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