Pathology: Umbrella term for emphysemaand chronic bronchitis.
Progressive airway obstruction with little to noreversibility
Emphysema:dilatation and destruction of terminal air spaces
Chronic bronchitis:productive cough on most days for at least 3 months of two successive years.
Aetiology: Tobaccosmoking, occupational environments, alpha-1 anti-trypsin deficiency
Symptoms: Cough,sputum production, breathlessness and wheeze
Signs: Tachypnoea,hyperinflated thorax, lip pursing, plethoric, cyanosis, use of accessorymuscles, quiet breath sounds.
Investigations: Spirometry: Obstructive pattern
Transfer factor: Reduced in emphysema
Chest X-Ray: Hyperinflation, bullae
HRCT: Examines degree of emphysema
Treatment: Smokingcessation, pulmonary rehabilitation, appropriate self management plans (e.g.home steroids and antibiotics). Appropriate oxygen therapy if needed
Figure 2.7 TreatmentPathway For COPD
Complications: Infectiveexacerbations, pneumothorax, cor pulmonale, pulmonary hypertension, immobility,weight loss, ventilatory failure
Prognosis: Onlystopping smoking and long term oxygen therapy (LTOT) improve prognosis
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