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CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease (COPD) is an inflammatory respiratory disease characterized by reversible airflow limitation.

The patient usually have chronic cough, sputum production or dyspnea with or without history of risk factors for the disease.

The chronic airflow limitation is caused by a combination of small airways disease and parenchymal destruction.

It is a preventable & treatable disease.

Introduction

  • 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

Definition

  • 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

Signs and Symptoms

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

Risk Factors

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
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