Pulmonology Book

Background Information

  • Chronic Obstructive Pulmonary Disease

Bronchial Disorders

Management

Miscellaneous

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Chronic Obstructive Pulmonary DiseaseAka: Chronic Obstructive Lung Disease, COPD

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  1. Epidemiology
    1. COPD Incidence in U.S.: 14 Million patients
    2. COPD affects 20% of adults in U.S.
    3. COPD fourth leading cause of death in U.S.
  2. Risk factors
    1. Cigarette smoking and Exposure to Tobacco smoke
      1. Chronic Tobacco abuse risk of COPD: 15%
      2. Tobacco abuse is responsible for 90% of COPD cases
    2. Domestic or Occupational pollutants
    3. Recurrent respiratory infections (especially Infancy)
    4. Atopic Patients
    5. Family History of COPD
    6. Alpha-1-antitrypsin deficiency
      1. Suspect in patients under age 45 without other risk
      2. Other protease deficiencies may also be related
  3. Definition of Chronic Obstructive Pulmonary Disease
    1. See Emphysema and Chronic Bronchitis
    2. Progressive chronic airflow obstruction
    3. Irreversibility distinguishes COPD from Asthma
    4. Types
      1. Chronic Bronchitis
      2. Emphysema
  4. Diagnosis: Pulmonary Function Tests
    1. See Emphysema and Chronic Bronchitis
    2. GOLD criteria
      1. FEV1 to FVC ratio: <70% and
      2. FEV1 <80% of predicted post-Bronchodilator
    3. Severity stratification
      1. Moderate: FEV1 <80% of predicted
      2. Severe: FEV1 <50% of predicted
      3. Very Severe: FEV1 <30% of predicted
    4. Other findings
      1. DLCO diminished in Emphysema
      2. Increased Total Lung Capacity
      3. Increased Residual Volume
  5. Labs
    1. See Emphysema and Chronic Bronchitis
    2. Arterial Blood Gas
      1. Indicated in severe or very severe COPD
    3. Alpha-1-antitrypsin indications
      1. Age under 45 years
      2. No prior smoking history
      3. Family History of alpha-1-antitrypsin deficiency
      4. Comorbid Cirrhosis
  6. Radiology: Chest XRay
    1. See Emphysema and Chronic Bronchitis
    2. Lung hyperinflation
    3. Diaphragm flattening
    4. Distal pulmonary vessel tapering
    5. Increased basilar markings in Chronic Bronchitis
  7. Differential Diagnosis
    1. Asthma
    2. Bronchiectasis
    3. Bronchiolitis Obliterans
    4. Congestive Heart Failure
    5. Tuberculosis
    6. Cystic Fibrosis
  8. Complications
    1. Severe Chronic Dyspnea (66%)
    2. Severe total body pain (25%)
  9. Screening
    1. Spirometry in 10 pack year smokers over age 40
      1. Zielinski (2001) Chest 119:731
  10. Prognosis
    1. Factors associated with a worse prognosis (mortality)
      1. FEV1 < 750 cc (<50% of predicted)
      2. Rapid FEV1 decline
      3. Lower diffusion capacity
      4. Hypoxia with PaO2 <55 mmHg
      5. Older patients
      6. Continued Tobacco abuse
      7. Hypercapnia with PaCO2 > 45 mmHg
      8. Right-sided Heart Failure
      9. Malnutrition
      10. Resting tachycardia
    2. Factors associated with a better prognosis
      1. Post-Bronchodilator FEV1 shows reversible component
      2. Atopy history
  11. References
    1. Madison (1998) Lancet 352:467
    2. Martinez (1998) Postgrad Med 103(4):112

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