II. Epidemiology

  1. COPD Incidence in U.S.: 15 Million patients
  2. COPD affects 6% of adults in U.S.
  3. COPD results in 126,000 deaths per year in U.S. (4th leading cause of death)

III. Risk Factors

  1. Cigarette smoking and Exposure to Tobacco smoke
    1. Active, continuous smoking confers COPD absolute risk of 25%
    2. Tobacco abuse is responsible for >80% of COPD cases
    3. Women have a greater degree of lung damage and Impairment for a given exposure
      1. Increased hyper-responsiveness to exogenous toxins
      2. Chapman (2004) Clin Chest Med 25:331-41 [PubMed] (or open in [QxMD Read])
  2. Domestic or Occupational pollutants
    1. See Irritant-induced Asthma
    2. See Allergic Occupational Asthma
    3. Mineral Dust (e.g. Mining of coal or hard rock, Concrete manufacture, Silica)
    4. Organic Dust (e.g. Cotton, hemp, grains)
    5. Gas Fumes (e.g. heavy metals, welding, sulfur dioxide, isocyanates)
    6. Boschetto (2006) J Occup Med Toxicol 1:11 [PubMed] (or open in [QxMD Read])
  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

IV. Definition: 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

V. Diagnosis: Pulmonary Function Tests

  1. See Emphysema and Chronic Bronchitis
  2. GOLD criteria
    1. FEV1 to FVC ratio: 0.7 and
    2. FEV1 <80% of predicted post-Bronchodilator
  3. GOLD Severity stratification
    1. Mild: FEV1 80% or greater than predicted
    2. Moderate: FEV1 <80% of predicted
    3. Severe: FEV1 <50% of predicted
    4. Very Severe: FEV1 <30% of predicted
  4. Other findings
    1. DLCO diminished in Emphysema
    2. Increased Total Lung Capacity
    3. Increased Residual Volume

VI. Staging

VII. 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

VIII. Imaging: 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

X. Complications

  1. Severe Chronic Dyspnea (66%)
  2. Severe total body pain (25%)

XI. Screening

  1. Spirometry in 10 pack year smokers over age 40
    1. Zielinski (2001) Chest 119:731-6 [PubMed] (or open in [QxMD Read])

XIV. 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

Images: Related links to external sites (from Google)

Ontology: Chronic Obstructive Airway Disease (C0024117)

Definition (NCI) A chronic and progressive lung disorder characterized by the loss of elasticity of the bronchial tree and the air sacs, destruction of the air sacs wall, thickening of the bronchial wall, and mucous accumulation in the bronchial tree. The pathologic changes result in the disruption of the air flow in the bronchial airways. Signs and symptoms include shortness of breath, wheezing, productive cough, and chest tightness. The two main types of chronic obstructive pulmonary disease are chronic obstructive bronchitis and emphysema.
Definition (MEDLINEPLUS)

Chronic Obstructive Pulmonary Disease (COPD) makes it hard for you to breathe. Coughing up mucus is often the first sign of COPD. Chronic bronchitis and emphysema are common COPDs.

Your airways branch out inside your lungs like an upside-down tree. At the end of each branch are small, balloon-like air sacs. In healthy people, both the airways and air sacs are springy and elastic. When you breathe in, each air sac fills with air like a small balloon. The balloon deflates when you exhale. In COPD, your airways and air sacs lose their shape and become floppy, like a stretched-out rubber band.

Cigarette smoking is the most common cause of COPD. Breathing in other kinds of irritants, like pollution, dust or chemicals, may also cause or contribute to COPD. Quitting smoking is the best way to avoid developing COPD.

Treatment can make you more comfortable, but there is no cure.

