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72-570: Chronic obstructive pulmonary disease ( COPD ) is a type of progressive lung disease characterized by chronic respiratory symptoms and airflow limitation. GOLD 2024 defined COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms ( dyspnea or shortness of breath , cough , sputum production and/or exacerbations) due to abnormalities of the airways ( bronchitis , bronchiolitis ) and/or alveoli ( emphysema ) that cause persistent, often progressive, airflow obstruction. The main symptoms of COPD include shortness of breath and

144-554: A cough , which may or may not produce mucus . COPD progressively worsens , with everyday activities such as walking or dressing becoming difficult. While COPD is incurable, it is preventable and treatable. The two most common types of COPD are emphysema and chronic bronchitis and have been the two classic COPD phenotypes . However, this basic dogma has been challenged as varying degrees of co-existing emphysema, chronic bronchitis, and potentially significant vascular diseases have all been acknowledged in those with COPD, giving rise to

216-598: A "care plan" in case of future exacerbations. Patients may watch for symptoms, such as shortness of breath, change in character or amount of mucus, and start self-treatment as discussed with a health care provider. This allows for treatment right away until a doctor can be seen. The symptoms of acute exacerbations are treated using short-acting bronchodilators. A course of corticosteroids, usually in tablet or intravenous rather than inhaled form, can speed up recovery. The IV and oral forms of steroids have been found to be equivalent. Antibiotics are often used but will only help if

288-775: A decline in the FEV1 . There is evidence of it causing some respiratory problems and its use in combination may have a cumulative toxic effect suggesting it as a risk factor for spontaneous pneumothorax, bullous emphysema , COPD and lung cancer. A noted difference between marijuana use and tobacco was that respiratory problems were resolved with stopping usage unlike the continued decline with stopping tobacco smoking. Respiratory symptoms reported with marijuana use included chronic cough, increased sputum production and wheezing but not shortness of breath. Also these symptoms were typically reported ten years ahead of their affecting tobacco smokers. Another study found that chronic marijuana smokers even with

360-459: A difficulty noted of determining the best treatment. The only genotype is the alpha-1 antitrypsin deficiency (AATD) genetic subtype and this has a specific treatment. The cause of the development of COPD is the exposure to harmful particles or gases, including tobacco smoke , that irritate the lung causing inflammation that interacts with a number of host factors. Such exposure needs to be significant or long-term. The greatest risk factor for

432-505: A genetic susceptibility, factors associated with poverty , aging and physical inactivity. Asthma and tuberculosis are also recognized as risk factors, as the comorbidity of COPD is reported to be 12 times higher in patients with asthma after adjusting for smoking history. In Europe airway hyperresponsiveness is rated as the second most important risk factor after smoking. A host factor of an airway branching variation , arising during development has been described. The respiratory tree

504-637: A greater exposure. These fuels are used as the main source of energy in 80% of homes in India , China and sub-Saharan Africa . Intense and prolonged exposure to workplace dusts , chemicals and fumes increases the risk of COPD in smokers, nonsmokers and never-smokers. Substances implicated in occupational exposure and listed in the UK, include organic and inorganic dusts such as cadmium , silica , dust from grains and flour and fumes from cadmium and welding that promote respiratory symptoms. Workplace exposure

576-621: A high rate of morbidity and mortality and this rate is amplified when comorbid with COPD. Tuberculosis is a risk factor for the development of COPD, and is also a potential comorbidity. Most people with COPD die from comorbidities and not from respiratory problems. Anxiety and depression are often complications of COPD. Other complications include reduced quality of life and increased disability, cor pulmonale , frequent chest infections including pneumonia , secondary polycythemia , respiratory failure , pneumothorax , lung cancer, and cachexia (muscle wasting). Along with these complications, there

648-460: A major step forward in the diagnosis and quality of treatment of COPD. Acute exacerbations can be partially prevented. Some infections can be prevented by vaccination against pathogens such as influenza and Streptococcus pneumoniae . Regular medication use can prevent some COPD exacerbations; long acting beta-adrenoceptor agonists (LABAs), long-acting anticholinergics, inhaled corticosteroids and low-dose theophylline have all been shown to reduce

