Chronic Obstructive Pulmonary Disease ( Copd )

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1.2 Chronic Obstructive Pulmonary Disease (COPD)
1.2.1 What is COPD?
COPD is a chronic inflammation of the airways leading to fixed airflow obstruction and restricted gas exchange. The term COPD includes two basic respiratory pathologies: chronic bronchitis and emphysema (GOLD, 2006) that are described below. The condition is not reversible and may progressively worsen with time (NICE, 2010).
Chronic bronchitis: is the narrowing of the bronchi and bronchioles due to thickening of the airway walls and enlargement of mucus glands from chronic inflammation (Hogg, 2008). COPD caused by chronic bronchitis is characterized by excessive mucus production and expectoration, with mucus plugging contributing to obstruction of the bronchial tree,
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The severity of COPD is clinically categorised into four stages by the Global initiative for Obstructive Lung Disease (GOLD), based on the predicted percentage (%) of normal FEV1, in subjects presenting with < 0.7 FEV1/FVC post-bronchodilator ratio (GOLD,2006) (Table 1.1). Introduction

Table 1.1: GOLD stages of COPD severity GOLD 2016
All the stages had FEV1/FVC ratio <0.7, post-bronchodilator
Although a useful guide, severity assessment based on FEV1 alone is considered a weak marker for predicting morbidity and mortality as there is a poor association between extent of airflow obstruction and common COPD symptoms like breathlessness, exercise capacity and health status, (Celli et al., 2004). Several other measures such as the BODE (body mass index (B), airflow obstruction (O), dyspnoea (D), exercise capacity (E)) and ADO (age (A), dyspnoea (D) and airflow obstruction (O) indices have been developed and are superior for accurately defining disease severity (Puhan et al., 2009).
1.2.3 COPD symptoms
COPD patients experience shortness of breath and suffer from tightness in their chest, which leads to wheezing and laboured breathing. Damage to the lung parenchyma and recoiling mechanisms causes poor oxygenation of blood and accumulation of carbon dioxide (GOLD, 2006). COPD is characterized by persistent cough, sputum production due to excess mucus secretion by damaged airways and impaired ciliary mucus clearance. Expectoration of
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