NIH: National Heart, Lung, and Blood Institute

Definition (NCI) A type of lung disease marked by permanent damage to tissues in the lungs, making it hard to breathe. Chronic obstructive pulmonary disease includes chronic bronchitis, in which the bronchi (large air passages) are inflamed and scarred, and emphysema, in which the alveoli (tiny air sacs) are damaged. It develops over many years and is usually caused by cigarette smoking.
Definition (CSP) chronic, irreversible obstruction of air flow from the lungs.
Definition (MSH) A disease of chronic diffuse irreversible airflow obstruction. Subcategories of COPD include CHRONIC BRONCHITIS and PULMONARY EMPHYSEMA.
Concepts Disease or Syndrome (T047)
MSH D029424
ICD10 J44.9
SnomedCT 195948000, 155569000, 195935004, 155585005, 155565006, 155617000, 196003006, 13645005, 413846005
English CHRONIC OBSTRUCTIVE LUNG DISEASE, Chronic Obstructive Pulmonary Disease, COPD, Pulmonary Disease, Chronic Obstructive, CHRONIC OBSTRUCT AIRWAYS DISEASE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, Chronic obstructive lung disease, NOS, COAD-Chron obstruc airway dise, COLD - Chron obstruc lung dise, COPD - Chron obstr pulmon dise, Chro irreversible airway obstr, Chron obstruc pulmon disease, Chronic obstr.airway dis.NOS, Chronic obstruc airway disease, Chronic obstructive airways disease NOS, Chronic obstructive lung dis, Chronic obstructive pulmonary disease (COPD), COAD, Chronic Obstructive Airway Disease, Chronic Obstructive Lung Disease, Chronic obstructive pulmonary disease, unspecified, Chronic Obstructive Airways Disease, CHRONIC OBSTRUCTIVE LUNG DIS, PULM DIS CHRONIC OBSTRUCTIVE, CHRONIC OBSTRUCTIVE PULM DIS, CHRONIC OBSTRUCTIVE AIRWAY DIS, CAFL - Chron airflow limitatn, CAL - Chron airflow limitation, COLD (chronic obstructive lung disease), chronic obstructive pulmonary disease (diagnosis), chronic obstructive pulmonary disease, chronic obstructive lung disease, copd, Chronic obstructive airways disease NOS (disorder), Chr obstruc pulmonary dis NOS, Chronic obstructive pulmonary disease NOS, COPD (Chronic Obstructive Pulmonary Disease), AIRWAY OBSTRUCTION CHRONIC, Chronic Obstructive Pulmonary Disease (COPD), OBSTRUCTIVE PULMONARY DISEASE (COPD), CHRONIC, COPD, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, DISEASE (COPD), CHRONIC OBSTRUCTIVE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, (COPD), PULMONARY DISEASE (COPD), CHRONIC OBSTRUCTIVE, Chronic obstructive airway disease NOS, Chronic obstructive lung disease NOS, Pulmonary Disease, Chronic Obstructive [Disease/Finding], Chronic airways disease, chronic airflow limitation, chronic obstructive pulmonary disease (COPD), coad, chronic airway disease, Chronic obstructive bronchopneumopathy, Chronic airway obstruction, COLD, COAD - Chronic obstructive airways disease, COLD - Chronic obstructive lung disease, COPD - Chronic obstructive pulmonary disease, Chronic airflow limitation, Chronic airway disease, Chronic irreversible airway obstruction, Chronic obstructive airway disease, Chronic obstructive lung disease, Chronic obstructive pulmonary disease, CAFL - Chronic airflow limitation, CAL - Chronic airflow limitation, Chronic obstructive lung disease (disorder), Chron obstructive pulmonary disease, disease (or disorder); respiratory tract, chronic, obstructive, disease (or disorder); respiratory tract, obstructive, chronic, lung; disease, obstructive (chronic), lung; obstruction, disease, chronic, obstruction; airway, chronic, obstruction; lung, disease, chronic, airway; obstruction, chronic, respiratory tract; disorder, chronic, obstructive, respiratory tract; disorder, obstructive, chronic, Chronic obstructive lung disease [Ambiguous], Chronic obstructive pulmonary disease finding (finding), Chronic obstructive pulmonary disease finding, Chronic obstruct airways disease, Chronic obstructive airways disease, Obstructive airways disease (chronic), Chronic airway obstruction; not otherwise specified, COPD NOS, Chronic obstr airways disease, Chronic obstr lung disease, Chronic obstr pulmon disease, chronic airways disease, chronic obstr airways disease, chronic obstr lung disease, chronic obstr pulmon disease
Dutch chronisch aspecifieke respiratoire aandoening, CARA, chronisch obstructieve luchtwegaandoening, obstructieve luchtwegaandoening (chronisch), chronische luchtstroombeperking, chronisch obstructieve longaandoening, chronische obstructieve luchtwegaandoening, chronische obstructieve bronchopneumopathie, Chronisch obstructieve longziekte (COPD), aandoening; luchtwegen, chronisch, obstructief, aandoening; luchtwegen, obstructief, chronisch, long; aandoening, obstructief (chronisch), long; obstructie, aandoening, chronisch, luchtweg; obstructie, chronisch, luchtwegen; aandoening, chronisch, obstructief, luchtwegen; aandoening, obstructief, chronisch, obstructie; long, aandoening, chronisch, obstructie; luchtweg, chronisch, Chronische obstructieve longaandoening, niet gespecificeerd, COPD, Chronische obstructieve longziekte, longziekte, chronische obstructieve
Portuguese Doença pulmonar obstrutiva crónica, Doença respiratória obstrutiva crónica, Doença obstrutiva (crónica) das vias respiratórias, Limitação crónica da ventilação, Doença crónica obstrutiva das vias respiratórias, DOENCA OBSTRUT CRONICA VIAS RESPI, Broncopneumopatia obstrutiva crónica, DPOC, COAD, COPD, Doença Obstrutiva Crônica das Vias Aéreas, Doença Obstrutiva Crônica do Pulmão, Doença Obstrutiva Crônica Pulmonar, Doença Pulmonar Obstrutiva Crônica
Spanish Enfermedad pulmonar obstructiva crónica, Enfermedad obstructiva crónica de las vías respiratorias, Limitación crónica del flujo respiratorio, Enfermedad obstructiva de las vías respiratorias (crónica), Neumopatía Obstructiva Crónica, Neumopatia Obstructiva Cronica, Chronic obstructive lung disease, Chronic obstructive lung disease [Ambiguous], Enfermedad Obstructiva Cronica de las Vias Aereas, Enfermedad Obstructiva Crónica de las Vías Aéreas, INSUF RESPIRATORIA CRONICA OBSTRU, Chronic obstructive airways disease NOS, Bronconeumopatía obstructiva crónica, EPOC, enfermedad pulmonar obstructiva crónica (trastorno), enfermedad pulmonar obstructiva crónica, SAI (trastorno), enfermedad pulmonar obstructiva crónica, SAI, enfermedad pulmonar obstructiva crónica, neumopatía obstructiva crónica, hallazgo relacionado con enfermedad pulmonar obstructiva crónica (hallazgo), hallazgo relacionado con enfermedad pulmonar obstructiva crónica, COAD, EVOC, Enfermedad Pulmonar Cronica Obstructiva, Enfermedad Pulmonar Obstructiva Cronica, Enfermedad del Pulmon Cronica Obstructiva, Enfermedad del Pulmón Crónica Obstructiva, Enfermedad Pulmonar Crónica Obstructiva, Enfermedad Pulmonar Obstructiva Crónica
