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{{Chronic obstructive pulmonary disease}}
{{Chronic obstructive pulmonary disease}}
{{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AOEIC}} {{CZ}}
{{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AOEIC}} {{CZ}}


==Overview==
==Overview==
'''Chronic obstructive pulmonary disease''' ('''COPD'''), also known as '''chronic obstructive airway disease''' ('''COAD'''), is a group of [[disease]]s characterized by the pathological limitation of airflow in the [[airway]] that is not fully reversible <ref name="pmid12198919">{{cite journal |author=Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC |title=Chronic obstructive pulmonary disease surveillance--United States, 1971-2000 |journal=[[MMWR. Surveillance Summaries : Morbidity and Mortality Weekly Report. Surveillance Summaries / CDC]] |volume=51 |issue=6 |pages=1–16 |year=2002 |month=August |pmid=12198919 |doi= |url= |accessdate=2012-03-01}}</ref>. COPD is the umbrella term for chronic [[bronchitis]], [[emphysema]] and a range of other lung disorders. It is most often due to [[tobacco smoking]],<ref name="dev">Devereux G. ''ABC of chronic obstructive pulmonary disease. Definition, epidemiology, and risk factors.'' [[British Medical Journal|BMJ]] 2006;332:1142-1144. PMID 16690673</ref> but can be due to other airborne irritants such as coal dust, [[asbestos]] or solvents, [[congenital]] conditions such as [[alpha-1-antitrypsin deficiency]] and as well as preserved meats containing nitrites.
Six minute walk tests act as a predictor of mortality in patients with moderate COPD (patients who desaturate have worse mortality compared with those who don't desaturate.)


== Diagnosis ==
==Other Diagnostic Studies==
[[File:COPD.JPG|thumb|A chest X-ray demonstrating severe COPD. Note the small size of the heart in comparison to the lungs.]]


The diagnosis of COPD should be considered in anyone who has [[dyspnea]], chronic cough or sputum production, and/or a history of exposure to risk factors for the disease such as regular tobacco smoking.<ref name="pmid17507545"/><ref name="pmid7956395">{{cite journal |author=Badgett RG, Tanaka DJ, Hunt DK, ''et al.'' |title=The clinical evaluation for diagnosing obstructive airways disease in high-risk patients |journal=Chest |volume=106 |issue=5 |pages=1427–31 |year=1994 |pmid=7956395| doi = 10.1378/chest.106.1427 |doi_brokendate=2010-04-06}}</ref> No single symptom or sign can adequately confirm or exclude the diagnosis of COPD,<ref name="pmid7815660">{{cite journal |author=Holleman DR, Simel DL |title=Does the clinical examination predict airflow limitation? |journal=JAMA |volume=273 |issue=4 |pages=313–9 |year=1995 |pmid=7815660| doi = 10.1001/jama.273.4.313}}</ref> although COPD is uncommon under the age of 40&nbsp;years.
===Pulmonary Function Test / Spirometry===


