Las CT divide los enficemas en
Centriacinar emphysema occurs preferentially in the upper lobes and produces holes in the center of secondary
pulmonary lobules. The walls of emphysematous spaces are usually imperceptible, but central vessels may be visible
(image 4). In contrast, the walls of cysts in pulmonary Langerhans histiocytosis, another cystic lung disease of cigarette
smokers, are thicker
Panacinar emphysema more commonly involves the lung bases and involves the entire secondary pulmonary lobule
(image 6). Panacinar emphysema can cause a generalized paucity of vascular structures. Among patients with alpha-1
antitrypsin deficiency, panacinar emphysema is the more common pattern.
Paraseptal (distal acinar) emphysema produces small, subpleural collections of gas located in the periphery of the
secondary pulmonary lobule
Imaging is not required to diagnose COPD. However, in patients with severe COPD,
CT scanning identifies individuals with predominantly upper lobe disease who may be candidates for lung volume reduction
El diagnostico se confirma luego de
Spirometry demonstrating airflow limitation (ie, a forced expiratory volume in one second/forced vital capacity [FEV /FVC]
ratio less than 0.7 or less than the lower limit of normal [LLN] PLUS an FEV less than 80 percent of predicted) that is
incompletely reversible after the administration of an inhaled bronchodilator
Absence of an alternative explanation for the symptoms and airflow limitation (table 3) . The differential diagnosis of
COPD is discussed below
The Global Initiative for COPD (GOLD) guidelines suggest repeating spirometry on a separate occasion to demonstrate
persistence of airflow limitation (FEV /FVC <0.7 or less than the LLN) for patients with an initial FEV /FVC between 0.6
In areas of high prevalence of alpha-1 antitrypsin (AAT) deficiency, it is appropriate to screen all patients with COPD by
obtaining an AAT serum level and AAT genotyping [
Nombre diagnosticos diferenciales de EPOC
Among patients who present in mid or later life with dyspnea, cough, and sputum production,
the differential diagnosis is broad (eg, heart failure, COPD, interstitial lung disease, thromboembolic disease
Typically, the finding of persistent airflow limitation on pulmonary function testing and the absence of radiographic features of
heart failure or interstitial lung disease direct the clinician to a narrower differential of COPD, chronic obstructive asthma,
bronchiectasis, tuberculosis, constrictive bronchiolitis, and diffuse panbronchiolitis . Importantly, these conditions can
commonly occur together, for example, patients with asthma may develop COPD and patients with COPD may have
EPOC vs asma obstructiva
In some patients with chronic asthma, a clear distinction from COPD is not possible. As
an example, a patient, who has had atopic asthma since childhood and smoked cigarettes for 15 years in their twenties
and thirties could present in their fifties with a combination of asthma and COPD.
EPOC vs falla cardiaca
Heart failure is a common cause of dyspnea among middle-aged and older patients and some patients
experience chest tightness and wheezing with fluid overload due to heart failure. Occasionally, airflow limitation is noted,
although a restrictive pattern is more common. Heart failure is usually differentiated by the presence of fine basilar
crackles, radiographic evidence of an increased heart size and pulmonary edema. The brain natriuretic peptide is typically
increased in heart failure, but can also be increased during right heart strain from cor pulmonale
linfangioleiomiomatosis vs EPOC
Lymphangioleiomyomatosis (LAM) is seen primarily in young women of childbearing age.
Pulmonary function testing frequently reveals mild airflow obstruction, although a mixed obstructive-restrictive pattern may
be seen. CT scans typically demonstrate small, thin-walled cysts that can at times be confused with emphysema.
However, the airspaces in emphysema are not actually cysts but are caused by the destruction of alveolar walls and
permanent enlargement of distal airspaces, so the "walls" are typically inapparent.
En quienes esta recomendado hacer cribado de EPOC
Routine screening spirometry is generally not indicated for adults who have none of the features suggestive of
COPD (eg, no dyspnea, cough, sputum production or progressive decline in activity), as asymptomatic mild airflow obstruction
does not require treatment [51,101]. Asymptomatic and nonsmoking subjects with mild airflow obstruction, but no history of
asthma, do not have the same progressive decline in lung function that is observed among individuals who have a similar
degree of airflow obstruction and are symptomatic or continue to smoke
Decrements in forced
expiratory volume in one second (FEV ), even within the normal range, are associated with increased risk of acute cardiac
events independent of age, gender, and smoking history .
