This document provides an overview of chronic obstructive pulmonary disease (COPD). It defines COPD and related terms like chronic bronchitis and emphysema. It then discusses the epidemiology, pathogenesis, pathologic changes, clinical characterization, diagnosis, assessment of severity and staging, differential diagnosis, and principles of management of COPD. The key points are that COPD is characterized by persistent respiratory symptoms and airflow limitation caused by exposure to noxious particles/gases. Cigarette smoking is the most common risk factor globally. The major pathophysiology involves inflammation and narrowing of the small airways leading to decreased airflow. Spirometry is the gold standard for diagnosis and assessment of severity. Management involves assessing/monitoring

1. Chronic obstructive
pulmonary disease (COPD)
Amsalu Bitew
( Internist , PCCM Fellow )
May/ 2022

2. Outline
DEFINITIONS
EPIDEMIOLOGY
PATHOGENESIS
PATHOLOGY
PATHOPHYSILOGY
CLINICAL CHARACTERIZATION
DIAGNOSIS
ASSESSMENT OF SEVERITY & STAGING
DIFFERENTIAL DIAGNOSIS
PRINCIPLES OF MANAGEMENT

3. DEFINITONS
COPD- A disease that is characterized by persistent respiratory
symptoms and airflow limitation that is due to airway and/or
alveolar abnormalities usually caused by significant exposure to
noxious particles or gases and influenced by host factors
including abnormal lung development.
Chronic bronchitis — it is defined as a chronic productive
cough for three months in each of two successive years in a
patient in whom other causes of chronic cough (eg,
bronchiectasis) have been excluded.

4. DEFINITONS
Emphysema — It is a pathological term that describes some of
the structural changes that include abnormal and permanent
enlargement of the airspaces distal to the terminal bronchioles
that is accompanied by destruction of the airspace walls, without
obvious fibrosis (ie, there is no fibrosis visible to the naked eye).
Asthma — It is a chronic inflammatory disorder of the airways
associated with variable & reversible airway responsiveness that
leads to recurrent episodes of wheezing, breathlessness, chest
tightness, and coughing, particularly at night or in the early
morning.

5. DEFINITIONS

6. EPIDEMIOLOGY
- Third leading cause of death in the world
- Estimated 384 million cases of COPD globally with estimated
prevalence of 12%
-More than 3 million people died of COPD in 2016 accounting for 6%
of all deaths globally
-Burden is projected to increase because of continued exposure to
COPD risk factors and aging of the population
- Prevalence of COPD is higher in smokers and ex-smokers compared
to non-smokers
-Higher in ≥ 40year group compared to those < 40 years of age
-Higher in men than in women

7. PATHOGENESIS OF COPD

8. PATHOGENESIS OF COPD
• Cellular responses- activation of Macrophages & epithelial cells
- recruitment of neutrophils & CD8+ T lymph
- B lymphocyte activation
● Release of CYTOKINES AND CHEMOKINES
-interferon (IFN)-γ, CCR5, and CXCR3, monokine induced by interferon
gamma (MIG), and IP-10,TNF-α , IL-1β
● Inflammation, Airway Remodeling,and Airflow Limitation
● Mucus hyper secretion
● A protease/antiprotease imbalance
● Increased oxidative stress

9. PATHOLOGIC CHANGES IN COPD

12. Pathophysiology
• The major physiologic abnormality is a decreased maximum expiratory flow resulting from
-Loss of lung elasticity.
-Increase in airway resistance in small airways
• The major site of airflow limitation in COPD occurs in the small conducting airways less than 2
mm in diameter resulting from inflammation and airway thickening.

13. Pathophysiology

14. RISK FACTORS

15. RISK FACTORS
• GENETICS - A significant familial risk of airflow limitation has been observed in smoking
siblings of patients. Deficiency of A1AT, a major circulating inhibitor of serine proteases, is
the best documented genetic risk factor.
• SMOKING - Globally, cigarette smoking is the most commonly encountered risk factor for
COPD. The crucial factor seems to be the amount smoked and the extent of inhalation.
• OTHER ENVIRONMENTAL FACTORS - occupational exposures
- Biomass fuel exposure (smoke from wood,
animal dung, crop residues, and coal )
• INFECTIONS AND EXACERBATIONS- severe childhood respiratory infection has
been associated with reduced lung function and increased respiratory symptoms in adulthood.
Tuberculosis has been shown to be a risk factor for COPD,

16. RISK FACTORS
• ASTHMA AND BRONCHIAL HYPERREACTIVITY- different studies showed a significant
increment of COPD in asthmatics & individuals with bronchial hyperreactivity.
• OTHERS

17. CLINICAL CHARACTERIZATION
OF COPD
• HISTORY (symptoms) - cough, sputum production, and exertional dyspnea
- wheezing
- chest tightness
- variability/episodic events
•PHYSICAL FINDINGS- normal at early stage
- cachexia , “tripod” position
- barrel chest , Hoover’s sign
- poor diaphragmatic excursion
- hyper resonance
- decreased breath sounds / expiratory wheeze / basal crackles
- cyanosis / yellow staining on the fingers

18. CLINICAL CHARACTERIZATION
OF COPD
• LABORATORY FINDINGS- elevated hematocrit level
- elevated serum bicarbonate level
- Arterial blood gases may demonstrate resting or exertional
hypoxemia, hypercapnia & acidemia
- low α1AT levels with genotyping
• PULMONARY FUNCTION TESTS- spirometry
- peak expiratory flow
- lung volumes
- diffusion capacity
- arterial blood gas analysis

19. CLINICAL CHARACTERIZATION
OF COPD
• Spirometry is “the gold standard”—most reproducible, standardized, objective way of
measuring airflow limitation
• Expiratory airflow limitation is the hallmark physiologic change of COPD;FEV1, FVC,
FEV1/FVC all decreased

21. CHANGES IN LUNG VOLUMES

22. CLINICAL CHARACTERIZATION
OF COPD
• IMAGING – Though it is usually done to exclude other differential diagnoses &
complications, the following findings might be detected ;
- normal
- rapidly tapering vascular shadows
- increased radiolucency of the lungs
- flat diaphragm
- long ,narrow heart shadow
- bullae
- cysts / typical emphysematous changes

25. DIAGNOSIS

26. ASSESSMENT OF SEVERITY AND STAGING OF COPD

30. Comorbidities in COPD

33. DIFFERENTIAL DIAGNOSIS

34. COPD MANAGEMENT
• Four components
- Assess and monitor disease
- Reduce risk factors
- Manage stable COPD
Education
Pharmacologic
Nonpharmacologic
- Manage exacerbations

35. THANK YOU