Clinical meaning
COPD features persistent airflow limitation from obstructive bronchiolitis and emphysema. Inhaled irritants activate macrophages and neutrophils releasing proteases (MMP-9, elastase) overwhelming alpha-1 antitrypsin. Mucus gland hyperplasia and goblet cell metaplasia cause chronic mucus hypersecretion. FEV1/FVC <0.7 post-bronchodilator confirms diagnosis. GOLD classification guides therapy.
Diagnosis & workup
Diagnostics & workup: - D-dimer (high sensitivity, low specificity for PE) - CT pulmonary angiography for PE evaluation - Pulse oximetry and continuous SpO2 monitoring - Thoracentesis with Light criteria for pleural effusion classification - Polysomnography for sleep-disordered breathing - Methacholine challenge for suspected asthma with normal spirometry - Procalcitonin for bacterial vs viral pneumonia differentiation
Risk factors: - GERD with chronic microaspiration - Childhood asthma with persistent airway hyperreactivity - Obesity with restrictive physiology and OSA - Prematurity with bronchopulmonary dysplasia history - Prior TB exposure or latent TB infection - Radiation therapy to chest - Cystic fibrosis genotype (CFTR mutations)