1. Chronic Obstructive pulmonary disease Yuqi Zhou, M.D & Ph.D Pulmonary Medicine 3rd Affiliated Hospital of Sun-Yat Set University

6. Fig 1 . Venn diagram illustrating the overlap between the diagnosis of chronic bronchilitis, emphysema and asthma,and their contribution to COPD.

12. Chronic Bronchitis Emphysema Bronchiolitis Small airways disease

13. Clinical findings

15. Two symptom patterns Decreased minute ventilation Increased minute ventilation Exercise ventilation Severe oxygen desaturation, without OSA. Mild to moderate oxygen desaturation, with OSA. Nocturnal ventilation Cardiac output normal. PAP ↑ ↑ Cardiac output normal to slightly low. PAP ↑ Hemodynamics Increased perfusion to low V/Q areas Increased ventilation to high V/Q areas Special evaluations V/Q matching Total lung capacity normal or ↑ DLco normal, Static lung compliance normal Total lung capacity ↑ DLco reduced, Static lung compliance ↑ Pulmonary function tests Elevated hemoglobin. PaO 2 ↓PaCO 2 ac↑,X-ray, increased interstitial markings (“dirty lung”) Normal hemoglobin. PaO 2 ↓PaCO 2 ac↓,X-ray, hyperinflation. Laboratory studies Chronic cough, purulent sputum, overweight, peripheral edema. Age 30-40y Dyspnea, mucoid sputum, thin, chest is quiet. Age 50y History and physical examination Blue bloaters Pink puffers

16. Patient with emphysema

19. Spirometry: Normal and COPD

20. Pulmonary function tests ---Static lung volumes in a normal subject(A) and a patient with COPD

23. Streptococcus pneumoniae Haemophilus Influenza

25. Chest X-ray film

27. Table 1 Points that differentiate asthma from COPD COPD Asthma History Smoker or ex-smoker Nearly all Possibly Symptoms under age 45 Uncommon Often Chronic productive cough Common Uncommon Breathlessness Persistent and progressive Variable Winter bronchitis Common Uncommon Investigations Serial PEF Obstructive picture May be normal Day to day and diurnal variation Reversibility testing Minimal variation Usually<15% or 200ml change Usually>15% or 200ml change

34. Table 2 Home oxygen therapy Group Ⅱ PaO 2 =56-59mmHg or S aO 2 =89% if there is evidence of any of the following 1.Dependent edema suggesting congestive heart failure 2.Pulmonary on ECG (P wave >3 mm in standard lead Ⅱ,Ⅲ, or aVF) 3.Hematocrit >56% Group Ⅰ(any of following) 1. PaO 2 ≤55mmHg or S aO 2 ≤88% taken at rest breathing room air, while awake. 2.During sleep (prescription for nocturnal oxygen use only) (1) PaO 2 ≤55mmHg or S aO 2 ≤88% for a patient whose awake ,resting, room air PaO 2 is ≥56mmHg or S aO 2 ≥89% or (2)Decrease in PaO 2 >56mmHg or decrease in S aO 2 >5% associated with symptoms or signs reasonably attributed to hypoxemia(e.g.,impaired cognitive processes,nocturnal restlessness, insomnia) 3.During exercise (prescription for oxygen use only during exercise) (1) PaO 2 ≤55mmHg or S aO 2 ≤88% taken during exercise for a patient whose awake ,resting, room air PaO 2 is ≥56mmHg or S aO 2 ≥89% and (2) There is evidence that the use of supplemental oxygen during exercise improves the hypoxemia that was demonstrated during exercise while breathing room air.

53. Thank you for your attention ！