===Spirometry===
*COPD is particularly characterized if a ratio of forced expiratory volume over 1 second ([[FEV1|FEV<sub>1</sub>]]) to [[forced vital capacity]] (FVC) being < 0.7 and the [[FEV1|FEV<sub>1</sub>]] < 70% of the predicted value when compared with a matched control. <ref>[http://www.patient.co.uk/showdoc/40002357/ PatientPlus - Spirometry]</ref>, <ref name="pmid22319804">{{cite journal |author= |title= |journal=[[]] |volume= |issue= |pages= |year= |pmid=22319804 |doi= |url= |accessdate=2012-03-05}}</ref> (see [[Spirometry]]).
The diagnosis of COPD is confirmed by [[spirometry]],<ref name="pmid17507545">{{cite journal |author=Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J |title=Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=176 |issue=6 |pages=532–55 |year=2007 |month=September |pmid=17507545 |doi=10.1164/rccm.200703-456SO |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17507545 |accessdate=2012-03-02}}</ref> a test that measures the forced expiratory volume in one second (FEV<sub>1</sub>), which is the greatest volume of air that can be breathed out in the first second of a large breath. Spirometry also measures the forced vital capacity (FVC), which is the greatest volume of air that can be breathed out in a whole large breath. Normally, at least 70% of the FVC comes out in the first second (i.e. the [[FEV1/FVC|FEV<sub>1</sub>/FVC ratio]] is >70%). A ratio less than normal defines the patient as having COPD. More specifically, the diagnosis of COPD is made when the FEV<sub>1</sub>/FVC ratio is <70%. The GOLD criteria also require that values are after [[bronchodilator]] medication has been given to make the diagnosis, and the NICE criteria also require FEV1%. According to the ERS criteria, it is [[FEV1% predicted]] that defines when a patient has COPD, that is, when FEV1% predicted is < 88% for men, or < 89% for women.
*Normally, at least 70% of the FVC comes out in the first second (i.e. the [[FEV1/FVC|FEV<sub>1</sub>/FVC ratio]] is >70%). A ratio less than normal defines the patient as having COPD.
*More specifically, the diagnosis of COPD is made when the FEV<sub>1</sub>/FVC ratio is <70%.
*The GOLD criteria also require that values are after [[bronchodilator]] medication has been given to make the diagnosis,
*The NICE criteria also require FEV1%.
*According to the ERS criteria, it is [[FEV1% predicted]] that defines when a patient has COPD, that is, when FEV1% predicted is < 88% for men, or < 89% for women.
*Spirometry can help to determine the severity of COPD.<ref name="pmid17507545">{{cite journal |author=Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J |title=Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=176 |issue=6 |pages=532–55 |year=2007 |month=September |pmid=17507545 |doi=10.1164/rccm.200703-456SO |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17507545 |accessdate=2012-03-02}}</ref>
*The FEV<sub>1</sub> (measured after bronchodilator medication) is expressed as a percentage of a predicted "normal" value based on a person's age, gender, height and weight:
*The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.<ref name="Celli04">{{cite journal |author=Celli BR, Cote CG, Marin JM, ''et al.'' |title=The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease |journal=N. Engl. J. Med. |volume=350 |issue=10 |pages=1005–12 |year=2004 |month=March |pmid=14999112 |doi=10.1056/NEJMoa021322 }}</ref>


Spirometry can help to determine the severity of COPD.<ref name="pmid17507545">{{cite journal |author=Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J |title=Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=176 |issue=6 |pages=532–55 |year=2007 |month=September |pmid=17507545 |doi=10.1164/rccm.200703-456SO |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=17507545 |accessdate=2012-03-02}}</ref> The FEV<sub>1</sub> (measured after bronchodilator medication) is expressed as a percentage of a predicted "normal" value based on a person's age, gender, height and weight:
===COPD Severity===


{| class="wikitable" style="text-align:center;width:60%;"
The severity of COPD can be classified as follows using spirometry
 
{| class="wikitable" style="text-align:center;width:75%;"
|-
!Severity!! Post-bronchodilator FEV1 |FEV<sub>1</sub> /FVC!!FEV<sub>1</sub> % predicted
|-
|-
! Severity of COPD (GOLD scale)!! FEV<sub>1</sub> % predicted
|At risk||>0.7||≥80
|-
|-
| Mild (GOLD 1) || ≥80
|Mild COPD||≤0.7||≥80
|-
|-
| Moderate (GOLD 2)|| 50–79
|Moderate COPD||≤0.7||50-80
|-
|-
| Severe (GOLD 3) || 30–49
|Severe COPD||≤0.7||30-50
|-
|-
| Very severe (GOLD 4)|| <30 or chronic respiratory failure symptoms
|Very Severe COPD||≤0.7||<30 '''or''' 30-50 with Chronic Respiratory Failure symptoms
|}
|}


The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.<ref name=Celli04>{{cite journal |author=Celli BR, Cote CG, Marin JM, ''et al.'' |title=The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease |journal=N. Engl. J. Med. |volume=350 |issue=10 |pages=1005–12 |year=2004 |month=March |pmid=14999112 |doi=10.1056/NEJMoa021322 }}</ref>
===Six Minute Walking Distance===
 
*It act as a good predictor of mortality in patients with [[COPD]].
*Patients who desaturate during 6MWD have higher mortality compared to those who doesn't desaturate.
*This test is a part of BODE index which is used as a mortality predictor for patients with COPD.
*The [[BODE index]] has the following component
**[[Body mass index]]
**Obstruction (FEV1)
**[[Dyspnea]] (MMRC dyspnea scale)
**6 minute walking distance.


