COPD

Sophie Tatishvili
Illustration courtesy of healthflexhhs.com
protease-antiprotease imbalance hypothesis
α1-Antitrypsin, normally present in serum, tissue fluids, and macrophages, is a major inhibitor of proteases
(particularly elastase) secreted by neutrophils during inflammation. Most common is the normal (M) allele
and the corresponding phenotype . Pts homozygous for the Z allele have markedly decreased serum levels of
α1-antitrypsin. In smokers, neutrophils and macrophages accumulate in alveoli due to direct chemoattractant
effects of nicotine. Accumulated neutrophils are activated and release their granules, rich in a variety of
cellular proteases (neutrophil elastase, proteinase and metalloproteinases macrophage elastase is not inhibited
by α1-antitrypsin and, indeed, can proteolytically digest this antiprotease oxidant-antioxidant imbalance
hypothesis reactive oxygen species contained in smoke MBBS Medicine (Humanity First)

Oxygen species released by the inflammatory cells.

 Lung Emphysema

Mild centrilobular emphysema. CT section through the upper lobes shows subtle areas of lung
destruction limited to individual secondary pulmonary lobules (arrows). The structure of these
lobules is intact, including the central core structures. Such subtle emphysema will often remain
undetected on conventional chest radiographs October 2008 European Radiology 19(3):537-51 DOI:
10.1007/s00330-008-1186-4
https://sites.google.com/site/informationoncopd/risk-factors
Data from Rabe KF, Hurd S, Anzueto A,
et al. Global strategy for the diagnosis,
management, and prevention of chronic
obstructive pulmonary disease: GOLD
executive summary. Am J Respir Crit
Care Med 2007;176:532–555
http://rsdc.com.au/RespiratoryFunctionTesting.aspx
Pulmonary Function Test

http://lungexpert.co.za/lung-function-test /
European Respiratory Journal 2015 46: PA2786; DOI: 10.1183/13993003.congress-
2015.PA2786
COPD cont.
 Spirograms and flow volume
curves.
(A) Restrictive ventilatory
defect.
(B) Normal spirogram.
(C)Obstructive ventilatory
defect

Reprinted with permission from Gold WM. Pulmonary function testing. In: Murray JF, Nadel
JA, eds. Textbook of respiratory medicine. 3d ed. Philadelphia: Saunders, 2000:805 .
Spirometry

http://www.cmaj.ca/content/183/1/77/F6.large.jpg
Spirometry cont.
COPD x-Ray

Pulmonary Pharmacology & Therapeutics (2002) 15, 341-351 doi:10.1006/pupt.2002.0380,

available online at http://www.idealibrary.com on IDEAL®
 Kaplan–Meier Survival
Curves for the Four Quartiles
of the Body-Mass Index,
Degree of Airflow
Obstruction and Dyspnea, and
Exercise Capacity Index
(Panel A) and the Three
Stages of Severity of Chronic
Obstructive Pulmonary
Disease as Defined by the
American Thoracic Society
(Panel B). In Panel A, quartile
1 is a score of 0 to 2, quartile
2 is a score of 3 to 4, quartile
3 a score of 5 to 6, and
quartile 4 a score of 7 to 10.
Survival differed significantly
among the four groups (P

n engl j med 350;10 www.nejm.org march 4, 2004

COPD and comorbidities

journal.copdfoundation.org I JCOPDF © 2014

COPD and comorbidities cont.
COPD and CVD
COPD Management
COPD Management cont.
COPD mMRC
COPD mMRC cont.
COPD and CAT
Risk assessement
COPD management
COPD management cont.
COPD surgery
COPD surgery cont.