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Chronic Obstructive Pulmonary DiseaseAka: Chronic Obstructive Lung Disease, COPD

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  1. See Also
    1. Chronic Bronchitis
    2. Emphysema
    3. COPD Management
    4. Alpha-1-Antitrypsin Deficiency
    5. Acute Exacerbation of Chronic Bronchitis
  2. Epidemiology
    1. COPD Incidence in U.S.: 14-26 Million patients
    2. COPD affects 10% of adults in U.S.
    3. COPD fourth leading cause of death in U.S.
  3. Risk factors
    1. Cigarette smoking and Exposure to Tobacco smoke
      1. Active, continuous smoking confers COPD absolute risk of 25%
      2. Tobacco abuse is responsible for >80% of COPD cases
      3. Women have a greater degree of lung damage and Impairment for a given exposure
        1. Increased hyper-responsiveness to exogenous toxins
        2. Chapman (2004) Clin Chest Med 25:331
    2. Domestic or Occupational pollutants
      1. See Irritant-induced Asthma
      2. See Allergic Occupational Asthma
      3. Mineral Dust (e.g. Mining of coal or hard rock, Concrete manufacture, Silica)
      4. Organic Dust (e.g. Cotton, hemp, grains)
      5. Gas Fumes (e.g. heavy metals, welding, sulfur dioxide, isocyanates)
      6. Boschetto (2006) J Occup Med Toxicol 1:11
    3. Recurrent respiratory infections (especially Infancy)
    4. Atopic Patients
    5. Family History of COPD
    6. Alpha-1-Antitrypsin Deficiency
      1. Suspect in patients under age 45 without other risk
      2. Other protease deficiencies may also be related
  4. Definition: Chronic Obstructive Pulmonary Disease
    1. See Emphysema and Chronic Bronchitis
    2. Progressive chronic airflow obstruction
    3. Irreversibility distinguishes COPD from Asthma
    4. Types
      1. Chronic Bronchitis
      2. Emphysema
  5. Diagnosis: Pulmonary Function Tests
    1. See Emphysema and Chronic Bronchitis
    2. GOLD criteria
      1. FEV1 to FVC ratio: <70% and
      2. FEV1 <80% of predicted post-Bronchodilator
    3. Severity stratification
      1. Moderate: FEV1 <80% of predicted
      2. Severe: FEV1 <50% of predicted
      3. Very Severe: FEV1 <30% of predicted
    4. Other findings
      1. DLCO diminished in Emphysema
      2. Increased Total Lung Capacity
      3. Increased Residual Volume
  6. Staging
    1. See COPD Staging
  7. Labs
    1. See Emphysema and Chronic Bronchitis
    2. Arterial Blood Gas
      1. Indicated in severe or very severe COPD
    3. Alpha-1-antitrypsin indications
      1. Age under 45 years
      2. No prior smoking history
      3. Family History of Alpha-1-Antitrypsin Deficiency
      4. Comorbid Cirrhosis
  8. Imaging: Chest XRay
    1. See Emphysema and Chronic Bronchitis
    2. Lung hyperinflation
    3. Diaphragm flattening
    4. Distal pulmonary vessel tapering
    5. Increased basilar markings in Chronic Bronchitis
  9. Differential Diagnosis
    1. Asthma
    2. Bronchiectasis
    3. Bronchiolitis Obliterans
    4. Congestive Heart Failure
    5. Lung Cancer
    6. Cystic Fibrosis
    7. Interstitial Lung Disease (e.g. Idiopathic Pulmonary Fibrosis, Sarcoidosis)
    8. Tuberculosis
  10. Complications
    1. Severe Chronic Dyspnea (66%)
    2. Severe total body pain (25%)
  11. Screening
    1. Spirometry in 10 pack year smokers over age 40
      1. Zielinski (2001) Chest 119:731
  12. Grading
    1. MRC Dyspnea Index
    2. BODE Index
  13. Prognosis
    1. Factors associated with a worse prognosis (mortality)
      1. FEV1 < 750 cc (<50% of predicted)
      2. Rapid FEV1 decline
      3. Lower diffusion capacity
      4. Hypoxia with PaO2 <55 mmHg
      5. Older patients
      6. Continued Tobacco abuse
      7. Hypercapnia with PaCO2 > 45 mmHg
      8. Right-sided Heart Failure
      9. Malnutrition
      10. Resting tachycardia
    2. Factors associated with a better prognosis
      1. Post-Bronchodilator FEV1 shows reversible component
      2. Atopy history
  14. References
    1. Madison (1998) Lancet 352:467
    2. Martinez (1998) Postgrad Med 103(4):112

Chronic Obstructive Airway Disease (C0024117)

Definition (MSH)A disease of chronic diffuse irreversible airflow obstruction. Subcategories of COPD include CHRONIC BRONCHITIS and PULMONARY EMPHYSEMA.
Definition (CSP)chronic, irreversible obstruction of air flow from the lungs.
ConceptsDisease or Syndrome (T047)
ICD9496
MSHD029424
EnglishCAFL - Chronic airflow limitation, CAL - Chronic airflow limitation, Chronic airflow limitation, Chronic airway disease, Chronic airway obstruction, Chronic irreversible airway obstruction, CHRONIC OBSTRUCTIVE AIRWAY DIS, Chronic Obstructive Airway Disease, Chronic Obstructive Airways Disease, CHRONIC OBSTRUCTIVE LUNG DIS, Chronic Obstructive Lung Disease, CHRONIC OBSTRUCTIVE PULM DIS, chronic obstructive pulmonary disease, Chronic obstructive pulmonary disease finding, COAD, COAD - Chronic obstructive airways disease, COLD, COLD - Chronic obstructive lung disease, COPD, COPD - Chronic obstructive pulmonary disease, PULM DIS CHRONIC OBSTRUCTIVE
Spanishenfermedad pulmonar obstructiva cronica, EPOC, hallazgo relacionado con enfermedad pulmonar obstructiva cronica, neumopatia obstructiva cronica
Parent ConceptsLung diseases (C0024115), Chronic obstructive pulmonary disease and bronchiectasis (C0810017), Bronchial Diseases (C0006261), Lung Diseases, Obstructive (C0600260), Non-Neoplastic Lung Disorder (C1335019), Chronic Obstructive Airway Disease (C0024117), Chronic disease of respiratory system (C0264220), Bronchiolar disease (C0264364), Respiratory finding (C0425442), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesAOD, CCS, COSTAR, CSP, DXP, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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