Pulmonology Book


Chronic Obstructive Pulmonary Disease

Aka: Chronic Obstructive Pulmonary Disease, Chronic Obstructive Lung Disease, COPD
  1. See Also
    1. Chronic Bronchitis
    2. Emphysema
    3. COPD Staging
    4. COPD Management
    5. Alpha-1-Antitrypsin Deficiency
    6. Acute Exacerbation of Chronic Bronchitis
    7. Antibiotic Use in COPD Exacerbation
    8. COPD Exacerbation Prevention
    9. COPD Action Plan
  2. Epidemiology
    1. COPD Incidence in U.S.: 15 Million patients
    2. COPD affects 6% of adults in U.S.
    3. COPD results in 126,000 deaths per year in U.S. (4th leading cause of death)
  3. Risk Factors
    1. Age over 35 years old (esp. >45 years old)
    2. Cigarette smoking and Exposure to Tobacco smoke
      1. Active, continuous smoking confers COPD absolute risk of 25%
      2. Tobacco use >40 pack years has LR+ 7.3
      3. Tobacco Abuse is responsible for >80% of COPD cases
      4. 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 25:331-41 [PubMed]
    3. 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 [PubMed]
    4. Recurrent respiratory infections (especially Infancy)
    5. Atopic Patients
    6. Family History of COPD
    7. 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 ("Blue Bloater")
      2. Emphysema ("Pink Puffer")
  5. Diagnosis: Symptoms
    1. Risk factors (see above) AND
    2. At least one of the following
      1. Dyspnea at rest or Dyspnea on exertion
      2. Chronic Cough with or without Sputum production
      3. Wheezing
  6. Diagnosis: Pulmonary Function Tests
    1. See Emphysema and Chronic Bronchitis
    2. GOLD criteria
      1. Post-Bronchodilator FEV1 to FVC Ratio: 0.7
    3. GOLD and NICE Severity stratification
      1. Mild: FEV1 80% or greater than predicted
      2. Moderate: FEV1 <80% of predicted
      3. Severe: FEV1 <50% of predicted
      4. Very Severe: FEV1 <30% of predicted
    4. Other findings
      1. DLCO diminished in Emphysema
      2. Increased Total Lung Capacity
      3. Increased Residual Volume
      4. Peak Flow <350 L/min
  7. Staging
    1. See COPD Staging
  8. 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
  9. 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
  10. Differential Diagnosis
    1. Asthma
    2. Bronchiectasis (associated with recurrent Pneumonia)
    3. Bronchiolitis Obliterans
    4. Diffuse panbronchiolitis (associated with Immunodeficiency in asian descent)
    5. Congestive Heart Failure
    6. Lung Cancer
    7. Cystic Fibrosis
    8. Interstitial Lung Disease (e.g. Idiopathic Pulmonary Fibrosis, Sarcoidosis)
    9. Tuberculosis
    10. Kyphoscoliosis and other chest wall disorders (e.g. severe Pectus Excavatum)
    11. Pulmonary Arterial Hypertension
    12. Upper airway obstruction (tracheal stenosis, tracheal mass)
    13. Vocal Cord Dysfunction
  11. Complications
    1. Severe Chronic Dyspnea (66%)
    2. Severe total body pain (25%)
  12. Screening
    1. COPD Screening is not recommended in asymptomatic patients (ACP, GOLD, AAFP, USPTF)
    2. Prior proposed recommendations for screening: Spirometry in 10 pack year smokers over age 40 years
      1. Zielinski (2001) Chest 119:731-6 [PubMed]
  13. Grading
    1. mMRC Dyspnea Index
    2. COPD Assessment Test (CAT Tool)
    3. BODE Index
  14. Management
    1. See COPD Management
    2. See Medications in COPD Management
    3. See Acute Exacerbation of Chronic Bronchitis
  15. Prevention
    1. See COPD Exacerbation Prevention
  16. Prognosis
    1. See BODE Index
    2. 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
    3. Factors associated with a better prognosis
      1. Post-BronchodilatorFEV1 shows reversible component
      2. Atopy history
  17. References
    1. Gentry (2017) Am Fam Physician 95(7): 433-41 [PubMed]
    2. Lee (2013) Am Fam Physician 88(10): 655-63 [PubMed]
    3. Madison (1998) Lancet 352:467-73 [PubMed]
    4. Martinez (1998) Postgrad Med 103(4):112-25 [PubMed]

Chronic Obstructive Airway Disease (C0024117)

Definition (MEDLINEPLUS)

Chronic Obstructive Pulmonary Disease (COPD) makes it hard for you to breathe. Coughing up mucus is often the first sign of COPD. Chronic bronchitis and emphysema are common COPDs.

