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: - Peak expiratory flow rate monitoring for asthma - Chest X-ray PA and lateral (infiltrates, hyperinflation, effusions) - CT chest high-resolution for interstitial/parenchymal disease - Polysomnography for sleep-disordered breathing - Bronchoscopy with BAL for diagnostic sampling - Thoracentesis with Light criteria for pleural effusion classification - D-dimer (high sensitivity, low specificity for PE)
Risk factors: - Age >65 with declining mucociliary clearance - Indoor air pollution and biomass fuel exposure - Family history of alpha-1 antitrypsin deficiency - Prior TB exposure or latent TB infection - Environmental allergen sensitization (dust mites, mold, pollen) - Prematurity with bronchopulmonary dysplasia history - GERD with chronic microaspiration