720-532: A marked decrease in the number of cold and flu infections during this time. Smoke from wildfires is proving an increasing risk in many parts of the world and government agencies have published protective advice on their websites. In the US the EPA advises that the use of dust masks do not give protection from the fine particles in wildfires and instead advise the use of well-fitting particulate masks . This same advice

792-588: A modified MRC scale that if used, needs to include other tests since it is simply a test of breathlessness experienced. Scores on CAT range from 0–40 with the higher the score, the more severe the disease. Spirometry may help to determine the severity of airflow limitation. This is typically based on the FEV1 expressed as a percentage of the predicted "normal" for the person's age, gender, height and weight. Guidelines published in 2011 by American and European medical societies recommend partly basing treatment recommendations on

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864-510: A possibility of certain inhaled corticosteroids for COPD providing a protective role against COVID-19. Differentiating COVID-19 symptoms from an exacerbation is difficult; mild prodromal symptoms may delay its recognition and where they include loss of taste or smell COVID-19 is to be suspected. Many definitions of COPD in the past included chronic bronchitis and emphysema but these have never been included in GOLD report definitions. Emphysema

936-484: A significant and chronic inflammatory response to inhaled irritants which ultimately leads to bronchial and alveolar remodelling in the lung known as small airways disease . Thus, airway remodelling with narrowing of peripheral airway and emphysema are responsible for the alteration of lung function. Mucociliary clearance is particularly altered with a dysregulation of cilia and mucus production. Small airway disease sometimes called chronic bronchiolitis , appears to be

1008-497: Is alpha-1 antitrypsin deficiency (AATD) and this is the only genotype (genetic subtype) with a specific treatment. This risk is particularly high if someone deficient in alpha-1 antitrypsin (AAT) also smokes. It is responsible for about 1–5% of cases and the condition is present in about three to four in 10,000 people. Mutations in MMP1 gene that encodes for interstitial collagenase are associated with COPD. The COPDGene study

1080-462: Is asthma-COPD overlap , which is a condition sharing clinical features of both asthma and COPD. Spirometry measures are inadequate for defining phenotypes and chest X-ray, CT and MRI scans have been mostly employed. Most cases of COPD are diagnosed at a late stage and the use of imaging methods would allow earlier detection and treatment. The identification and recognition of different phenotypes can guide appropriate treatment approaches. For example,

1152-468: Is tobacco smoking with an increased rate of developing COPD shown in smokers and ex-smokers. Of those who smoke, about 20% will get COPD, increasing to less than 50% in heavy smokers. In the United States and United Kingdom, of those with COPD, 80–95% are either current or previous smokers. Several studies indicate that women are more susceptible than men to the harmful effects of tobacco smoke. For

1224-420: Is a chronic cough, which may or may not be productive of mucus as phlegm . Phlegm coughed up as sputum can be intermittent and may be swallowed or spat out depending on social or cultural factors and is therefore not always easy to evaluate. However, an accompanying productive cough is only seen in up to 30% of cases. Sometimes limited airflow may develop in the absence of a cough. Symptoms are usually worse in

1296-492: Is a filter for harmful substances and any variant has the potential to disrupt this. A variation has been found to be associated with the development of chronic bronchitis and another with the development of emphysema. A branch variant in the central airway is specifically associated with an increased susceptibility for the later development of COPD. A genetic association for the variants has been sometimes found with FGF10 . Alcohol abuse can lead to alcoholic lung disease and

1368-420: Is a sudden worsening of signs and symptoms that lasts for several days. The key symptom is increased breathlessness, other more pronounced symptoms are of excessive mucus, increased cough and wheeze. A commonly found sign is air trapping giving a difficulty in complete exhalation . The usual cause of an exacerbation is a viral infection , most often the common cold . The common cold is usually associated with

1440-512: Is an air pollutant associated with an increased risk of hospitalization due to the exacerbations caused. Long-term exposure is indicated as an increased rate of mortality in COPD. Studies have shown that people who live in large cities have a higher rate of COPD compared to people who live in rural areas. Areas with poor outdoor air quality, including that from exhaust gas , generally have higher rates of COPD. Urban air pollution significantly effects

