Chronic Obstructive Pulmonary Disease and Emphysema
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- Chronic obstructive pulmonary disease (COPD) encompasses several diffuse pulmonary diseases, including chronic bronchitis, asthma, cystic fibrosis, bronchiectasis, and emphysema:
- Chronic bronchitis is defined clinically by increased mucus production and recurrent cough present on most days for at least 3 mo/yr during at least 2 consecutive years.
- Emphysema, the destruction of interalveolar septa, occurs in the distal or terminal airways and involves both airways and lung parenchyma.
Affects ∼10–20% of adults; >100,000 deaths/yr in the US
- 14 million people have chronic bronchitis; 2 million people have emphysema.
- 4th leading cause of death in the US
- Smoking; passive smoking, especially adults whose parents smoked; cannabis use (1 joint is equivalent to 2.5–5 cigarettes) (3)
- Severe viral pneumonia early in life
- Alcohol consumption
- Airway hyperactivity
- Pollution (indoor such as heating or outdoor) (3)
- Chronic bronchitis is not a genetic disorder.
- Antiprotease deficiency (due to α1-antitrypsin deficiency) is an inherited, rare disorder due to 2 autosomal-codominant alleles.
- Avoidance of smoking is the most important preventive measure.
- Early detection through pulmonary function tests (PFTs) in high-risk patients may be useful in preserving remaining lung function.
- Impaired gas (CO2 and O2) exchange
- Chronic bronchitis: Airway obstruction (2)
- Emphysema: Destruction of lung parenchyma
Cigarette and/or cannabis smoking, air pollution, antiprotease deficiency (α1-antitrypsin), occupational exposure (firefighters), infection possibly (viral), occupational pollutants (cadmium, silica)
Commonly Associated Conditions
- Pulmonary: Lung cancer, chronic respiratory failure, acute bronchitis, sleep apnea
- Cardiac: Coronary artery disease
- Ear, nose, and throat (ENT): Chronic sinusitis, laryngeal carcinoma
- Miscellaneous: Malnutrition, osteoporosis, muscle dysfunction, depression