Your airways branch out inside your lungs like an upside-down tree. At the end of each branch are small, balloon-like air sacs. In healthy people, both the airways and air sacs are springy and elastic. When you breathe in, each air sac fills with air like a small balloon. The balloon deflates when you exhale. In COPD, your airways and air sacs lose their shape and become floppy, like a stretched-out rubber band.

Cigarette smoking is the most common cause of COPD. Breathing in other kinds of irritants, like pollution, dust or chemicals, may also cause or contribute to COPD. Quitting smoking is the best way to avoid developing COPD.

Treatment can make you more comfortable, but there is no cure.

NIH: National Heart, Lung, and Blood Institute

Definition (NCI_NCI-GLOSS) A type of lung disease marked by permanent damage to tissues in the lungs, making it hard to breathe. Chronic obstructive pulmonary disease includes chronic bronchitis, in which the bronchi (large air passages) are inflamed and scarred, and emphysema, in which the alveoli (tiny air sacs) are damaged. It develops over many years and is usually caused by cigarette smoking.
Definition (NCI) A chronic and progressive lung disorder characterized by the loss of elasticity of the bronchial tree and the air sacs, destruction of the air sacs wall, thickening of the bronchial wall, and mucous accumulation in the bronchial tree. The pathologic changes result in the disruption of the air flow in the bronchial airways. Signs and symptoms include shortness of breath, wheezing, productive cough, and chest tightness. The two main types of chronic obstructive pulmonary disease are chronic obstructive bronchitis and emphysema.
Definition (CSP) chronic, irreversible obstruction of air flow from the lungs.
Definition (MSH) A disease of chronic diffuse irreversible airflow obstruction. Subcategories of COPD include CHRONIC BRONCHITIS and PULMONARY EMPHYSEMA.
Concepts Disease or Syndrome (T047)
MSH D029424
ICD10 J44.9
SnomedCT 155585005, 155569000, 155617000, 196003006, 155565006, 195935004, 195948000, 10169006, 13645005, 413846005
LNC LP90123-8, LP57616-2, LA10559-5
English Chronic Obstructive Pulmonary Disease, COPD, Pulmonary Disease, Chronic Obstructive, CHRONIC OBSTRUCT AIRWAYS DISEASE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, COAD-Chron obstruc airway dise, COLD - Chron obstruc lung dise, COPD - Chron obstr pulmon dise, Chro irreversible airway obstr, Chron obstruc pulmon disease, Chronic obstr.airway dis.NOS, Chronic obstruc airway disease, Chronic obstructive airways disease NOS, Chronic obstructive lung dis, COAD, Chronic Obstructive Airway Disease, Chronic Obstructive Lung Disease, Chronic obstructive pulmonary disease, unspecified, Chronic Obstructive Airways Disease, Hyperactive airway disease, CHRONIC OBSTRUCTIVE LUNG DIS, PULM DIS CHRONIC OBSTRUCTIVE, CHRONIC OBSTRUCTIVE PULM DIS, CHRONIC OBSTRUCTIVE AIRWAY DIS, CAFL - Chron airflow limitatn, CAL - Chron airflow limitation, COLD (chronic obstructive lung disease), chronic obstructive pulmonary disease (diagnosis), chronic obstructive pulmonary disease, chronic obstructive lung disease, Chr obstruc pulmonary dis NOS, Chronic Obstructive Pulmonary Disease (COPD), Chronic obstructive airway disease NOS, Chronic obstructive lung disease NOS, Pulmonary Disease, Chronic Obstructive [Disease/Finding], Chronic airways disease, airways diseases small, chronic airflow limitation, chronic obstructive pulmonary disease (COPD), small airways disease, coad, small airway disease, chronic airway disease, reactive