). Osteoporosis, heart disease, musclewasting and depression are all more common in people with COPD.
Acute exacerbations of COPD
An acute exacerbation of COPD is a suddenworsening of COPD symptoms (shortness of breath,quantity and color of phlegm) that typically lasts for several days. It may be triggered by an infectionwith bacteria or viruses or by environmental pollutants. Typically, infections cause 75% or moreof the exacerbations; bacteria can roughly be foundin 25% of cases, viruses in another 25%, and bothviruses and bacteria in another 25%. PulmonaryEmbolism can also cause exacerbations of COPD.Airway inflammation is increased during theexacerbation resulting in increased hyperinflation,reduced expiratory air flow and worsening of gastransfer. This can also lead to hypo ventilation andeventually hypoxia, thus can lead to insufficienttissue perfusion then cell necrosis.
The diagnosis of COPD is confirmed byspirometry, a test that measures breathing.Spirometry measures the forced expiratoryvolume in one second (FEV
) which is thegreatest volume of air that can be breathedout in the first second of a large breath.Spirometry also measures the forced vitalcapacity (FVC) which is the greatest volumeof air that can be breathed out in a wholelarge breath. Normally at least 70% of theFVC comes out in the first second (i.e. theFEV
/FVC ratio is >70%). A ratio of lessthan normal defines the patient as havingCOPD. More specifically, the diagnosis of COPD is made when the FEV
/FVC ratio is<70%.The
D criteria also requires thatvalues are after bronchodilator medicationhas been given to make the diagnosis, andthe NICE criteria also requiresFEV1%.According to the ERS criteria, it isFEV1% predicted that defines when a patient has COPD, that is, when FEV1% predicted is < 88% pred for men, or < 89%for women.Spirometry can help to determine the severity of COPD. The FEV
(measured post-bronchodilator) isexpressed as a percent of a predicted "normal" value based on a person's age, gender, height and weight:
everity of COPDF
Mild 80Moderate 50±79Severe 30±49Very severe<30 or Chronic respiratory failuresymptomsThe severity of COPD also depends on the severityof dyspnea and exercise limitation. These and other factors can be combined with spirometry results to