with a history of severe childhood respiratory infections
  • Previous tuberculosis

Exposures

• Tobacco smoke
  • Most commonly encountered risk factor
  • Includes history of tobacco use or prolonged exposure to second-hand smoke
  • Smoking during pregnancy can put the fetus at risk

• Occupational dusts & chemicals
• Air pollution
• Smoke from home cooking & heating fuels
• Socioeconomic status