1512-575: Is an associated risk of developing pulmonary hypertension . The estimated prevalence of pulmonary hypertension complicating COPD was reported at 39% in a meta-analysis. Of the people with COPD listed for lung transplantation, 82% were documented as having pulmonary hypertension via right heart catheterization, noting a mean pulmonary arterial pressure greater than 20mm Hg. Despite pulmonary hypertension being relatively rare in people with COPD, mild elevations of pulmonary arterial pressure can lead to worse outcomes, including risk of death. Cognitive impairment

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1584-406: Is an important risk factor for COPD. It is advised that everybody with COPD be screened for A1AD. Metabolic syndrome has been seen to affect up to fifty percent of those with COPD and significantly affects the outcomes. When comorbid with COPD there is more systemic inflammation. It is not known if it co-exists with COPD or develops as a consequence of the pathology. Metabolic syndrome on its own has

1656-518: Is an ongoing longitudinal study into the epidemiology of COPD, identifying phenotypes and looking for their likely association with susceptible genes. Genome wide analyses in concert with the International COPD Genetics Consortium has identified more than 80 genome regions associated with COPD and further studies in these regions has been called for. Whole genome sequencing is an ongoing collaboration (2019) with

1728-498: Is believed to be the cause in 10–20% of cases and in the United States, it is believed to be related to around 30% of cases among never smokers and probably represents a greater risk in countries without sufficient regulations. The negative effects of dust exposure and cigarette smoke exposure appear to be cumulative. Genetics play a role in the development of COPD. It is more common among relatives of those with COPD who smoke than unrelated smokers. The most well known genetic risk factor

1800-422: Is causing a bacterial AECB. An early morning sample is preferred. E-nose showed the ability to smell the cause of the exacerbation. The definition of a COPD exacerbation is commonly described as "lost in translation", meaning that there is no universally accepted standard with regard to defining an acute exacerbation of COPD. Many organizations consider it a priority to create such a standard, as it would be

1872-427: Is common in those with COPD as it is for other lung conditions that affect airflow. Cognitive impairment is associated with the declining ability to cope with the basic activities of daily living . It is unclear if those with COPD are at greater risk of contracting COVID-19 , though if infected they are at risk of hospitalization and developing severe COVID-19. However, there are laboratory and clinical studies showing

1944-441: Is defined as enlarged airspaces ( alveoli ) whose walls break down resulting in permanent damage to the lung tissue and is just one of the structural abnormalities that can limit airflow. The condition can exist without airflow limitation but commonly it does. Chronic bronchitis is defined as a productive cough that is present for at least three months each year for two years but does not always result in airflow limitation although

2016-489: Is just one of the structural abnormalities that can limit airflow and can exist without airflow limitation in a significant number of people. Chronic bronchitis does not always result in airflow limitation. However, in young adults with chronic bronchitis who smoke, the risk of developing COPD is high. Many definitions of COPD in the past included emphysema and chronic bronchitis, but these have never been included in GOLD report definitions. Emphysema and chronic bronchitis remain

2088-406: Is more complex, with a diverse group of disorders of differing risk factors and clinical courses that has resulted in a number of subtypes or phenotypes of COPD being accepted and proposed. The two classic emphysematous and chronic bronchitic phenotypes are fundamentally different conditions with unique underlying mechanisms. Another subtype of COPD, categorized by some as a separate clinical entity,

2160-444: Is not sufficient for the diagnosis of COPD. Screening using spirometry in those without symptoms has uncertain effect and is generally not recommended; however, it is recommended for those without symptoms but with a known risk factor. A number of methods can be used to assess the affects and severity of COPD. The MRC breathlessness scale or the COPD assessment test (CAT) are simple questionnaires that may be used. GOLD refers to

2232-492: Is not useful to establish a diagnosis of COPD but it is of use in either excluding other conditions or including comorbidities such as pulmonary fibrosis and bronchiectasis . Characteristic signs of COPD on X-ray include hyperinflation (shown by a flattened diaphragm and an increased retrosternal air space) and lung hyperlucency. A saber-sheath trachea may also be shown that is indicative of COPD. Obstructive lung disease Too Many Requests If you report this error to

