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Chronic obstructive pulmonary disease (COPD) is a progressive, preventable, and treatable airflow limitation caused predominantly by tobacco smoking and biomass fuel exposure. It affects over 300 million people worldwide and is a leading cause of morbidity and mortality.
COPD involves two overlapping pathologic processes: emphysema (destruction of alveolar walls reducing elastic recoil and gas exchange surface area) and chronic bronchitis (airway inflammation, mucus hypersecretion, and small airway remodeling). Dynamic hyperinflation — air trapping due to incomplete exhalation — drives dyspnea on exertion and impairs ventilatory mechanics. Systemic inflammation contributes to extrapulmonary manifestations including cardiovascular disease, muscle wasting, and osteoporosis.
Clinical reasoning differentiates COPD from asthma (fixed vs. reversible obstruction), heart failure (orthopnea, BNP), and bronchiectasis. Spirometry showing FEV1/FVC <0.70 post-bronchodilator confirms obstruction. GOLD staging guides pharmacotherapy. COPD exacerbation management targets the precipitant (infection, air pollution) with short-acting bronchodilators, systemic steroids, and antibiotics when purulent sputum or increased dyspnea is present. Non-invasive ventilation reduces intubation rates in exacerbations with hypercapnic respiratory failure.