Classification

• A system that combines spirometric classification, symptom assessment, and history of exacerbations to determine the impact of COPD on a patient's health status.

• Grade and groups are calculated separately

• GOLD spirometric grades 1–4

  • Assessed using spirometry at the time of diagnosis and then annually to track any decline in FEV1

  • Inform the prognosis of a patient

• GOLD Groups A–D

  • Calculated based on the history of exacerbations and severity of symptoms

  • Used to guide management

GOLD grades inform the prognosis of a patient; GOLD groups guide management.

Emphysema is characterized by the destruction of lung parenchyma and is often seen in patients with advanced pulmonary disease. The presence of emphysema does not necessarily correlate with spirometric findings. Emphysema can be divided into the following subtypes

• Centrilobular emphysema (centriacinar emphysema)

  • Most common type of emphysema

  • Classically seen in smokers

  • Characterized by the destruction of the respiratory bronchiole (central portion of the acinus); spares distal alveoli

  • Usually affects the upper lobes

• Panlobular emphysema (panacinar emphysema)

  • Rare type of emphysema

  • Associated with α1-antitrypsin deficiency

  • Characterized by the destruction of the entire acinus (respiratory bronchiole and alveoli)

  • Usually affects the lower lobes

• Other subtypes

  • Cicatricial emphysema

    • Mainly caused by exposure to quartz dust

    • Results in chronic inflammation and nodular scar formation

  • Giant bullous emphysema

    • Characterized by large bullae (congenital or acquired) that extrude into the surrounding tissue

    • Bullae may rupture, leading to pneumothorax.

    • Depending on the shape of the bullae, resection should be considered.

  • Senile emphysema

    • Loss of pulmonary elasticity with age may lead to an emphysematous lung.

    • Considered a normal consequence of aging