Covers the definitions of chronic bronchitis, emphysema and COPD, with the spirometric diagnostic criterion, then moves through risk factors such as smoking, indoor and occupational exposures and alpha-1 antitrypsin deficiency. It explains the inflammatory pathogenesis, airway and parenchymal changes, and a table of emphysema types, followed by clinical features, a pink puffer versus blue bloater comparison, GOLD spirometric grades and groups, differential diagnosis, stable-disease management, and exacerbation care and complications.
Topic 2 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 8 sections, about 2,118 words (16 min of reading), with 15 flashcards.
In this note
Definitions
Etiology and risk factors
Pathogenesis
Clinical presentation
Diagnosis
Management of stable COPD
Exacerbation of COPD
Complications of COPD
Definitions
Chronic bronchitis (clinical definition): productive cough on most days for at least 3 months a year in 2 consecutive years, after other causes of chronic cough have been excluded. Simple chronic bronchitis = hypersecretion with cough and sputum but no airflow obstruction; chronic obstructive bronchitis = with obstruction.
Pulmonary emphysema (anatomical definition): permanent enlargement of the air spaces distal to the terminal bronchioles with destruction of their walls, without obvious fibrosis.
COPD (GOLD): a common, preventable and treatable heterogeneous lung condition with chronic respiratory symptoms (dyspnoea, cough, sputum, exacerbations) caused by abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema), which cause persistent, often progressive airflow obstruction. In practice: COPD = chronic obstructive bronchitis + emphysema in varying proportions.
Diagnostic criterion: post-bronchodilator FEV1/FVC < 0.70 in a person with symptoms and exposure.
COPD is the 3rd–4th leading cause of death worldwide.
Etiology and risk factors
Tobacco smoking is the main cause (about 80–90% in Europe): cigarettes, pipes, cigars, water-pipe, passive smoking. Risk rises with pack-years; only a fraction of smokers develop clinically significant COPD (susceptibility).
Indoor air pollution: burning biomass (wood, dung) for cooking and heating in poorly ventilated homes — the main cause in women in developing countries.
Occupational exposure: organic and inorganic dusts (coal, silica, cotton, grain), chemicals, fumes; often underestimated.
Outdoor air pollution: contributes, with a smaller effect.
Genetic: α1-antitrypsin deficiency (AATD; SERPINA1 gene, PiZZ genotype, autosomal codominant) → early panlobular emphysema of the lower lobes, often under 45 years, and liver disease.
Abnormal lung growth and development: low birth weight, prematurity, severe childhood respiratory infections → a lower peak lung function.
Other causes of chronic bronchitis without smoking: recurrent bronchopulmonary infections (e.g. with a left-to-right shunt such as VSD, or antibody deficiency), disorders of mucociliary clearance (cystic fibrosis, primary ciliary dyskinesia), airway narrowing (bronchial stenosis).
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