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What is chronic obstructive pulmonary disease?

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Minal

Chronic Obstructive Pulmonary Disease (COPD) is progressive, irreversible airway obstruction usually due to smoking.

Emphysema: enlargement of air spaces and destruction of parenchyma causing closure of small airways and loss of lung elasticity.

Lung Dysfunction results from airflow limitation (loss of elastic recoil, increased collapsibility/ narrowing of small airways) and impaired gas exchange (V/Q mismatch, alveolar destruction, increased dead space causing hypercarbia)

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Epidemiology:

  • Cigarette smoking (> 90% of cases), air pollution, occupational inhalation, alpha 1 – AT deficiency)
  • Genetic predisposition.

Signs and Symptoms:

Patients usually have a combination of bronchitis and emphysematous signs and symptoms

 Chronic Bronchitis (Blue Bloaters):

  • A productive cough for at least 3 months during 2 or more successive years.
  • Exertional Dyspnoea
  • Fatigue
  • Right Heart Failure
  • Rhonchi/ Wheezes
  • Cyanosis/ hypoxemia
  • Obesity
  • Late CO2 retention

Emphysematous Symptoms (Pink Puffers):

  • A minimal cough
  • Weight loss
  • Severe dyspnoea
  • Increased work of breathing
  • Prolonged expiration
  • Flattened diaphragm
  • Pursed lip breathing
  • Hyper-resonance
  • Accessory muscle use
  • Minimal hypoxemia
  • Decreased air movement
  • Barrel chest tripod sitting
  • Normal pCO2

Diagnosis:

  • Pulmonary Function Tests (PFTs):
  • Decreased FEV1,/ forced Ventricle Capacity (FVC) (<70% predicted)
  • Increased Lung Volumes (FRC, RV, RV/ TLC ratio): due to airway obstruction, resulting in airway trapping and hyperinflation.
  • Decreased diffusing capacity: especially in emphysema
  • X-Ray Chest:
  • Flattened diaphragms, hyperinflation, bullae and increased lucency in lung; small heart
  • Arterial Blood Gas (ABG):
  • Hypoxaemia (due to V/Q mismatch), hypercarbia
  • Complete Blood Count (CBC):
  • Polycythemia secondary to chronic hypoxemia
  • CT Scan:
  • Centrilobular emphysema, bullae

Treatment:

  • Stop smoking
  • Bronchodilators: anticholinergics are the preferred agents; long-acting Beta-agonists decrease infections and improve symptoms.
  • Oxygen therapy: continuous/ night time O2
  • Antibiotics
  • Corticosteroids
  • Theophylline
  • Non-invasive positive pressure ventilation (BiPAP)

 Lung volume reduction surgery and lung transplant may benefit selected patients with end-stage disease

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