Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Non-septic obstructive airway diseaseSeptic obstructive airway disease ++ 490 Bronchitis, not specified as acute or chronic491 Chronic bronchitis492 Emphysema493 Asthma494 Bronchiectasis495 Extrinsic allergic alveolitis496 Chronic airway obstruction, not elsewhere classified ++ 780.7 Malaise and fatigue786.0 Dyspnea and respiratory abnormalities786.05 Shortness of breath ++ F17 Nicotine dependenceJ44 Other chronic obstructive pulmonary diseaseJ41 Chronic simple and mucopurulent chronic bronchitisJ42 Unspecified chronic bronchitisJ43 EmphysemaJ45 AsthmaJ47 BronchiectasisZ57.31 Occupational exposure to environmental tobacco smokeZ72.0 Tobacco useZ77.22 Exposure to environmental tobacco smokeZ87.891 Personal history of nicotine dependence ++ 6C: Impaired ventilation, respiration/gas exchange, and aerobic capacity/endurance associated with airway clearance dysfunction16F: Impaired ventilation and respiration/gas exchange associated with respiratory failure2 +++ Description ++ A cluster of chronic lung diseases that cause air to be trapped in lungs and hyperinflationAfflicted individuals usually have both emphysema and chronic bronchitisChronic airflow limitation, narrowing of airways (not fully reversible)DisordersChronic bronchitis: inflammation of airway with increased mucus productionObstructive bronchiolitisEmphysema: damaged air sacs and small tubes of the lungsChronic obstructive lung disease (COLD)Chronic obstructive airway disease (COAD)Chronic airflow limitation (CAL)Chronic obstructive respiratory disease (CORD)Subdivided into septic and non-septic3Non-septicCough is productiveBreathing sounds: rales, wheezingSepticCough can be variableBreathing sounds decreased +++ Essentials of Diagnosis ++ Most individuals have lost 50% lung function when diagnosedDiagnostic guidelinesGOLD (the Global Initiative for Chronic Obstructive Lung Disease)Guidelines from American Thoracic Society and European Respiratory SocietyDiagnosisPhysical examinationAir-flow limitation on pulmonary function test (spirometer)Spirometer measures compared to predicted values for age, height, body weight, genderExpressed as FEV (function expiratory volume)Chronic coughHypoxemiaHypercapnia +++ General Considerations ++ Mortality rates increase with repeated exposure to irritant or causative factorsMost cases include cigarette smokingAcute exacerbations often caused by lung infection, exposure to air pollution, smoke, cold air temperature, dust, chemical smellsAdults with asthma are 12 times more likely to develop COPD than adults without asthmaMust monitor oxygen levels in patients with COPD; can become apneicLoss of airflow usually due toLost elasticity in airways and air sacsIncreased mucus productionDamage to air sacInflammation, thickening of airway walls +++ Demographics ++ Most commonly presents at age 55 to 60 yearsMore common in men than women in middle ageIncreasing prevalence among women (associated with increased smoking among women) +++ Signs and Symptoms ++ Chest tightness3WheezingDyspneaCoughShoulder raised to allow increased airflow to lungsShortness of breathTensed muscles from dyspneaDepressionParadoxical inspirationDigital clubbingBarrel chest deformity3 +++ Functional Implications ++ Disabling dyspnea ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.