COPD

Chronic obstructive pulmonary disease.

It is of 2 types

1. Emphysema: it is defined as a permanent loss of pulmonary alveolar walls or respiratory bronchiole's walls. It results in the loss of gas exchange surface. Patients are also called pink puffers and they are typically huffing and puffing. Remember that its diagnosis is made by one of three modalities: CT of the chest or biopsy of the lung or PFT with gas exchange. For exam purposes, one needs to know 2 causes for this. a) Smoking & b) alfa 1 antitrypsin deficiency.

Technically and for exam purposes, emphysema is diagnosed using a lung biopsy.

2. Chronic bronchitis: It is a diagnosis made by history. It  is defined as chronic production of sputum on most days of 3 consecutive months for 2 consecutive years. Patients are also called blue bloaters. They typically hypo ventilate and are hypercapneic. They do not seem to be mentally bothered by their state.

The two usually present as a somewhat mixed disease. There is commonly a component of bronchospasm and excessive bronchial secretions. Their acute exacerbation is supposed to be treated with antibiotics, steroids, bronchodilators and oxygen.

Acute bronchitis in a patient without chronic bronchitis does not require antibiotics - this fact is very frequently asked on tests.

The long term management of COPD is done using steroids (preferably inhaled steroids), bronchodilators and oxygen. The only two modalities that improve long term outcome and survival in COPD are Oxygen therapy and lung transplant. 

Also review the flow volume loop if you have not already done so.