Internal Medicine Pulmonology

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD)
Gross anatomical sample showing centrilobular emphysema, a classic consequence of smoking.

Introduction – Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a disease that is increasing dramatically. For persons between 45 and 65 years, the prevalence is 10% and it increases with age.

The chronic obstructivity, which is due to a combination of bronchiolitis and emphysema, develops quietly. Therefore, the patient does not experience breathing problems that are so obvious that they motivate physician contact until lung function is halved or further deteriorated.  COPD is consequently underdiagnosed significantly.


Causes

  • Smoking – the dominant risk factor. At least 50% of those who smoke develop spirometry changes as seen in COPD
  • Passive smoking
  • Occupational exposure to respiratory irritants
  • Family history of obstructive pulmonary disease
  • Exposure to gases when burning biofuels
  • Respiratory tract infections in childhood
  • Bronchial hyperreactivity
  • Atopy
  • Alpha-1 antitrypsin deficiency – can lead to emphysema, even in people who do not smoke.

Symptoms – Chronic obstructive pulmonary disease

  • Breathing problems – initially no or light. Then shortness of breath on exertion, in severe COPD even at rest
  • Cough
  • Mucus
  • Wheezing and hisses – vary in severity
  • Cyanosis and peripheral edema – may occur

Symptoms increase with the severity of COPD.


Clinical Findings

Spirometry is the basis for diagnosing COPD. Must always be performed.

  • The ratio FEV1 / FVC <0.7
  • No normalization of the ratio after bronchodilator treatment
  • Hyperinflation (barrel chest)
  • Hypoxia
  • Carbon dioxide retention in some patients
  • High Hb (polycythemia) may occur.

Assessment of Severity

Consider the following:

  • Spirometric classification.
     
  • Respiratory symptoms (can be measured with the CAT questionnaire, COPD Assessment Test).
     
  • Occurrence of exacerbations (the risk increases with the number of exacerbations in the past year).

Differential Diagnoses – Chronic obstructive pulmonary disease

  • Asthma
  • Bronchiectasis
  • Bronchiolitis obliterans
  • Cystic fibrosis
  • Infection
  • Heart failure
  • Tumor
  • Idiopathic Pulmonary Fibrosis (IPF)

Comorbidities

  • Cardiovascular disease (about 50%)
  • Anxiety, depression and cognitive failure
  • Asthma
  • Osteoporosis
  • Lung cancer
  • The metabolic syndrome

All co-morbid conditions should be treated according to standard guidelines.


Diagnostics

  1. Spirometry with reversibility test
  2. Steroid Testing
  3. Chest X-ray – sometimes supplemented with computed tomography
  4. Arterial blood gas
  5. Pulse oximetry in regular follow-up and in exacerbations
  6. Alpha-1 antitrypsin determination, especially in non-smokers, aged below 50 years and deterioration of lung function is rapid.
  7. CBC

Further Reading