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: - CT chest high-resolution for interstitial/parenchymal disease - 6-minute walk test for functional capacity assessment - Methacholine challenge for suspected asthma with normal spirometry - Sputum culture, Gram stain, and AFB stain - CT pulmonary angiography for PE evaluation - Bronchoscopy with BAL for diagnostic sampling - Pulse oximetry and continuous SpO2 monitoring
Risk factors: - Family history of alpha-1 antitrypsin deficiency - Connective tissue disease with ILD predisposition - Radiation therapy to chest - Immunocompromised state increasing pneumonia susceptibility - Childhood asthma with persistent airway hyperreactivity - Environmental allergen sensitization (dust mites, mold, pollen) - Obesity with restrictive physiology and OSA