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  • Non-septic obstructive airway disease
  • Septic obstructive airway disease

  • 490 Bronchitis, not specified as acute or chronic
  • 491 Chronic bronchitis
  • 492 Emphysema
  • 493 Asthma
  • 494 Bronchiectasis
  • 495 Extrinsic allergic alveolitis
  • 496 Chronic airway obstruction, not elsewhere classified

  • 780.7 Malaise and fatigue
  • 786.0 Dyspnea and respiratory abnormalities
  • 786.05 Shortness of breath

  • F17 Nicotine dependence
  • J44 Other chronic obstructive pulmonary disease
  • J41 Chronic simple and mucopurulent chronic bronchitis
  • J42 Unspecified chronic bronchitis
  • J43 Emphysema
  • J45 Asthma
  • J47 Bronchiectasis
  • Z57.31 Occupational exposure to environmental tobacco smoke
  • Z72.0 Tobacco use
  • Z77.22 Exposure to environmental tobacco smoke
  • Z87.891 Personal history of nicotine dependence


  • A cluster of chronic lung diseases that cause air to be trapped in lungs and hyperinflation
  • Afflicted individuals usually have both emphysema and chronic bronchitis
  • Chronic airflow limitation, narrowing of airways (not fully reversible)
  • Disorders
    • Chronic bronchitis: inflammation of airway with increased mucus production
    • Obstructive bronchiolitis
    • Emphysema: damaged air sacs and small tubes of the lungs
    • Chronic obstructive lung disease (COLD)
    • Chronic obstructive airway disease (COAD)
    • Chronic airflow limitation (CAL)
    • Chronic obstructive respiratory disease (CORD)
  • Subdivided into septic and non-septic3
    • Non-septic
      • Cough is productive
      • Breathing sounds: rales, wheezing
    • Septic
      • Cough can be variable
      • Breathing sounds decreased

Essentials of Diagnosis

  • Most individuals have lost 50% lung function when diagnosed
  • Diagnostic guidelines
    • GOLD (the Global Initiative for Chronic Obstructive Lung Disease)
    • Guidelines from American Thoracic Society and European Respiratory Society
  • Diagnosis
    • Physical examination
    • Air-flow limitation on pulmonary function test (spirometer)
      • Spirometer measures compared to predicted values for age, height, body weight, gender
      • Expressed as FEV (function expiratory volume)
    • Chronic cough
    • Hypoxemia
    • Hypercapnia

General Considerations

  • Mortality rates increase with repeated exposure to irritant or causative factors
  • Most cases include cigarette smoking
    • Acute exacerbations often caused by lung infection, exposure to air pollution, smoke, cold air temperature, dust, chemical smells
  • Adults with asthma are 12 times more likely to develop COPD than adults without asthma
  • Must monitor oxygen levels in patients with COPD; can become apneic
  • Loss of airflow usually due to
    • Lost elasticity in airways and air sacs
    • Increased mucus production
    • Damage to air sac
    • Inflammation, thickening of airway walls


  • Most commonly presents at age 55 to 60 years
  • More common in men than women in middle age
  • Increasing prevalence among women (associated with increased smoking among women)

Signs and Symptoms

  • Chest tightness3
  • Wheezing
  • Dyspnea
  • Cough
  • Shoulder raised to allow increased airflow to lungs
  • Shortness of breath
  • Tensed muscles from dyspnea
  • Depression
  • Paradoxical inspiration
  • Digital clubbing
  • Barrel chest deformity3

Functional Implications

  • Disabling dyspnea ...

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