Smoking leads to lung destruction over time, causing irreversible obstruction to air flow
When enough damage occurs, patients develop chronic symptoms of SOB, DOE, cough, sputum production
Acute exacerbations (~50% of which are caused by bacterial infections) present with sudden worsening of obstruction from combination of: bronchoconstriction, mucosal edema and increased mucous production
Risk Factors
> 20 pack yr smoking hx
Sometimes second hand smoke contributes
Consider alpha-1 anti-trypsin if < 40 and/or without significant smoking hx
Symptoms
SOB
DOE
Sputum
Cough
Wheezing
Acute exacerbation associated w/worsening SOB and colored sputum
Physical Exam Findings
Wheezing
Can have elevated respiratory rate and significant work of breathing if advanced and/or acutely ill
Often diminished breath sounds
Sometimes barreled chested
Rarely cyanosis and clubbing
Weight loss and wasting if very advanced
Tests
COPD defined by PFTs, with FEV1/FVC < .7. COPD severity described as: Mild FEV1 >80% predicted; Mod FEV1 50-80%; Severe FEV1 < 50%; Very Severe FEV1 < 30%