===Other tests===
===Right Sided Heart Catheterization===
On [[chest x-ray]], the classic signs of COPD are overexpanded lung ([[Hyperaeration|hyperinflation]]), a flattened diaphragm, increased retrosternal airspace, and bullae.<ref name=Old2007>{{cite journal |author=Torres M, Moayedi S |title=Evaluation of the acutely dyspneic elderly patient |journal=Clin. Geriatr. Med. |volume=23 |issue=2 |pages=307–25, vi |year=2007 |month=May |pmid=17462519 |doi=10.1016/j.cger.2007.01.007 |url=}}</ref> It can be useful to help exclude other lung diseases, such as [[pneumonia]], [[pulmonary edema]] or a [[pneumothorax]].<ref name=Old2007/> Complete pulmonary function tests with measurements of lung volumes and gas transfer may also show hyperinflation and can discriminate between COPD with emphysema and COPD without emphysema. A high-resolution [[computed tomography]] scan of the chest may show the distribution of emphysema throughout the lungs and can also be useful to exclude other lung diseases.


A blood sample taken from an [[artery]], i.e. [[Arterial Blood Gas]] (ABG), can be tested for blood gas levels which may show low oxygen (hypoxaemia) and/or high carbon dioxide (respiratory acidosis if pH is also decreased). A blood sample taken from a [[vein]] may show a high blood count (reactive polycythemia), a reaction to long-term hypoxemia.
*It is not routinely done. However, in cases when [[pulmonary hypertension]] is suspected clinically and on [[echocardiography]] then a right heart catheterization can be done to measure [[pulmonary artery pressure]] and see the response of [[vasodilator]]s


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 15:55, 12 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]

Overview

Six minute walk tests act as a predictor of mortality in patients with moderate COPD (patients who desaturate have worse mortality compared with those who don't desaturate.)

Other Diagnostic Studies

Pulmonary Function Test / Spirometry

  • COPD is particularly characterized if a ratio of forced expiratory volume over 1 second (FEV1) to forced vital capacity (FVC) being < 0.7 and the FEV1 < 70% of the predicted value when compared with a matched control. [1], [2] (see Spirometry).
  • Normally, at least 70% of the FVC comes out in the first second (i.e. the FEV1/FVC ratio is >70%). A ratio less than normal defines the patient as having COPD.
  • More specifically, the diagnosis of COPD is made when the FEV1/FVC ratio is <70%.
  • The GOLD criteria also require that values are after bronchodilator medication has been given to make the diagnosis,
  • The NICE criteria also require FEV1%.
  • According to the ERS criteria, it is FEV1% predicted that defines when a patient has COPD, that is, when FEV1% predicted is < 88% for men, or < 89% for women.
  • Spirometry can help to determine the severity of COPD.[3]
  • The FEV1 (measured after bronchodilator medication) is expressed as a percentage of a predicted "normal" value based on a person's age, gender, height and weight:
  • The severity of COPD also depends on the severity of dyspnea and exercise limitation. These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.[4]

COPD Severity

The severity of COPD can be classified as follows using spirometry

Severity FEV1 /FVC FEV1 % predicted
At risk >0.7 ≥80
Mild COPD ≤0.7 ≥80
Moderate COPD ≤0.7 50-80
Severe COPD ≤0.7 30-50
Very Severe COPD ≤0.7 <30 or 30-50 with Chronic Respiratory Failure symptoms

Six Minute Walking Distance

  • It act as a good predictor of mortality in patients with COPD.
  • Patients who desaturate during 6MWD have higher mortality compared to those who doesn't desaturate.
  • This test is a part of BODE index which is used as a mortality predictor for patients with COPD.
  • The BODE index has the following component

Right Sided Heart Catheterization

References

  1. ↑ PatientPlus - Spirometry
  2. ↑ [[]]. PMID 22319804. Missing or empty |title= (help); |access-date= requires |url= (help)
  3. ↑ Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J (2007). "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary". American Journal of Respiratory and Critical Care Medicine. 176 (6): 532–55. doi:10.1164/rccm.200703-456SO. PMID 17507545. Retrieved 2012-03-02. Unknown parameter |month= ignored (help)
  4. ↑ Celli BR, Cote CG, Marin JM; et al. (2004). "The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease". N. Engl. J. Med. 350 (10): 1005–12. doi:10.1056/NEJMoa021322. PMID 14999112. Unknown parameter |month= ignored (help)

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