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For further information, see CMDT Part 9-06: Chronic Obstructive Pulmonary Disease

Key Features

Essentials of Diagnosis

  • History of cigarette smoking or other chronic inhalational exposure

  • Chronic cough, dyspnea, and sputum production

  • Rhonchi, decreased intensity of breath sounds, and prolonged expiration on physical examination

  • Airflow limitation on pulmonary function testing

General Considerations

  • The term "COPD" has evolved from an umbrella term for chronic bronchitis and emphysema to one that refers to a clinical syndrome of chronic respiratory symptoms, structural pulmonary abnormalities (airways or alveoli) and impaired lung function, arising from multiple causes that result in airflow limitation that is not fully reversible

  • Cigarette smoking is by far the most important cause of COPD in North America and Western Europe

  • Other causes include exposures to

    • Environmental tobacco smoke

    • Occupational dusts and chemicals

    • Indoor air pollution from biomass fuel used for cooking and heating in poorly ventilated buildings

  • Outdoor air pollution, airway infection, environmental factors, and allergy have also been implicated, along with hereditary factors (most notably, deficiency of alpha-1-antiprotease [alpha-1-antitrypsin])

  • Atopy and bronchoconstriction in response to nonspecific airway stimuli may be important risk factors

Clinical Findings

Symptoms and Signs

  • Presentation

    • Usually at 40–50 years of age

    • Cough

    • Sputum production

    • Shortness of breath

  • Dyspnea initially occurs only with heavy exertion, progressing to symptoms at rest in severe disease

  • Exacerbation of symptoms beyond normal day-to-day variation, often including increased dyspnea, an increased frequency or severity of cough, increased sputum volume, or change in sputum character

  • Infections (viral more commonly than bacterial) precede exacerbations in most patients

  • Late-stage COPD characterized by

    • Hypoxemia

    • Pneumonia

    • Pulmonary hypertension

    • Cor pulmonale

    • Respiratory failure

  • Clinical findings may be absent early

  • Patients are often dichotomized as "pink puffers" or "blue bloaters" depending on whether emphysema or chronic bronchitis predominates (Table 9–6)

Table 9–6.Patterns of disease in advanced COPD.

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