Respiratory System >
Chronic Obstructive Pulmonary Disease (COPD)

“Syndrome of irreversible airflow obstruction”

Includes sub-types Chronic Bronchitis & Emphysema

Risk Factors
  • Modifiable:
    • Smoking (>20 pack year)
  • Non-Modifiable:
    • Age (>65)
    • Lower Socioeconomic Status
    • High Pollution Exposure
Aetiology
  • Predominantly caused by inhaled toxins
  • Genetic predisposition (alpha-1-antitrypsin deficiency)
Pathophysiology
  • Chronic Bronchitis:
    • Underlying inflammation
    • Goblet Cells become hyperactive
    • Increased mucous production
    • Causes Inflammatory Oedema
  • Emphysema:
    • Oxidative damage occurs, reducing elastic recoil
    • Causes abnormal dilation of airways distal to the terminal bronchioles
Clinical Presentation
  • Chronic Bronchitis:
    • Productive cough for >3months for 2 successive years
    • Blue Bloater presentation
      • Central cyansis
      • Reduced exercise tolerance
      • Abnormal auscultation
      • Dyspnea (shortness of breath) at rest
  • Emphysema:
    • Pink Puffer presentation
      • CO2 retention
      • Low body mass
      • Use of accessory inspiratory muscles
      • Barrel chest
      • Pursed lips
      • Non-productive cough
Investigations
  • Bloods:
    • Arterial Blood Gas – Chronic type II with decreased O2 and increased CO2
  • Imaging:
    • Chest X-Ray – Looking for hyperinflated chest or flattened diaphragmatic lines
    • CT scan – Looking for bullae and to rule out other diagnosis
  • Special:
    • Spirometry – Is there a low FEV1:FEV ratio (<70%)?
    • Peak Flow
    • Sats – Decreased O2 sat of 88-92%
    • Sputum sample
  • On Examination
    • Increased respiratory rate
Management
  • Conservative:
    • Smoking cessation – possible use of Varenicline to aid cessation
  • Medical:
    • Combined LABA and LAMA inhalers
    • Combined LABA, LAMA and GCS inhalers
    • Oxygen therapy via Venturi Mask to 88-92% Sat (do not go above 92% to avoid reperfusion damage)
  • Surgical:
    • Volume resection – removal of emphysemic tissue to provide space for remaining tissue to expand into
Complications
  • COPD Exacerbation (Viral / Bacterial)
  • Medication non-compliance
  • Malignancy
  • Pulmonary Embolism
  • Pneumothorax

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