Objectives • Defining COPD • To be familiar with the new GOLD classification system
COPD Defined by GOLD • COPD as a disease state is characterized by airflowlimitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.
OLD Subtypes • Chronic bronchitis: • chronic productive cough for 3 months in 2 consecutive years. • Emphysema: • Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of airspace walls without obvious fibrosis. • Chronic obstructive asthma: • Asthma with airflow obstruction that does not remit completely
revised GOLD classification • Looks at 3 things: • Symptoms • FEV1 • History of exacerbations
CASE • 74 YO M with COPD p/w SOB x 2 days. At baseline he does not have any physical limitations. His last spirometry three years ago showed mild COPD. He was never given any inhalers besides a rescue inhaler that he seldom uses. He has never been intubated, but gets about 3 exacerbations per year. 2 days ago he required it around the clock after having URI symptoms. He has increased greenish sputum over the past couple of days. He called 911 after waking up SOB. He was given duonebs and placed on CPAP. • What classification is he?
summary • COPD is characterized by airflow limitation, progressive, and has an enhanced chronic inflammatory response. • Revised GOLD classification uses FEV1, symptoms, history of exacerbations • It’s still important to know the OLDFEV1 classification system because it’s used in the NEW GOLD classification. • For diagnosis and exacerbation treatment of COPD, see the newly revised COPD mini lecture!
References Global Strategy for the Diagnosis, Management, and Prevention of COPD Updated 2013 Uptodate