Progressive airway obstruction (FEV<80% predicted, FEV/FVC<0.

7) with little or no reversibility

Includes:
chronic bronchitis (cough, sputum production on most days for 3 months of 2 successive years) emphysema (enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls)

Onset >35yo Prevalence 10-20% of over 40s 18% of male and 14% of female The rates in women have been increasing One of the leading cause of lost working days

Chronic bronchitis Airway narrowing & airflow limitation due to:

hypertrophy and hyperplasia of mucussecreting glands of bronchial tree, bronchial wall inflammation, mucosal oedema

Emphysema
Dilatation and destruction of the lung tissue distal to the terminal bronchioles Lead to loss of elastic recoil expiratory airflow limitation and air trapping

Smoking Atmospheric pollution Alpha 1-antitrypsin deficiency

Chronic productive cough Wheeze Persistent and progressive breathlessness

Smoker or ex-smoker

Breathless at rest, with prolong expiration use accessory muscles of respiration Poor chest expansion Lung hyperinflated Resonant or hyperresonant percussion note Wheeze or quiet breath sound Pink puffer: SOB, no cynosis Blue bloaters: hyperventilate; cynosis, oedema, CO2 retention (warm peripheries, bounding pulse, flapping tremor, confusion)