Chronic Obstructive Pulmonary Disease and Emphysema

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Description

The 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines chronic obstructive pulmonary disease (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.
  • COPD was the third leading cause of death and 90% of these deaths occur in low- to medium-income countries.

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% and is projected to rise.

Etiology and Pathophysiology

COPD is the end-result of lifetime environmental exposures including noxious gasses or particles leading to pathologic processes in the airways, lung parenchyma, and pulmonary vasculature.

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

Genetics

α1-Antitrypsin deficiency caused by SERPINA1 gene, an inherited disorder due to two autosomal codominant alleles, is rare, although it is the best documented genetic risk factor for COPD.

Risk Factors

  • History of severe childhood respiratory infections and/or asthma and airway hyperreactivity
  • Smoking tobacco or marijuana: including passive smoking and water pipe
  • Lower level of education and lower socioeconomic status
  • Indoor air pollution (especially indoor biomass cooking worldwide): wood, animal dung, crop residues, coal, open fires or poorly functioning stoves
  • Occupational organic and inorganic dusts, chemical agents and fumes
  • Outdoor air pollution (particulate matter, ozone, oxides of nitrogen and sulfur, heavy metals, greenhouse gasses)
  • Aging: including healthy aging as well as the cumulative summation of lung exposure over time

General Prevention

  • Smoking cessation and general avoidance of noxious material is the most important preventative measure.
  • Reduction of exposure to dusts, fumes, and gases; air pollutants, efficient ventilation, nonpolluting cooking stoves; avoid potential irritants.

Commonly Associated Conditions

  • Pulmonary: lung cancer, respiratory failure, obstructive sleep apnea, pulmonary hypertension (HTN), asthma, bronchiectasis
  • Cardiovascular: HTN, cardiovascular disease (CVD), peripheral vascular disease (PVD) arrhythmia (especially low FEV1), heart failure
  • Ear/nose/throat (ENT): chronic sinusitis, laryngeal carcinoma
  • Gastrointestinal (GI): gastroesophageal reflux disease (GERD); musculoskeletal (MSK): osteoporosis
  • Heme: polycythemia, anemia
  • Neuro-psych: depression, anxiety, insomnia, cognitive impairment

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