Chronic Obstructive Pulmonary Disease
(=chronic obstructive airways disease)
Definition: Airway obstruction
that does not change in severity over several months.
Disability at 30%; Death at 15%.
COPD is a syndrome and not a disease.
There are eleven causes:
Conventionally, COPD refers only to widespread obstruction of
intrathoracic airways (so cause 4 is excluded), and "specific" causes
of obstruction are also usually excluded (causes 5 to 12).
α1-antitrypsin deficiency, &c.
- chronic obstructive bronchitis
- chronic irreversible asthma
- tracheal stenosis
- bronchiectasis—cystic fibrosis,
hypogammaglobulinaemia, Kartagener's syndrome, &c.
- obstructive bronchiolitis—mineral
connective tissue diseases, &c.
- bronchopulmonary dysplasia
- histiocytosis X
Definition: Chronic mucus hypersecretion
sufficient to cause expectoration
(in three consecutive months for at least two years).
Diagnosis is clinical.
Definition: pathological dialation of the air spaces
distal to the terminal bronchiole, with destruction of their walls
and without obvious fibrosis.
Diagnosis is by imaging and lung function tests.
- Increasing age
- Gender (M>F)
- Environmental pollution (urban>rural)
- Socioeconomic status (low status>high status)
- Occupation (Cadmium workers; coal & gold miners)
- Diet (fish and antioxidents possibly protective)
- Genetic factors (α1-antitrypsin deficiency)
- Low birthweight
- Childhood bronchiolitis
Physiological hypoventilation during sleep→hypoxia (Douglas, 1979).
More common in "blue bloaters" than "pink puffers".
Patients with noctural hypoxaemia more likely to die at night.
- Stop smoking
- Antibiotics for acute infections
- Bronchodilators (occasional)
- Bronchodilators (regular)
- Steroid (trail then inhaled steroids if positive)
- Influenza vaccine
- Pulmonary rehabilitation
- Long term O2 therapy
- Ambulatory O2