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2304-528: Is offered in Canada and Australia to the effects of their forest fires. The number of exacerbations is not seen to relate to any stage of the disease; those with two or more a year are classed as frequent exacerbators and these lead to a worsening in the disease progression. Frailty in ageing increases exacerbations and hospitalization. Acute exacerbations in COPD are often unexplained and thought to have many causes other than infections. A study has emphasized

2376-507: Is seen to be an independent risk factor for COPD. Mucociliary clearance is disrupted by chronic exposure to alcohol; macrophage activity is diminished and an inflammatory response promoted. The damage leads to a susceptibility for infection, including COVID-19 , more so when combined with smoking; smoking induces the upregulation of the expression of ACE2 , a receptor for the SARS-CoV-2 virus. The primary risk factor for COPD globally

2448-416: Is significantly low blood oxygen . High flow oxygen may be harmful in those with an acute exacerbation of COPD. In the prehospital environment those given high flow O 2 rather than titrating their O 2 saturations to 88% to 92% had worse outcomes. In specific circumstances high flow oxygen however can be beneficial. Antibiotics and steroids appear useful in mild to severe disease. There should also be

2520-551: Is started, resulting in an increase in the total volume of air in the lungs at any given time, a process called air trapping which is closely followed by hyperinflation . Hyperinflation from exercise is linked to shortness of breath in COPD, as breathing in is less comfortable when the lungs are already partly filled. Hyperinflation may also worsen during an exacerbation. There may also be a degree of airway hyperresponsiveness to irritants similar to those found in asthma. Low oxygen levels and eventually, high carbon dioxide levels in

2592-421: Is the frequent exacerbator. The frequent exacerbator has two or more exacerbations a year, has a poor prognosis and is described as a moderately stable phenotype. A pulmonary vascular COPD phenotype has been described due to cardiovascular dysfunction. A molecular phenotype of CFTR dysfunction is shared with cystic fibrosis . A combined phenotype of chronic bronchitis and bronchiectasis has been described with

2664-409: Is the second most commonly smoked substance, but evidence linking its use to COPD is very limited. Limited evidence shows that marijuana does not accelerate lung function decline. A low use of marijuana gives a bronchodilatory effect rather than the bronchoconstrictive effect from tobacco use, but it is often smoked in combination with tobacco or on its own by tobacco smokers. Higher use however has shown

2736-458: Is usually performed on people with fever and, especially, hemoptysis (blood in the sputum), to rule out pneumonia and get information on the severity of the exacerbation. Hemoptysis may also indicate other, potentially fatal, medical conditions. A history of exposure to potential causes and evaluation of symptoms may help in revealing the cause the exacerbation, which helps in choosing the best treatment. A sputum culture can specify which strain

2808-568: The National Heart, Lung and Blood Institute (NHLBI) to identify rare genetic determinants. COPD is a progressive lung disease in which chronic, incompletely reversible poor airflow (airflow limitation) and an inability to breathe out fully ( air trapping ) exist. The poor airflow is the result of small airways disease and emphysema (the breakdown of lung tissue ). The relative contributions of these two factors vary between people. Air trapping precedes lung hyperinflation. COPD develops as

2880-516: The PDE4 inhibitor roflumilast is targeted at the chronic-bronchitic phenotype. Two inflammatory phenotypes show a phenotype stability: the neutrophilic inflammatory phenotype and the eosinophilic inflammatory phenotype. Mepolizumab , a monoclonal antibody , has been shown to have benefit in treating the eosinophilic inflammatory type rather than the use of oral corticosteroids, but further studies have been called for. Another recognized phenotype

2952-422: The connective tissue of the lungs by proteases (particularly elastase ) that are insufficiently inhibited by protease inhibitors . The destruction of the connective tissue of the lungs leads to emphysema, which then contributes to the poor airflow and finally, poor absorption and release of respiratory gases. General muscle wasting that often occurs in COPD may be partly due to inflammatory mediators released by

