Chronic Obstructive Pulmonary Disease and Emphysema

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Basics

Description

  • The Global Initiative for Chronic Obstructive Lung Disease (GOLD) describes COPD in the following words: “COPD is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development . . . The chronic airflow limitation that is characteristic of COPD is caused by a mixture of small airways disease and parenchymal destruction (emphysema), the relative contributions of which vary from person to person . . . Chronic inflammation causes structural changes, narrowing of the small airways, and destruction of lung parenchyma . . . A loss of small airways may contribute to airflow limitation and mucociliary dysfunction is a characteristic feature of the disease” (1).
  • This new definition no longer includes the terms “emphysema” and “chronic bronchitis.”
  • Third leading cause of death in the United States
  • Projected to be the third leading cause of death globally by 2020 (2); 3.2 million deaths worldwide (2)

Epidemiology

Incidence
The incidence of COPD is 8.9/1,000 person-years (3).

Prevalence
  • The prevalence of COPD is 4.7% (3).
  • 4-year mortality rates range from 28% for mild to moderate COPD to 62% for moderate to severe COPD.

Etiology and Pathophysiology

Exposure to noxious gasses or particles (see “Risk Factors”) leading to the following pathologic processes in the lung:

  • Impaired gas (carbon dioxide and oxygen) exchange
  • Persistent airway obstruction
  • Destruction of lung parenchyma
Genetics
  • Genetics may contribute to host response to noxious gasses or particles.
  • Antiprotease deficiency (due to α1-antitrypsin deficiency) is an inherited, rare disorder due to two autosomal codominant alleles.

Risk Factors

  • Smoking tobacco or marijuana: including passive smoking and water pipe (2)
  • Severe pneumonia early in life including viral (4)
  • Aging
  • Lower level of education and poverty (4)
  • Asthma
  • Indoor pollution (especially indoor biomass cooking worldwide) (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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Basics

Description

  • The Global Initiative for Chronic Obstructive Lung Disease (GOLD) describes COPD in the following words: “COPD is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development . . . The chronic airflow limitation that is characteristic of COPD is caused by a mixture of small airways disease and parenchymal destruction (emphysema), the relative contributions of which vary from person to person . . . Chronic inflammation causes structural changes, narrowing of the small airways, and destruction of lung parenchyma . . . A loss of small airways may contribute to airflow limitation and mucociliary dysfunction is a characteristic feature of the disease” (1).
  • This new definition no longer includes the terms “emphysema” and “chronic bronchitis.”
  • Third leading cause of death in the United States
  • Projected to be the third leading cause of death globally by 2020 (2); 3.2 million deaths worldwide (2)

Epidemiology

Incidence
The incidence of COPD is 8.9/1,000 person-years (3).

Prevalence
  • The prevalence of COPD is 4.7% (3).
  • 4-year mortality rates range from 28% for mild to moderate COPD to 62% for moderate to severe COPD.

Etiology and Pathophysiology

Exposure to noxious gasses or particles (see “Risk Factors”) leading to the following pathologic processes in the lung:

  • Impaired gas (carbon dioxide and oxygen) exchange
  • Persistent airway obstruction
  • Destruction of lung parenchyma
Genetics
  • Genetics may contribute to host response to noxious gasses or particles.
  • Antiprotease deficiency (due to α1-antitrypsin deficiency) is an inherited, rare disorder due to two autosomal codominant alleles.

Risk Factors

  • Smoking tobacco or marijuana: including passive smoking and water pipe (2)
  • Severe pneumonia early in life including viral (4)
  • Aging
  • Lower level of education and poverty (4)
  • Asthma
  • Indoor pollution (especially indoor biomass cooking worldwide) (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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