Chronic Obstructive Pulmonary Disease and Emphysema

Chronic Obstructive Pulmonary Disease and Emphysema is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Chronic obstructive pulmonary disease (COPD) usually describes a mixture of chronic bronchitis and emphysema. It is characterized by airflow limitation that is not fully reversible, inflammation, and is progressive (1,2).
  • Chronic bronchitis is defined clinically by increased mucus production and recurrent cough present on most days for at least 3 months per year during at least two consecutive years without another cause.
  • Emphysema, the destruction of interalveolar septa, occurs in the distal or terminal airways and involves both airways and lung parenchyma.

Epidemiology

Incidence
Affects >5% of adults in the United States and is the 12th leading cause of morbidity (1)


Prevalence
  • Third leading cause of death in the United States (1)
  • Projected to be the third leading cause of death globally by 2020 (2); 3.2 million deaths worldwide (2)

Etiology and Pathophysiology

Cigarette and/or cannabis smoking, air pollution (including indoor), antiprotease deficiency (α1-antitrypsin), occupational exposure (firefighters), infection (viral), occupational pollutants (cadmium, silica)

  • Impaired gas (carbon dioxide and oxygen) exchange
  • Chronic bronchitis: airway obstruction (3)
  • Emphysema: destruction of lung parenchyma
Genetics
  • Chronic bronchitis is not a genetic disorder.
  • Antiprotease deficiency (due to α1-antitrypsin deficiency) is an inherited, rare disorder due to two autosomal codominant alleles.

Risk Factors

  • Smoking: passive smoking, especially adults whose parents smoked; cannabis use (one joint is equivalent to 2.5 to 5 cigarettes) (1,2,3)
  • Severe pneumonia early in life including viral (4)
  • Aging
  • Lower level of education and poverty (4)
  • Airway hyperactivity
  • Indoor pollution (open fire for cooking or heating) (4)
  • Occupational organic or inorganic dusts (4)

General Prevention

  • Avoidance of smoking is the most important preventive measure.
  • Early detection through pulmonary function tests (PFTs) in high-risk patients may be useful in preserving remaining lung function.

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
  • Miscellaneous: malnutrition, osteoporosis, muscle dysfunction, depression

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Chronic Obstructive Pulmonary Disease and Emphysema ID - 116133 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116133/all/Chronic_Obstructive_Pulmonary_Disease_and_Emphysema PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -