This is a flowchart on COPD (chronic bronchitis and emphysema), covering the etiology, pathophysiology, and manifestations (blue bloater and pink puffer).
ADDITIONAL TAGS:
Tissue destruction
Risk factors / SDOH
Cell / tissue damage
Structural factors
Chronic obstructive pulmonary disease
Medicine / iatrogenic
Infectious / microbial
Biochem / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Environmental, toxin
Hereditary / development
Pressure / flow physiology
Pathophysiology
Etiology
Manifestations
Chronic productive cough
Pulmonary hypertension
Cor pulmonale
Oblideration
Induce structural changes of lung parenchyma
↑ neutrophils, macrophages, CD8+ T cells
Cytokine release
Stimulation of growth factor release
Peribronchiolar fibrosis
Narrowing of airway
Emphysema
Goblet cell proliferation and hypertrophy, mucus hypersecretion, and impaired ciliary function
Smooth muscle hyperplasia in small airways and pulmonary vasculature
Hypoxic vasoconstriction
Chronic inflammation
Tobacco use
Second-hand smoke
Air pollution, fine dusts:
Recurrent pulmonary infections
Premature birth
Tuberculosis
Lung growth, development abnormalities
Exogenous factors:
Endogenous factors:
α1-Antitrypsin deficiency
Airway hyperresponsiveness
Primary ciliary dyskinesia (e.g., Kartagener syndrome)
Immunodeficiency (IgA deficiency)
Noxious stimuli → ↑ oxidative stress → ↑ ROS
↑ proteases
Nicotine and other noxious stimuli inactivate protease inhibitors (like α1-antitrypsin)
↑ elastase activity
Destroys alveolar walls
Loss of elastic tissue and lung parenchyma
Enlargement of airspaces
↓ elastic recoil, ↑ lung compliance
↓ tethering of small airways
Expiratory airway collapse
Air trapping, hyperinflation
↓ ventilation, ↑ dead space
Pulm shunt, ↓ blood volume in pulmonary capillaries
↑ number of alveoli ventilated but not perfused
↓ DLCO, ↑ V/Q mismatch
Cyanosis
Tachycardia
Prolonged expiratory phase, end-expiratory wheezing, crackles, muffled breath sounds, coarse rhonchi on auscultation
Presenting symptoms
Features of advanced COPD
Pursed lip breathing:
↑ luminal airway pres., maintains open airway
Hypoxia and hypercapnia
Dyspnea
Tripoding, use of accessory muscles: recruits muscles to increase ventilation​​
Barrel chest
Pink puffer vs Blue bloater
↑ TLC , ↑ FRC​
↑ AP diameter
Hyperresonance
Jugular venous distension
Hepatosplenomegaly
Peripheral edema
Clubbing
+/- weight loss, wasting, cachexia
Right ventricular hypertrophy
Chronic bronchitis
Emphysema