what is COPD
chronic obstructive pulmonary disease
chronic slowly progressive disorder characterised by airflow obstruction
pathological features of COPD
- glandular hypertrophy, reduced number of cilia
- goblet cell metaplasia; smooth muscle hypertrophy; fibrosis
- loss of alveolar fine structure
physiological consequences of COPD
- increased cough +/- sputum
- increased mucus production, increased expiratory flow resistance
- loss of lung recoil, reduced gas exchange
symptoms of COPD
- cough with/without sputum
- dyspnoea (SOB)
- wheeze
2 clinical phenotypes of COPD
chronic bronchitis
emphysema
clinical diagnosis of chronic bronchitis
daily productive cough for 3 months ore more, in at least 2 consecutive years
clinical diagnosis of emphysema
permanent enlargement and destruction of airspaces distal to the terminal bronchiole
3 types of chronic bronchitis
simple mucoid bronchitis
mucopurulent (pus) bronchitis
chronic obstructive bronchitis
clinical manifestations of chronic bronchitis
- hypersecretion of mucus by goblet cells
- bronchospasm, dyspnoea and wheezing
- hypoxia and hypercapnia (elevated CO2)
- productive cough
- increased body weight
a complication of chronic bronchitis
cor-pulmonale (right-sided HF)
emphysema
an abnormal permanent enlargement of large spaces distal to the terminal bronchioles, accompanied by destruction of their walls
clinical manifestations of emphysema
- loss of intricate alveolar structure
- small highly effective gas-exchanging units into large, inefficient cyst-like spaces
- larger volumes of gas need to be inhaled to meet metabolic needs
- severe difficulty breathing
effect of emphysema on oxygen and carbon dioxide levels
chronic respiratory failure
low blood oxygen levels (hypoxemia) and elevated levels of carbon dioxide (hypercapnia, hypercarbia, chronic respiratory acidosis)
symptoms of chronic bronchitis
- recurrent productive cough
- hypoxic/hypercapnia
- cyanotic
- increased RR
- Ronchi and wheezing
- cardiac enlargement
symptoms of emphysema
- dyspnoea
- increased CO2 retention
- pink complexion (hyperventilation)
- minima cyanosis
- pursed lips breathing
- barrel chest
- thin (loss of appetite, muscle wasting)
BODE index
predicts disease severity in COPD
4 predictors of BODE index
- body mass index (BMI)
- degree of airflow obstruction assessed by FEV1
- mMRC dyspnoea scale
- exercise 6MWD test
