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

  • 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. The chronic airflow limitation that characterizes COPD is caused by a mixture of small airways disease (e.g., obstructive bronchiolitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person. Chronic inflammation causes structural changes, small airways narrowing, and destruction of lung parenchyma. A loss of small airways may contribute to airflow limitation and mucociliary dysfunction, 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 (2)
  • Projected to be the third leading cause of death globally by 2020 (3); 3.2 million deaths worldwide (3)

Epidemiology

Incidence
The incidence of COPD is 8.9/1,000 person-years (4).

Prevalence
The prevalence of COPD is 4.7% (4).

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: including passive smoking and water pipe. Marijuana may also contribute (1,2,3).
  • Severe pneumonia early in life including viral (5)
  • Aging
  • Lower level of education and poverty (5)
  • Asthma (1)
  • Indoor pollution (especially indoor biomass cooking worldwide) (5)
  • Occupational organic or inorganic dusts (5)

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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