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Chronic Obstructive Pulmonary Disease
Aka: Chronic Obstructive Pulmonary Disease, Chronic Obstructive Lung Disease, COPD
- See Also
- Chronic Bronchitis
- Emphysema
- COPD Staging
- COPD Management
- Alpha-1-Antitrypsin Deficiency
- Acute Exacerbation of Chronic Bronchitis
- Antibiotic Use in COPD Exacerbation
- COPD Exacerbation Prevention
- COPD Action Plan
- Epidemiology
- COPD Incidence in U.S.: 15 Million patients
- COPD affects 6% of adults in U.S.
- COPD results in 126,000 deaths per year in U.S. (4th leading cause of death)
- Risk Factors
- Age over 35 years old (esp. >45 years old)
- Cigarette smoking and Exposure to Tobacco smoke
- Active, continuous smoking confers COPD absolute risk of 25%
- Tobacco use >40 pack years has LR+ 7.3
- Tobacco Abuse is responsible for >80% of COPD cases
- Women have a greater degree of lung damage and Impairment for a given exposure
- Increased hyper-responsiveness to exogenous toxins
- Chapman (2004) Clin Chest Med 25:331-41 [PubMed]
- Domestic or Occupational pollutants
- See Irritant-induced Asthma
- See Allergic Occupational Asthma
- Mineral Dust (e.g. Mining of coal or hard rock, Concrete manufacture, Silica)
- Organic Dust (e.g. Cotton, hemp, grains)
- Gas Fumes (e.g. Heavy Metals, welding, Sulfur Dioxide, isocyanates)
- Boschetto (2006) J Occup Med Toxicol 1:11 [PubMed]
- Recurrent respiratory infections (especially Infancy)
- Atopic Patients
- Family History of COPD
- Alpha-1-Antitrypsin Deficiency
- Suspect in patients under age 45 without other risk
- Other protease deficiencies may also be related
- Definition: Chronic Obstructive Pulmonary Disease
- See Emphysema and Chronic Bronchitis
- Progressive chronic airflow obstruction
- Irreversibility distinguishes COPD from Asthma
- Types
- Chronic Bronchitis ("Blue Bloater")
- Emphysema ("Pink Puffer")
- Diagnosis: Symptoms
- Risk factors (see above) AND
- At least one of the following
- Dyspnea at rest or Dyspnea on exertion
- Chronic Cough with or without Sputum production
- Wheezing
- Diagnosis: Pulmonary Function Tests
- See Emphysema and Chronic Bronchitis
- GOLD criteria
- Post-Bronchodilator FEV1 to FVC Ratio: 0.7
- GOLD and NICE Severity stratification
- Mild: FEV1 80% or greater than predicted
- Moderate: FEV1 <80% of predicted
- Severe: FEV1 <50% of predicted
- Very Severe: FEV1 <30% of predicted
- Other findings
- DLCO diminished in Emphysema
- Increased Total Lung Capacity
- Increased Residual Volume
- Peak Flow <350 L/min
- Staging
- See COPD Staging
- Labs
- See Emphysema and Chronic Bronchitis
- Arterial Blood Gas
- Indicated in severe or very severe COPD
- Alpha-1-antitrypsin indications
- Age under 45 years
- No prior smoking history
- Family History of Alpha-1-Antitrypsin Deficiency
- Comorbid Cirrhosis
- Imaging: Chest XRay
- See Emphysema and Chronic Bronchitis
- Lung hyperinflation
- Diaphragm flattening
- Distal pulmonary vessel tapering
- Increased basilar markings in Chronic Bronchitis
- Differential Diagnosis
- Asthma
- Bronchiectasis (associated with recurrent Pneumonia)
- Bronchiolitis Obliterans
- Diffuse panbronchiolitis (associated with Immunodeficiency in asian descent)
- Congestive Heart Failure
- Lung Cancer
- Cystic Fibrosis
- Interstitial Lung Disease (e.g. Idiopathic Pulmonary Fibrosis, Sarcoidosis)
- Tuberculosis
- Kyphoscoliosis and other chest wall disorders (e.g. severe Pectus Excavatum)
- Pulmonary Arterial Hypertension
- Upper airway obstruction (tracheal stenosis, tracheal mass)
- Vocal Cord Dysfunction
- Complications
- Severe Chronic Dyspnea (66%)
- Severe total body pain (25%)
- Screening
- COPD Screening is not recommended in asymptomatic patients (ACP, GOLD, AAFP, USPTF)
- Prior proposed recommendations for screening: Spirometry in 10 pack year smokers over age 40 years
- Zielinski (2001) Chest 119:731-6 [PubMed]
- Grading
- mMRC Dyspnea Index
- COPD Assessment Test (CAT Tool)
- BODE Index
- Management
- See COPD Management
- See Medications in COPD Management
- See Acute Exacerbation of Chronic Bronchitis
- Prevention
- See COPD Exacerbation Prevention
- Prognosis
- See BODE Index
- Factors associated with a worse prognosis (mortality)
- FEV1 < 750 cc (<50% of predicted)
- Rapid FEV1 decline
- Lower diffusion capacity
- Hypoxia with PaO2 <55 mmHg
- Older patients
- Continued Tobacco Abuse
- Hypercapnia with PaCO2 > 45 mmHg
- Right-sided Heart Failure
- Malnutrition
- Resting Tachycardia
- Factors associated with a better prognosis
- Post-BronchodilatorFEV1 shows reversible component
- Atopy history
- References
- Gentry (2017) Am Fam Physician 95(7): 433-41 [PubMed]
- Lee (2013) Am Fam Physician 88(10): 655-63 [PubMed]
- Madison (1998) Lancet 352:467-73 [PubMed]
- Martinez (1998) Postgrad Med 103(4):112-25 [PubMed]