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3024-435: The FEV1. The GOLD guidelines group people into four categories based on symptoms assessment, degree of airflow limitation and history of exacerbations. Weight loss, muscle loss and fatigue are seen in severe and very severe cases. Use of screening questionnaires, such as COPD diagnostic questionnaire (CDQ), alone or in combination with hand-held flow meters is appropriate for screening of COPD in primary care. A chest X-ray

3096-488: The United States in 2010 the economic cost was put at US$ 32.1 billion and projected to rise to US$ 49 billion in 2020. In the United Kingdom this cost is estimated at £3.8 billion annually. A cardinal symptom of COPD is the chronic and progressive shortness of breath which is most characteristic of the condition. Shortness of breath (breathlessness) is often the most distressing symptom responsible for

3168-533: The Wikimedia System Administrators, please include the details below. Request from 172.68.168.133 via cp1102 cp1102, Varnish XID 555124782 Upstream caches: cp1102 int Error: 429, Too Many Requests at Thu, 28 Nov 2024 05:55:09 GMT Acute exacerbation of chronic obstructive pulmonary disease It may be triggered by an infection with bacteria or viruses or by environmental pollutants. Typically, infections cause 75% or more of

3240-403: The additional use of tobacco developed similar respiratory problems, but did not seem to develop airflow limitation and COPD. Exposure to particulates can bring about the development of COPD, or its exacerbations. Those with COPD are more susceptible to the harmful effects of particulate exposure that can cause acute exacerbations brought about by infections. Black carbon also known as soot ,

3312-454: The airways in the lungs , which in turn may cause a spontaneous pneumothorax . In infection, there is often weakness, fever and chills. If due to a bacterial infection, the sputum may be slightly streaked with blood and coloured yellow or green. As the lungs tend to be vulnerable organs due to their exposure to harmful particles in the air, several things can cause an acute exacerbation of COPD: In one-third of all COPD exacerbation cases,

3384-421: The arteries in the lungs, while emphysema leads to the breakdown of capillaries in the lungs. Both of these conditions may result in pulmonary heart disease also classically known as cor pulmonale . The diagnosis of COPD should be considered in anyone over the age of 35 to 40 who has shortness of breath , a chronic cough, sputum production, or frequent winter colds and a history of exposure to risk factors for

3456-754: The associated anxiety and level of disability experienced. Symptoms of wheezing and chest tightness associated with breathlessness can be variable over the course of a day or between days and are not always present. Chest tightness often follows exertion. Many people with more advanced COPD breathe through pursed lips , which can improve shortness of breath. Shortness of breath is often responsible for reduced physical activity and low levels of physical activity are associated with worse outcomes. In severe and very severe cases there may be constant tiredness , weight loss, muscle loss and anorexia . People with COPD often have increased breathlessness and frequent colds before seeking treatment. The most often first symptom of COPD

3528-467: The average being about three episodes per year. An acute exacerbation of COPD is associated with increased frequency and severity of coughing. It is often accompanied by worsened chest congestion and discomfort. Shortness of breath and wheezing are present in many cases. Exacerbations may be accompanied by increased amount of cough and sputum productions, and a change in appearance of sputum. An abrupt worsening in COPD symptoms may cause rupture of

3600-416: The blood , can occur from poor gas exchange due to decreased ventilation from airway obstruction, hyperinflation and a reduced desire to breathe. During exacerbations, airway inflammation is also increased, resulting in increased hyperinflation, reduced expiratory airflow and worsening of gas transfer. This can lead to low blood oxygen levels which if present for a prolonged period, can result in narrowing of

3672-435: The cause cannot be identified. The diagnostic criteria for acute exacerbation of COPD generally include a production of sputum that is purulent and may be thicker than usual, but without evidence of pneumonia (which involves mainly the alveoli rather than the bronchi ). Also, diagnostic criteria may include an increase in frequency and severity of coughing, as well as increased shortness of breath. A chest X-ray

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3744-419: The classification of other phenotypes or subtypes. Emphysema is defined as enlarged airspaces ( alveoli ) whose walls have broken down resulting in permanent damage to the lung tissue . Chronic bronchitis is defined as a productive cough that is present for at least three months each year for two years. Both of these conditions can exist without airflow limitation when they are not classed as COPD. Emphysema