airway disease, airway small disease, Chronic obstructive bronchopneumopathy, COPD (Chronic Obstructive Pulmonary Disease), Chronic obstructive airways disease NOS (disorder), Chronic alveolar emphysema of horses, PULMONARY DISEASE (COPD), CHRONIC OBSTRUCTIVE, COPD, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, (COPD), OBSTRUCTIVE PULMONARY DISEASE (COPD), CHRONIC, DISEASE (COPD), CHRONIC OBSTRUCTIVE, -- COPD, Chronic airway obstruction, COLD, COAD - Chronic obstructive airways disease, COLD - Chronic obstructive lung disease, COPD - Chronic obstructive pulmonary disease, Chronic airflow limitation, Chronic airway disease, Chronic irreversible airway obstruction, Chronic obstructive airway disease, Chronic obstructive lung disease, Chronic obstructive pulmonary disease, CAFL - Chronic airflow limitation, CAL - Chronic airflow limitation, Chronic obstructive lung disease (disorder), Chron obstructive pulmonary disease, disease (or disorder); respiratory tract, chronic, obstructive, disease (or disorder); respiratory tract, obstructive, chronic, lung; disease, obstructive (chronic), lung; obstruction, disease, chronic, obstruction; airway, chronic, obstruction; lung, disease, chronic, airway; obstruction, chronic, respiratory tract; disorder, chronic, obstructive, respiratory tract; disorder, obstructive, chronic, Chronic obstructive lung disease, NOS, Chronic obstructive lung disease [Ambiguous], Chronic obstructive pulmonary disease finding (finding), Chronic obstructive pulmonary disease finding, Chronic obstruct airways disease, Chronic obstructive airways disease, Obstructive airways disease (chronic), Chronic airway obstruction; not otherwise specified, Chronic obstructive pulmonary disease NOS, COPD NOS, Chronic obstr airways disease, Chronic obstr lung disease, Chronic obstr pulmon disease, chronic airways disease, chronic obstr airways disease, chronic obstr lung disease, chronic obstr pulmon disease
Dutch chronisch aspecifieke respiratoire aandoening, CARA, chronisch obstructieve luchtwegaandoening, obstructieve luchtwegaandoening (chronisch), hyperactieve luchtwegaandoening, chronische luchtstroombeperking, chronisch obstructieve longaandoening, chronische obstructieve luchtwegaandoening, chronische obstructieve bronchopneumopathie, Chronisch obstructieve longziekte (COPD), aandoening; luchtwegen, chronisch, obstructief, aandoening; luchtwegen, obstructief, chronisch, long; aandoening, obstructief (chronisch), long; obstructie, aandoening, chronisch, luchtweg; obstructie, chronisch, luchtwegen; aandoening, chronisch, obstructief, luchtwegen; aandoening, obstructief, chronisch, obstructie; long, aandoening, chronisch, obstructie; luchtweg, chronisch, Chronische obstructieve longaandoening, niet gespecificeerd, COPD, Chronische obstructieve longziekte, longziekte, chronische obstructieve
Portuguese Doença pulmonar obstrutiva crónica, Doença das vias respiratórias hiperactivas, Doença respiratória obstrutiva crónica, Doença obstrutiva (crónica) das vias respiratórias, Limitação crónica da ventilação, Doença crónica obstrutiva das vias respiratórias, DOENCA OBSTRUT CRONICA VIAS RESPI, Broncopneumopatia obstrutiva crónica, DPOC, COAD, COPD, Doença Obstrutiva Crônica das Vias Aéreas, Doença Obstrutiva Crônica do Pulmão, Doença Obstrutiva Crônica Pulmonar, Doença Pulmonar Obstrutiva Crônica
