COPD (Chronic obstructive pulmonary disease) is an obstructive lung disease, characterized by chronic poor airflow. It includes both chronic bronchitis and emphysema.

• SOB
• Wheezing
• Cough, including productive cough
• In ephysema, pink puffers (aka type A), including:
  • Pink complexion
  • Fast RR
  • Pursed lips
• In chronic bronchitis, blue bloaters (aka type B), including:
  • Cyanosis (bluish color of the skin and lips), from lower oxygen levels
  • Ankle swelling
• +In acute exacerbation of COPD:
  • Sputum, that is slightly streaked w/ blood, colored yellow/green, or thicker than usual, if due to a bacterial infection
  • Flu-like Sx (weakness, fever, chills), in infection

• Tobacco smoking, most commonly
• Genetics
• Air pollution, commonly from poorly vented cooking and heated fires

Acute exacerbation of COPD can be triggered by:

• Respiratory infection (50%), commonly due to Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella c. Less commonly, due to Chlamydia neumoniae and MRSA
• Allergens, e.g. pollens, wood/cigarette smoke, pollution
• Toxins, including various chemicals
• Failing to follow Tx, e.g. improper use of an inhaler

• Long term exposure to these irritants causes an inflammatory response in the lungs resulting in narrowing of the small airways and breakdown of lung tissue known as emphysema

• Poor airflow, on PFT's. In contrast to asthma, the airflow reduction doesn't improve significant w/ the administration of drugs
• CXR, including:
  • Overexpanded lungs
  • Flattened diaphragm
  • Increased retrosternal airspace
  • Bullae
  • Help exclude other lung diseases, e.g. pneumonia, pulmonary edema, or a pneumothorax
• High resolution CT of the chest, to:
  • Show distribution of emphysema througout the lungs, although unless surgery is planned, this rarely affects Mx
  • Exclude other lung diseases
• FBC
• ABG (arterial blood gas), used to determine the need for oxygen. It is recommended in Pt's w/ an FEV<35% predicted, those w/ a peripheral oxygen saturation of <92%, and those w/ Sx of CHF
• Testing for alpha-1 antitrypsin deficiency, in areas of the world where this is common, particularly Pt's <45yo, and emphysema affecting the lower parts of th elung

• Prevention, by reducing exposure to the known causes, including:
  • Quit smoking
  • Improve indoor and outdoor air quality
• Oral abx
• Rest
• Pulmonary rehabilitation
• Sx relief, including:
  • Painkillers
  • Fluids
  • Inhaled bronchodilators
  • Steroids
• Oxygen, including:
  • Supplemental oxygen, in Pt's w/ low oxygen levels at rest (partial pressure<53mmHg, or oxygen saturation<88%), as it decreases risk of heart failure and death if used 15 hours per day, and may improve Pt's ability to exercise. In Pt's w/ normal or mildly low oxygen levels, oxygen supplementation may improve SOB. There is a risk of fires and little benefit in Pt's who continue to smoke, where some recommend AGAINST it's use. During acute exacerbations, many require oxygen therapy. The use of high concentrations of oxygen without taking into account oxygen sats may cause INCREASED levels of CO2, and worse outcomes. In Pt's at high risk of high CO2 levels, oxygen sats of 90% are recommended, whilst those w/o this risk is recommended at 96%
  • Positive pressure ventilation, assist in Pt's w/ type 2 respiratory failure (i.e. acutely raised CO2 levels), which decreases the probabiltiy of death or need for ICU admission
• Surgery, for Pt's w/ very severe disease, is sometimes helpful, including:
  • Lung transplantation, sometimes performed for very severe COPD, particularly in younger Pt's
  • Lung volume reduction surgery, involving removing parts of the lung most damaged by emphysema, allowing the remaining, relatively good lung to expand and work better
• Prevent exacerbation, including:
  • Vaccination

• Typically worsens over time
• Increased use of drugs and hospitalization may be required in periods of acute exacerbation

• Acute exacerbation of COPD, is sudden worsening of COPD Sx, usually lasting for several days. Acute exacerbation can be caused by:
  • Respiratory infection, is responsible for 50% of COPD exacerbations. They are equally split, as to cause by viral or bacterial infections. Pathogens include:
    • Haemophilus influenzae
    • Streptococcus pneumoniae
    • Moraxella catarrhalis
    • Less commonly:
      • Chlamydia pneumoniae
      • MRSA
    • Pathogens seen more in Pt's w/ impaired lung function, FEV<35% predicted, include:
      • Haemophilus parainfluenzae, after repeated use of abx
      • Mycoplasma pneumoniae
      • Gram-negative, opportunistic pathogens, e.g. Pseudomonas aeruginosa and Klebsiella pneumoniae
  • Allergens
  • Toxins
  • Change in color of sputum
  • Air pollution
  • Failing to follow a drug therapy program
• Pneumothorax, due to rupture of the airways in the lungs

• 10% of kids are hospitalized
• 32% of adults in the developed world w/ CAP are admitted

• Worldwide, it affects 329m or nearly 5% of the population
• Results in 2.9m deaths per annum, up from 2.4m in 1990
• The number of deaths is projected to increase due to high smoking rates, and an aging population in many countries
• Results in economic costs of $2.1t per annum

• Pneumonia