Cada cuanto se recomienda hacer una espirometria
recommends annual spirometry to track decline in FEV . Spirometry is also essential to decision-making for lung volume
reduction and lung transplantation.
While not included in the symptom and risk assessments described above, spirometry is integral to the diagnosis of COPD and
severity assessment which contributes to prognosis. Follow-up spirometric assessment may also be helpful in therapeutic
decision making when, for instance, there is a discrepancy between spirometry and level of symptoms or in determining the
need to consider alternative diagnoses if symptoms are disproportionate to the degree of airflow obstruction.
En que consiste el sistema gold
GOLD system — The therapeutic strategy of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines
suggests using a combined assessment based on an individual's symptoms and exacerbation history to guide therapy [
Group A: Low risk, less symptoms: 0 to 1 exacerbation per year and no prior hospitalization for exacerbation; and CAT
score <10 or mMRC grade 0 to 1.
Group B: Low risk, more symptoms: 0 to 1 exacerbation per year and no prior hospitalization for exacerbation; and CAT
score ≥10 or mMRC grade ≥2.
Group C: High risk, less symptoms: ≥2 exacerbations per year or ≥1 hospitalization for exacerbation; and CAT score <10
or mMRC grade 0 to 1.
Group D: High risk, more symptoms: ≥2 exacerbations per year or ≥1 hospitalization for exacerbation; and CAT score ≥10
or mMRC grade ≥2.
En que consiste el sistema de la fundacion EPOC
SG ● 0: Normal spirometry
● SG 1: Mild, postbronchodilator FEV1/FVC ratio <0.7, FEV1 ≥60 percent predicted
● SG 2: Moderate, postbronchodilator FEV1/FVC ratio <0.7, 30 percent ≤FEV1 <60 percent predicted
● SG 3: Severe, postbronchodilator FEV1/FVC ratio <0.7, FEV1 <30 percent predicted
● SG U: Undefined, postbronchodilator FEV1/FVC ratio >0.7, FEV1 <80 percent predicted
¿que es el EPOC?
"COPD is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow
limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or
gases. The chronic airflow limitation that characterizes COPD is caused by a mixture of small airways disease (eg, obstructive
bronchiolitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person.
Chronic inflammation causes structural changes, small airways narrowing, and destruction of lung parenchyma. A loss of small
airways may contribute to airflow limitation and mucociliary dysfunction, a characteristic feature of the disease."
como se define bronquitis cronica
Chronic bronchitis is defined as a chronic productive cough for three months in each of two successive
years in a patient in whom other causes of chronic cough (eg, bronchiectasis) have been excluded
former smokers have increased airway mucin concentration (MUC5AC and MUC5B), compared with never smokers; those
with symptoms of chronic bronchitis also have higher concentrations than those of similar GOLD stage (table 1) without
en que consiste el enfisema
These changes include abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles that is accompanied by destruction of the airspace walls, without obvious fibrosis.
While emphysema can exist in individuals who do not have
airflow obstruction, it is more common among patients who have moderate or severe airflow obstruction
Asthma is a chronic inflammatory
disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with
airway responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing,
particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow
obstruction within the lung that is often reversible either spontaneously or with treatment
Dentro de las tres enfermedades o cuadros mas importantes del EPOC hay algunas excepciones
Patients with asthma whose airflow obstruction is completely reversible are not considered to have COPD (subset nine in
Patients with asthma whose airflow obstruction does not remit completely are considered to have COPD (subsets six,
seven, and eight in the figure). The etiology and pathogenesis of the COPD in such patients may be different from that of
patients with chronic bronchitis or emphysema.
Chronic bronchitis and emphysema with airflow obstruction commonly occur together (subset five in the figure) . Some
of these patients may also have asthma (subset eight in the figure).
Individuals with asthma may develop a chronic productive cough, either spontaneously or due to exposure (eg, cigarette
smoke, allergen). Such patients are often referred to as having asthmatic bronchitis, although this terminology has not
been officially endorsed in clinical practice guidelines (subset six in the figure).
Persons with chronic bronchitis, emphysema, or both are not considered to have COPD unless they have airflow
obstruction (subsets one, two, and eleven in the figure) [25,26].
Patients with airflow obstruction due to diseases that have a known etiology or a specific pathology (eg, cystic fibrosis,
bronchiectasis, obliterative bronchiolitis) are not considered to have COPD (subset 10 in the figure). However, these
exclusions are loosely defined .
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