French Syndrome obstructif des voies aériennes (chronique), Limitation chronique d'écoulement gazeux, Maladie obstruct chronique des voies aériennes, BRONCHOPNEUMOPATHIE CHRON.OBSTRUC, Bronchopneumopathie chronique obstructive, BPCO, Broncho-pneumopathie chronique obstructive, Maladie pulmonaire obstructive chronique
German chronisch obstruktive Atemwegserkrankung, chronisch obstruktiven Lungenerkrankung, obstruktive Atemwegserkrankung (chronisch), chronische Luftstrombehinderung, CHRONISCH OBSTRUKTIVE ATEMWEGSERK, Chronische obstruktive Lungenkrankheit, nicht naeher bezeichnet, Chronisch-obstruktive Bronchopneumopathie, COAD, COPD, Chronisch obstruktive Lungenkrankheit, Chronische obstruktive Atemwegserkrankungen, Lungenkrankheiten, chronisch obstruktive, Chronisch obstruktive pulmonale Krankheit, chronisch-obstruktive Lungenerkrankung
Italian Limitazione cronica di flusso nelle vie aeree, Malattia cronica ostruttiva delle vie aeree, Malattia ostruttiva cronica delle vie aeree, Malattia ostruttiva delle vie aeree (cronica), Malattia cronica ostruttiva polmonare, COAD, COPD, Malattia ostruttiva cronica del polmone, Malattia ostruttiva cronica delle vie respiratorie, Broncopneumopatia ostruttiva cronica, Malattia polmonare ostruttiva cronica
Japanese 慢性気流制限, 閉塞性気道疾患(慢性), COPD, マンセイヘイソクセイキドウシッカン, ヘイソクセイキドウシッカンマンセイ, COPD, マンセイヘイソクセイハイシッカン, マンセイキリュウセイゲン, 慢性閉塞性気道疾患, 慢性閉塞性肺疾患, 慢性気流閉塞, 慢性閉塞性気管支肺症, マンセイヘイソクセイキカンシハイショウ, 肺疾患-慢性閉塞性, 気流閉塞-慢性
Swedish Kroniskt obstruktiv lungsjukdom
Czech plicní nemoc chronická obstrukční, chronická obstrukční nemoc dýchacích cest, chronická obstrukční nemoc plic, CHOPN, Chronická obstrukce dýchacích cest, Chronické obstrukční onemocnění dýchacích cest, Chronické obstrukční plicní onemocnění, Chronické omezení průtoku v dýchacích cestách, Chronické obstrukční onemocnění plic, Obstrukční onemocnění dýchacích cest (chronické), Chronická obstruktivní bronchopneumopatie
Finnish Ahtauttava keuhkosairaus
Russian DYKHATEL'NYKH PUTEI OBSTRUKTIVNAIA BOLEZN' KHRONICHESKAIA, KHRONICHESKIE OBSTRUKTIVNYE BOLEZNI LEGKIKH, LEGKIKH BOLEZN' KHRONICHESKAIA OBSTRUKTIVNAIA, ЛЕГКИХ БОЛЕЗНЬ ХРОНИЧЕСКАЯ ОБСТРУКТИВНАЯ, ДЫХАТЕЛЬНЫХ ПУТЕЙ ОБСТРУКТИВНАЯ БОЛЕЗНЬ ХРОНИЧЕСКАЯ, ХРОНИЧЕСКИЕ ОБСТРУКТИВНЫЕ БОЛЕЗНИ ЛЕГКИХ
Korean 상세불명의 만성 폐쇄성 폐질환
Croatian KOBP, PLUĆNA BOLEST, KRONIČNA OPSTRUKTIVNA, KRONIČNA OPSTRUKTIVNA BOLEST PLUĆA
Polish Choroba płuc obturacyjna przewlekła, POCD, POChP, Przewlekła obturacyjna choroba płuc
Hungarian Krónikus obstructiv bronchopneumopathia, Obstructiv légúti betegség (chronikus), Chronikus obstructiv pulmonalis betegség, Chronikus obstuctiv légúti betegség, COPD, Chronikus obstructiv légúti betegség, Chronikus légúti szűkület, Chronikus obstructiv tüdőbetegség, KALB