Chronic Obstructive Pulmonary Disease and Emphysema
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- 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.
Affects >5% of adults in the United States and is the 12th leading cause of morbidity (1)
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
- 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.
- 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)
- Lower level of education and poverty (4)
- Airway hyperactivity
- Indoor pollution (open fire for cooking or heating) (4)
- Occupational organic or inorganic dusts (4)
- 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