Description

• A disease characterized by airflow obstruction due to several processes:
  • Emphysema: Irreversible alveolar destruction with loss of airway elastic recoil:
    • Represents accelerated aging of the lung
  • Chronic bronchitis: Airway inflammation without alveolar destruction:
    • Productive cough for at least 3 mo per year for 2 consecutive yr after other causes of chronic cough have been ruled out
  • Airflow limitation: abnormally decreased ability to exhale (decreased FEV1/FVC)
• Chronic obstructive pulmonary disease (COPD) affects ∼10% of the global population
  • 20–40% of COPD patients in the world are nonsmokers
• Diagnosed in patients who have the appropriate clinical context and with <0.7 FEV1/FVC postbronchodilation measured via spirometry
• The term “Pre-COPD” has been used to describe patients with severe symptoms and/or lung changes, but have an FEV1/FVC ratio ≥0.7
• The term “PRISM” describes patients with preserved FEV1/FVC ratio but impaired spirometry. These patients also have poor outcomes
• Classically, asthma is defined as airflow obstruction that is reversible (with medication or spontaneously) compared to COPD which is persistent obstruction:
  • People with long-standing asthma can later develop persistent airflow obstruction
• Increased incidence of hypertension, diabetes, congestive heart failure, and cardiovascular disease in those with COPD
• Frequent exacerbations lead to:
  • Greater mortality
  • Faster decline in lung function
  • Lower quality of life
  • Increased risk of hospitalization
• Symptom scores can be used:
  • Modified Medical Research Council (mMRC) dyspnea scale
  • Chronic Respiratory Questionnaire (CRQ)
  • St. George Respiratory Questionnaire (SGRQ)
  • Clinical COPD Questionnaire (CCQ)
  • COPD Assessment Test (CAT)
• GOLD grades and severity of airflow obstruction:
  • Gold 1: Mild:
    • FEV1 >80% predicted
  • Gold 2: Moderate:
    • FEV1 50–80% of predicted
  • Gold 3: Severe:
    • FEV1 30–49% of predicted
  • Gold 4: Very severe:
    • FEV1 <30% of predicted
• The GOLD ABE assessment tool uses the above grading scale combined with the number of exacerbations per year and the mMRC symptom scale to guide treatment recommendations.

Risk Factors