Chronic Obstructive Pulmonary Disease and Emphysema

Description

• The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as follows:
  • COPD is a heterogenous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction (1).
• COPD is ranked among the top causes of death in the United States, it was the third leading cause of death worldwide prior to the COVID-19 pandemic. Given its prevalence and chronicity, it causes a high resource utilization with multiple hospitalizations due to acute exacerbations, frequent office visits, and the need for chronic therapy. Globally, there are around 3,000,000 deaths annually due to COPD.

Epidemiology

Incidence
The incidence of COPD is 8.9/1,000 person-years.

Prevalence
Global prevalence of COPD based on the Burden of Obstructive Lung Diseases (BOLD) program is 10.3%

Etiology and Pathophysiology

Exposure to noxious gasses or particles leading to pathologic processes in the lung:

• Impaired gas (carbon dioxide [CO₂] and oxygen) exchange, persistent airway obstruction, destruction of lung parenchyma

Genetics
α₁-Antitrypsin deficiency is a rare, inherited disorder due to two autosomal codominant alleles.

Risk Factors

• Smoking tobacco or marijuana: including passive smoking and water pipe
• History of severe childhood respiratory infections
• Aging—including healthy aging as well as the cumulative summation of lung exposure over time
• Lower level of education and lower socioeconomic status
• Asthma and airway hyperreactivity
• Indoor air pollution (especially indoor biomass cooking worldwide)
• Occupational organic or inorganic dusts, chemical agents and fumes (i.e., high doses of pesticides)

General Prevention

Smoking cessation and general avoidance of noxious material are the most important preventative measures.

Commonly Associated Conditions

• Pulmonary: lung cancer, chronic respiratory failure, acute bronchitis, sleep apnea, pulmonary hypertension (HTN), asthma
• Cardiac: coronary artery disease, arrhythmia
• Ear/nose/throat (ENT): chronic sinusitis, laryngeal carcinoma