CHRONIC OBSTRUCTIVE PULMONARY DISEASE,WHAT TO KNOW?

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

• SYMPTOMS: Dyspnoea that is:
  • progressive over time 
  • characteristically worse with exercise
  • persistent
• Chronic cough:
  • may be intermittent and may be unproductive
  • recurrent wheeze 
• Chronic sputum production:
  • any pattern of chronic sputum production may indicate COPD
• Recurrent lower respiratory tract infections
• History of risk factors:
  • host factors (such as genetic factors, congenital/developmental abnormalities, etc) 
  • tobacco smoke (including popular local preparations) 
  • smoke from home cooking and heating fuels
  • occupational dusts, vapours, fumes, gases, and other chemicals
• Family history of COPD and/or childhood factors:
  • for example, low birthweight, childhood respiratory infection, etc

Table 1: Differential diagnosis of COPD

Diagnosis	Suggestive features
These features tend to be characteristic of the respective diseases, but are not mandatory. For example, a person who has never smoked may develop COPD (especially in the developing world where other risk factors may be more important than cigarette smoking); asthma may develop in adult and even in elderly patients.
COPD	Onset in mid-life Symptoms slowly progressive History of tobacco smoking or exposure to other types of smoke
Asthma	Onset early in life (often childhood) Symptoms vary widely from day to day Symptoms worse at night/early morning Allergy, rhinitis, and/or eczema also present Family history of asthma Obesity coexistence
Congestive heart failure	Chest X-ray shows dilated heart, pulmonary oedema. Pulmonary function tests indicate volume restriction, not airflow limitation
Bronchiectasis	Large volumes of purulent sputum Commonly associated with bacterial infection Chest X-ray/CT shows bronchial dilation, bronchial wall thickening.
Tuberculosis	Onset all ages Chest X-ray shows lung infiltrate Microbiological confirmation High local prevalence of tuberculosis
Obliterative bronchiolitis	Onset at younger age, non-smokers May have history of rheumatoid arthritis or acute fume exposure Seen after lung or bone marrow transplantation CT on expiration shows hypodense areas
Diffuse panbronchiolitis	Predominantly seen in patients of Asian descent Most patients are male and non-smokers Almost all have chronic sinusitis Chest X-ray and high-resolution computed tomography show diffuse small centrilobular nodular opacities and hyperinflation

Classification of airflow limitation severity in COPD (based on post-bronchodilator FEV1) GOLD 2020

• In patients with FEV1/FVC < 0.70:
  • GOLD 1—mild: FEV1≥ 80% predicted 
  • GOLD 2—moderate: 50% ≤ FEV1 < 80% predicted
  • GOLD 3—severe: 30% ≤ FEV1 < 50% predicted
  • GOLD 4—very severe: FEV1 < 30% predicted
  • mMRC SCALE FOR DYSPNOEA:
  • 

XRAY OF COPD