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Conhronic obstructive pulmonary disead6definition

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"Pulmonary Disease, Chronic Obstructive"[MeSH] AND definition

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Chronic Obstructive Pulmonary Disease (COPD) - Definition

COPD is an umbrella term for a group of conditions that cause persistent, largely fixed airflow limitation and dyspnea on exertion. Per Goldman-Cecil Medicine:
"COPD is characterized by persistent respiratory symptoms and airflow limitation that is due to airway or alveolar abnormalities usually caused by significant exposure to noxious particles or gases."
  • Goldman-Cecil Medicine, p. 889

Key diagnostic criterion

Airflow limitation is confirmed by spirometry when:
  • FEV1/FVC ratio < 0.7 (post-bronchodilator) - Goldman-Cecil Medicine, p. 889

What COPD includes

COPD is not a single disease but an umbrella covering two overlapping phenotypes, often coexisting in the same patient:
  1. Chronic bronchitis - defined clinically as productive cough (daily cough and sputum) for at least 3 months per year, in 2 or more consecutive years, in the absence of another cause.
  2. Emphysema - a pathological/structural diagnosis defined by permanent enlargement of air spaces distal to the terminal bronchiole, caused by destruction of alveolar walls, without obvious fibrosis.
Nearly all COPD patients have some combination of both the air-space destruction of emphysema and the airway changes of chronic bronchitis, though the proportion of each varies between individuals - Goldman-Cecil Medicine, p. 889.
The current GOLD (Global Initiative for Chronic Obstructive Lung Disease) definition, cited in Miller's Anesthesia, adds:
"...airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development."
  • Miller's Anesthesia, 10th ed.

Cause

The dominant cause worldwide is cigarette smoking (dose-dependent, measured in pack-years), followed by biomass fuel exposure, occupational dust/fume exposure, and factors that impair lung growth in early life (e.g., childhood respiratory infections) - Goldman-Cecil Medicine, p. 890.

Epidemiology

COPD typically presents in the sixth decade of life or later, affects an estimated 175 million people globally, and causes about 3.2 million deaths per year, making it the third leading cause of death worldwide - Goldman-Cecil Medicine, p. 890.
No conflicting recent systematic reviews/meta-analyses on the core definition turned up in a PubMed check (recent guideline hits were on comorbidity management and palliative care, not the definition itself), so the textbook definition above remains current and consistent with GOLD criteria.
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