3816-448: The developing lung and its maturation, and contributes a potential risk factor for the later development of COPD. The overall effect in relation to smoking is believed to be small. Poorly ventilated fires used for cooking and heating, are often fueled by coal or biomass such as wood and dry dung , leading to indoor air pollution and are one of the most common causes of COPD in developing countries . Women are affected more as they have

3888-499: The development of COPD is tobacco smoke. However, less than 50 percent of heavy smokers develop COPD, so other factors need to be considered, including exposure to indoor and outdoor pollutants, allergens, occupational exposure, and host factors. One of the known causes of COPD is the exposure to construction dust . The three main types of construction dust are silica dust , non-silica dust (e.g., dust from gypsum, cement, limestone, marble and dolomite) and wood dust . Host factors include

3960-406: The disease. Spirometry is then used to confirm the diagnosis. Spirometry measures the amount of airflow obstruction present and is generally carried out after the use of a bronchodilator , a medication to open up the airways. Two main components are measured to make the diagnosis, the forced expiratory volume in one second (FEV1), which is the greatest volume of air that can be breathed out in

4032-421: The elderly. The National Institute for Health and Care Excellence criteria additionally require a FEV1 less than 80% of predicted. People with COPD also exhibit a decrease in diffusing capacity of the lung for carbon monoxide due to decreased surface area in the alveoli, as well as damage to the capillary bed. Testing the peak expiratory flow (the maximum speed of expiration), commonly used in asthma diagnosis,

4104-682: The exacerbation is due to an infection. Antibiotics are indicated when a patient notes increased sputum production, purulent sputum, increased dyspnea , has an elevated white count, or is febrile . Examples of first-line antibiotics are amoxicillin, doxycycline, and co-trimoxazole . Severe exacerbations can require hospital care where treatments such as oxygen and mechanical ventilation may be required. Mechanical ventilation can be invasive ( endotracheal intubation ) or non-invasive forms of ventilation such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP). The incidence varies depending on which definition

4176-419: The exacerbations; bacteria can roughly be found in 25% of cases, viruses in another 25%, and both viruses and bacteria in another 25%. Airway inflammation is increased during the exacerbation resulting in increased hyperinflation, reduced expiratory air flow and decreased gas exchange. Exacerbations can be classified as mild, moderate, and severe. As COPD progresses, exacerbations tend to become more frequent,

4248-451: The first second of a breath and the forced vital capacity (FVC), which is the greatest volume of air that can be breathed out in a single large breath. Normally, 75–80% of the FVC comes out in the first second and a FEV1/FVC ratio less than 70% in someone with symptoms of COPD defines a person as having the disease. Based on these measurements, spirometry would lead to over-diagnosis of COPD in

4320-439: The frequency of COPD exacerbations. Other methods of prevention include: Based on the severity different treatments may be used. Mild exacerbations are treated with short acting bronchodilators (SABDs). Moderate exacerbations are treated with SABDs together with antibiotics or oral corticosteroids, or both. Severe exacerbations need hospital treatment, and the prognosis is poor. Oxygen therapy should be initiated if there

4392-452: The global population). It typically occurs in males and females over the age of 35–40. In 2019 it caused 3.2 million deaths, 80% occurring in lower and middle income countries, up from 2.4 million deaths in 1990. In 2021, it was the fourth biggest cause of death, responsible for approximately 5% of total deaths. The number of deaths is projected to increase further because of continued exposure to risk factors and an aging population. In

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4464-405: The lungs into the blood. Narrowing of the airways occurs due to inflammation and subsequent scarring within them. This contributes to the inability to breathe out fully. The greatest reduction in air flow occurs when breathing out, as the pressure in the chest is compressing the airways at this time. This can result in more air from the previous breath remaining within the lungs when the next breath

4536-491: The morning. A chronic productive cough is the result of mucus hypersecretion and when it persists for more than three months each year for at least two years, it is defined as chronic bronchitis . Chronic bronchitis can occur before the restricted airflow diagnostic of COPD. Some people with COPD attribute the symptoms to the consequences of smoking. In severe COPD, vigorous coughing may lead to rib fractures or to a brief loss of consciousness . An acute exacerbation

