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Chronic obstructive pulmonary disease (COPD)

Diagnosis

COPD is a term used to describe a wide range of airway disorders. Chronic bronchitis is a syndrome clinically defined as:

  1. Excessive production of mucus.
  2. Presence of symptoms, largely cough, on most days for at least 3 months annually during 2 or more successive years.
  3. Exclusion of bronchiectasis, TB, or other causes of these symptoms.

This syndrome describes airway disorders that range from simple chronic bronchitis (smokers cough) to the more severe chronic obstructive bronchitis. The addition of episodes of airway hyper-reactivity to the above syndrome establishes the diagnosis of chronic asthmatic bronchitis.

Pulmonary Function Tests:
The FEV(1) / timed VC ratio is decreased as the amount of VC time is increased.

VC, MBC are decreased, TLC and RV increased (this picture occurs in all obstructive diseases of the lung e.g. asthma (reversible), tumours, FB).  

Treatment

  • Stop smoking
  • Treatment of heart failure if present
  • Bronchodilators such as beta 2 receptor agonists (salbutamol) or anticholinergic inhalers such as ipratropium bromide.
  • A trial of corticosteroids is wise and should be instituted using oral prednisolone 30mg daily for 2 weeks. Lung function is measured before and after and an improvement of >15% in airflow limitation indicates the need for inhaled steroids. If no improvement occurs then steroids are discarded.
  • Antibiotics are used when the sputum turns yellow or green.
  • alpha 1 anditrypsin replacement in patients with levels below 310mg/L.
  • Respiratory failure is treated accordingly.
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