Pulmonology
COPD
만성폐쇄성폐질환
Progressive lung disease with non-reversible airflow limitation
- How common
- Common in smokers >40 yrs
- Typical age
- Ages 40+
What is it?
Inhaled irritants (mainly cigarette smoke) cause airway inflammation, mucus hypersecretion, and alveolar destruction.
Commonly affected: Small airways, alveoli, right ventricle
How it develops
- Chronic irritant exposureSmoking, biomass smoke, air pollution
- Neutrophilic inflammationProtease release (elastase)
- Airway remodelingSmall airway narrowing + goblet cell hyperplasia
- Alveolar destructionElastin breakdown → emphysema
Symptoms
- Progressive dyspneaOn exertion initially, then at rest
- Chronic productive coughMorning sputum production
- Cyanosis/clubbingWith chronic hypoxemia
- Wheezing/chest tightnessExpiratory wheeze
- Barrel chestHyperinflation deformity
How it is examined
- SpirometryPost-BD FEV1/FVC <0.7 confirms COPD
- GOLD stagingStage 1–4 by FEV1 % predicted
- ABGAssess hypoxemia/hypercapnia
Imaging
Hyperinflation, flat diaphragms, emphysematous changes.
- Hyperinflation
- Flattened diaphragms
- Vertical heart
Chest CT quantifies emphysema (centrilobular/panlobular).
- Centrilobular emphysema
- Bullae
Non-surgical care
- Smoking cessationMost important intervention to slow progression
- Long-acting anticholinergic (LAMA)Tiotropium (Spiriva) inhaler
- Long-acting β2-agonist (LABA)Salmeterol/indacaterol
- ICS + LABA comboFor frequent exacerbations or eosinophilia
- Pulm rehab + vaccinesExercise training + flu/pneumococcal vaccines
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Severe emphysema, giant bullae, end-stage disease
Procedures that may be discussed
- Lung volume reduction surgery (LVRS)
- Endobronchial valves
- Lung transplant
- Long-term oxygen therapy (LTOT)
Outlook
Quit smoking slows decline; severe disease has <50% 5-yr survival.