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About COPD

Cough

A chronic cough is usually the first symptom to occur. When it exists for more than three months a year for more than two years, in combination with sputum production and without another explanation, there is by definition chronic bronchitis. This condition can occur before COPD fully develops. The amount of sputum produced can change over hours to days. In some cases the cough may not be present or only occurs occasionally and may not be productive. Some people with COPD attribute the symptoms to a "smoker's cough". Sputum may be swallowed or spat out, depending often on social and cultural factors. Vigorous coughing may lead to rib fractures or a brief loss of consciousness. Those with COPD often have a history of "common colds" that last a long time

Shortness of breath

Shortness of breath is often the symptom that bothers people the most. It is commonly described as: "my breathing requires effort," "I feel out of breath," or "I can't get enough air in".Different terms, however, may be used in different cultures. Typically the shortness of breath is worse on exertion, of a prolonged duration, and worsens over time.In the advanced stages it occurs during rest and may be always present

Exacerbation

An acute exacerbation of COPD is defined as increased shortness of breath, increased sputum production, a change in the color of the sputum from clear to green or yellow, or an increase in cough in someone with COPD.This may present with signs of increased work of breathing such as fast breathing, a fast heart rate, sweating, active use of muscles in the neck, a bluish tinge to the skin, and confusion or combative behavior in very severe exacerbations. Crackles may also be heard over the lungs on examination with a stethoscope.

Cause

The primary cause of COPD is tobacco smoke, with occupational exposure and pollution from indoor fires being significant causes in some countries.Typically these exposures must occur over several decades before symptoms develop. A person's genetic makeup also affects the risk.

Smoking

Percentage of females smoking tobacco as of the late 1990s early 2000s
Percentage of males smoking tobacco as of the late 1990s early 2000s. Note the scales used for females and males differ.

The primary risk factor for COPD globally is tobacco smoking. Of those who smoke about 20% will get COPD, and of those who are lifelong smokers about half will get COPD. In the United States and United Kingdom, of those with COPD, 80-95% are either current smokers or previously smoked.

Occupational exposures

Intense and prolonged exposure to workplace dusts, chemicals and fumes increase the risk of COPD in both smokers and nonsmokers. Workplace exposures are believed to be the cause in 10-20% of cases.In the United States they are believed to be related to more than 30% of cases among those who have never smoked and probably represent a greater risk in countries without sufficient regulations.

Pathophysiology

On the left is a diagram of the lungs and airways with an inset showing a detailed cross-section of normal bronchioles and alveoli. On the right is lungs damaged by COPD with an inset showing a cross-section of damaged bronchioles and alveoli

COPD is a type of obstructive lung disease in which chronic incompletely reversible poor airflow (airflow limitation) and inability to breathe out fully (air trapping) exist. The poor airflow is the result of breakdown of lung tissue (known as emphysema) and small airways disease known as obstructive bronchiolitis. The relative contributions of these two factors vary between people.[1] Severe destruction of small airways can lead to the formation of large air pockets—known as bullae—that replace lung tissue. This form of disease is called bullous emphysema.

Spirometry

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 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.

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