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Pathology

Umbrella term for emphysema and chronic bronchitis.
Progressive airway obstruction with little to no reversibility 
Emphysema: dilatation and destruction of terminal air spaces 
Chronic bronchitis: productive cough on most days for at least 3 months of two successive years.

Aetiology

Tobacco smoking, occupational environments, alpha-1 anti-trypsin deficiency

Signs

Tachypnoea, hyperinflated thorax, lip pursing, plethoric, cyanosis, use of accessory muscles, quiet breath sounds. 

Symptoms

Cough, sputum production, breathlessness and wheeze

Investigations

Spirometry: Obstructive pattern
Transfer factor: Reduced in emphysema
Chest X-Ray: Hyperinflation, bullae
HRCT: Examines degree of emphysema

Treatment

Smoking cessation, pulmonary rehabilitation, appropriate self management plans (e.g. home steroids and antibiotics). Appropriate oxygen therapy if needed

Prognosis

Only stopping smoking and long term oxygen therapy (LTOT) improve prognosis
Infective exacerbations, pneumothorax, cor pulmonale, pulmonary hypertension, immobility, weight loss, ventilatory failure

Key Facts

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Key Images

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Key References

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