Spanish Enfermedad pulmonar obstructiva crónica, Enfermedad obstructiva crónica de las vías respiratorias, Enfermedad de vías aéreas hiperactivas, Limitación crónica del flujo respiratorio, Enfermedad obstructiva de las vías respiratorias (crónica), Enfermedad Obstructiva Crónica de las Vías Aéreas, INSUF RESPIRATORIA CRONICA OBSTRU, Bronconeumopatía obstructiva crónica, enfermedad pulmonar obstructiva crónica, SAI (trastorno), Chronic obstructive airways disease NOS, enfermedad pulmonar obstructiva crónica, SAI, Neumopatía Obstructiva Crónica, COAD, EPOC, enfermedad pulmonar obstructiva crónica (trastorno), enfermedad pulmonar obstructiva crónica, neumopatía obstructiva crónica, hallazgo relacionado con enfermedad pulmonar obstructiva crónica (hallazgo), hallazgo relacionado con enfermedad pulmonar obstructiva crónica, EVOC, Enfermedad del Pulmón Crónica Obstructiva, Enfermedad Pulmonar Crónica Obstructiva, Enfermedad Pulmonar Obstructiva Crónica
French Hyperactivité des voies aériennes, Syndrome obstructif des voies aériennes (chronique), Limitation chronique d'écoulement gazeux, Maladie obstruct chronique des voies aériennes, BRONCHOPNEUMOPATHIE CHRON.OBSTRUC, Bronchite chronique obstructive, Bronchopneumopathie chronique obstructive, BPCO, Broncho-pneumopathie chronique obstructive, Maladie pulmonaire obstructive chronique
German chronisch obstruktive Atemwegserkrankung, chronisch obstruktiven Lungenerkrankung, obstruktive Atemwegserkrankung (chronisch), hyperreaktive Atemwegserkrankung, chronische Luftstrombehinderung, CHRONISCH OBSTRUKTIVE ATEMWEGSERK, Chronische obstruktive Lungenkrankheit, nicht naeher bezeichnet, Chronisch-obstruktive Bronchopneumopathie, Chronisch obstruktive pulmonale Erkrankung, Chronische obstruktive Atemwegserkrankung, Chronisch obstruktive Lungenerkrankung, COAD, COPD, Chronisch obstruktive Lungenkrankheit, Lungenkrankheiten, chronisch obstruktive, Chronisch obstruktive pulmonale Krankheit, chronisch-obstruktive Lungenerkrankung
Italian Limitazione cronica di flusso nelle vie aeree, Malattia delle vie aeree iperattive, Malattia cronica ostruttiva delle vie aeree, Malattia ostruttiva cronica delle vie aeree, Malattia ostruttiva delle vie aeree (cronica), Malattia cronica ostruttiva polmonare, COAD, COPD, Malattia ostruttiva cronica del polmone, Malattia ostruttiva cronica delle vie respiratorie, Broncopneumopatia ostruttiva cronica, Malattia polmonare ostruttiva cronica
Japanese 慢性気流制限, 閉塞性気道疾患(慢性), COPD, 活動亢進性気道疾患, マンセイヘイソクセイキドウシッカン, ヘイソクセイキドウシッカンマンセイ, カツドウコウシンセイキドウシッカン, COPD, マンセイヘイソクセイハイシッカン, マンセイキリュウセイゲン, 慢性閉塞性気道疾患, 慢性閉塞性肺疾患, 慢性気流閉塞, 慢性閉塞性気管支肺症, マンセイヘイソクセイキカンシハイショウ, 肺疾患-慢性閉塞性, 気流閉塞-慢性
Swedish Kroniskt obstruktiv lungsjukdom
Czech plicní nemoc chronická obstrukční, chronická obstrukční nemoc dýchacích cest, chronická obstrukční nemoc plic, CHOPN, Chronická obstrukce dýchacích cest, Choroba hyperaktivních dýchacích cest, Chronické obstrukční onemocnění dýchacích cest, Chronické obstrukční plicní onemocnění, Chronické omezení průtoku v dýchacích cestách, Chronické obstrukční onemocnění plic, Obstrukční onemocnění dýchacích cest (chronické), Chronická obstruktivní bronchopneumopatie
Finnish Ahtauttava keuhkosairaus
Korean 상세불명의 만성 폐쇄성 폐질환
Polish Choroba płuc obturacyjna przewlekła, POCD, POChP, Przewlekła obturacyjna choroba płuc
Hungarian Krónikus obstructiv bronchopneumopathia, Obstructiv légúti betegség (chronikus), Chronikus obstructiv pulmonalis betegség, Chronikus obstuctiv légúti betegség, COPD, Hyperactiv légúti betegség, Chronikus obstructiv légúti betegség, Chronikus légúti szűkület, Chronikus obstructiv tüdőbetegség, KALB
Norwegian Kronisk obstruktiv lungesykdom, Røykelunger, KOLS
Derived from the NIH UMLS (Unified Medical Language System)

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