4608-557: The possibility of a pulmonary embolism as sometimes being responsible in these cases. Signs can include pleuritic chest pain and heart failure without signs of infection. Such emboli could respond to anticoagulants . COPD often occurs along with a number of other conditions ( comorbidities ) due in part to shared risk factors. Common comorbidities include cardiovascular disease , skeletal muscle dysfunction, metabolic syndrome , osteoporosis , depression , anxiety , asthma and lung cancer . Alpha-1 antitrypsin deficiency (A1AD)

4680-587: The precursor for the development of emphysema. The inflammatory cells involved include neutrophils and macrophages , two types of white blood cells. Those who smoke additionally have cytotoxic T cell involvement and some people with COPD have eosinophil involvement similar to that in asthma. Part of this cell response is brought on by inflammatory mediators such as chemotactic factors . Other processes involved with lung damage include oxidative stress produced by high concentrations of free radicals in tobacco smoke and released by inflammatory cells and breakdown of

4752-613: The predominant phenotypes of COPD but there is often overlap between them and a number of other phenotypes have also been described. COPD and asthma may coexist and converge in some individuals. COPD is associated with low-grade systemic inflammation. The most common cause of COPD is tobacco smoking . Other risk factors include indoor and outdoor air pollution including dust , exposure to occupational irritants such as dust from grains , cadmium dust or fumes , and genetics , such as alpha-1 antitrypsin deficiency . In developing countries , common sources of household air pollution are

4824-399: The presence or not of collateral ventilation , evident in emphysema and lacking in chronic bronchitis. This terminology was no longer accepted as useful, as most people with COPD have a combination of both emphysema and airway disease. These are now recognized as the two major phenotypes of COPD — emphysematous phenotype and chronic bronchitic phenotype. It has since been recognized that COPD

4896-478: The release of excessive proteases in lungs, which then degrades elastin , the major component of alveoli. Smoke also impairs the action of cilia , inhibiting mucociliary clearance that clears the bronchi of mucus, cellular debris and unwanted fluid. Other types of tobacco smoke, such as from cigar, pipe , water-pipe and hookah use, also confer a risk. Water-pipe or hookah smoke appears to be as harmful or even more harmful than smoking cigarettes. Marijuana

4968-433: The risk of developing COPD is great. These older definitions grouped the two types as type A and type B . Type A were emphysema types known as pink puffers due to their pink complexion, fast breathing rate and pursed lips. Type B were chronic bronchitic types referred to as blue bloaters due to low oxygen levels causing a bluish color to the skin and lips and swollen ankles. These differences were suggested to be due to

5040-428: The same amount of cigarette smoking, women have a higher risk of COPD than men. In non-smokers, exposure to second-hand smoke (passive smoking) is the cause of 1.2 million deaths from the more than 8 million deaths worldwide each year due to tobacco smoke . Women who smoke during pregnancy , and during the early life of the child is a risk factor for the later development of COPD in their child. Inhaled smoke triggers

5112-888: The use of coal and biomass such as wood and dry dung as fuel for cooking and heating . The diagnosis is based on poor airflow as measured by spirometry . Most cases of COPD can be prevented by reducing exposure to risk factors such as smoking and indoor and outdoor pollutants. While treatment can slow worsening, there is no conclusive evidence that any medications can change the long-term decline in lung function. COPD treatments include smoking cessation , vaccinations , pulmonary rehabilitation , inhaled bronchodilators and corticosteroids . Some people may benefit from long-term oxygen therapy , lung volume reduction and lung transplantation . In those who have periods of acute worsening , increased use of medications, antibiotics , corticosteroids and hospitalization may be needed. As of 2015, COPD affected about 174.5 million people (2.4% of

5184-608: The winter months but can occur at any time. Other respiratory infections may be bacterial or in combination sometimes secondary to a viral infection. The most common bacterial infection is caused by Haemophilus influenzae . Other risks include exposure to tobacco smoke (active and passive ) and environmental pollutants  – both indoor and outdoor. During the COVID-19 pandemic , hospital admissions for COPD exacerbations sharply decreased which may be attributable to reduction of emissions and cleaner air. There has also been

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