This document discusses the diagnosis and treatment of COPD. It covers spirometry measurements used to diagnose COPD, the GOLD classification system used to assess COPD severity based on lung function tests and symptoms, radiographic findings seen in COPD, the role of HRCT in evaluating COPD patients, tests to measure alpha-1 antitrypsin levels, and how the severity and progression of COPD relates to small airway disease and emphysema.
3. SPIROMETRY
• Spirometry measurements are evaluated by comparison of results with appropriate reference
values based on age ,height,sex and race.
• The presence of post bronchodilator FEV1/FVC < 0.7 confirms the presence of non - fully
reversible airflow obstruction .
• Patients already on bronchodilator treatment in whom spirometry is requested for monitoring
purposes do not need to stop their regular treatment .
• 400mcg SABA or 160mcg short acting anticholinergic or a combination of both can be used.
• Spirometry is done 10-15 mins after administration of SABA or 30-45 mins after anticholinergics.
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9. • Category E - has two more
sub-categories
- C (Moderate to severe
exacerbation history with
mMRC 0-1 or CAT < 10 )
- D (Moderate to severe
exacerbation history with
mMRC >2 or CAT >= 10 )
10. • The combined COPD assesment allows patients with same FEV1 to be
diffrentiated based on symptomatology
• For eg,
- A subject with FEV1 < 30 % with an mMRC of 2 & 3 exacerbations
in the past year would be labled GOLD GRADE 4 , group D
- Wheras a subject with FEV1 < 30% with an mMRC of 1 & 0
exacerbations in the past year would be labled GOLD GRADE 4 ,
group A
12. HRCT CHEST
• In chronic bronchitis, bronchial wall thickening may
be seen in addition to enlarged vessels. Repeated
inflammation can lead to scarring with
bronchovascular irregularity and fibrosis.
• Emphysema is diagnosed by alveolar septal
destruction and airspace enlargement, which may
occur in a variety of distributions.
• for COPD patients with persistent exacerbations,
symptoms out of proportion to disease severity on lung
function testing, FEV1 less than 45% predicted with
significant hyperinflation or for those who meet
criteria for lung cancer screening, chest CT imaging
should be considered.
• Also helps to rule out any infective causes for the
symptoms.
13. Alpha1 antitrypsin levels.
• WHO recommends screening for alpha 1 antitrypsin for all COPD
patients especially in endemic areas.
• Normal ranges b/w 75 - 150 mg/dl
• Alpha-1 antitrypsin deficiency is associated with the development of
COPD , where as increased levels of serum alpha-1 antitrypsin occur
in response to inflammation.
• so in Non-COPD patients , it is a risk factor, whereas in lung diseases
it is a marker of extend of lung damage.
14. SEVERITY OF COPD
• The early stages of COPD, based on the severity of airflow obstruction it is primarily
associated with medium and small airway disease .
• It is indicated by the majority of Global Initiative for Chronic Obstructive Lung Disease
(GOLD) spirometric airflow obstruction stage 1 and stage 2 subjects demonstrating little
or no emphysema.
• The early development of chronic airflow obstruction is driven by small airway disease.
• Advanced stages of COPD (GOLD stages 3 and 4) are typically characterized by
extensive emphysema.
• The subjects at greatest risk of progression in COPD are those with both aggressive
airway disease and emphysema.
• Thus, finding emphysema (by CT) either early or late in the disease process suggests
enhanced risk for disease progression.
