PPOK (Penyakit Paru Obstruktif Kronis) / COPD (Chronic Obstructive Pulmonary Disease))

Pengantar by JATI : Tadi ada kuliah pulmonologi tentang COPD, nah ini ada sekilas tulisan tentang COPD yang aq ambil dari CMDT 2006 :)

COPD is a disease state characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema; the airflow obstruction is generally progressive, may be accompanied by airway hyperreactivity, and may be partially reversible (American Thoracic Society).

Most patients with COPD have features of both emphysema and chronic bronchitis. Chronic bronchitis is a clinical diagnosis defined by excessive secretion of bronchial mucus and is manifested by daily productive cough for 3 months or more in at least 2 consecutive years. Emphysema is a pathologic diagnosis that denotes abnormal permanent enlargement of air spaces distal to the terminal bronchiole, with destruction of their walls and without obvious fibrosis.

Cigarette smoking is clearly the most important cause of COPD. It is estimated that 80% of patients seen for COPD have significant exposure to tobacco smoke. The remaining 20% frequently have a combination of exposures to environmental tobacco smoke, occupational dusts and chemicals, and indoor air pollution from biomass fuel used for cooking and heating in poorly ventilated buildings. Outdoor air pollution, airway infection, familial factors, and allergy have also been implicated in chronic bronchitis, and hereditary factors (deficiency of alfa1 antiprotease) have been implicated in COPD.
The pathogenesis of emphysema may involve excessive lysis of elastin and other structural proteins in the lung matrix by elastase and other proteases derived from lung neutrophils, macrophages, and mononuclear cells. Atopy and the tendency for bronchoconstriction to develop in response to nonspecific airway stimuli may be important risks for COPD.

Symptoms and Signs

Patients with COPD characteristically present in the fifth or sixth decade of life complaining of excessive cough, sputum production, and shortness of breath. Symptoms have often been present for 10 years or more. Dyspnea is noted initially only on heavy exertion, but as the condition progresses it occurs with mild activity. In severe disease, dyspnea occurs at rest. A hallmark of COPD is frequent exacerbations of illness that result in absence from work and eventual disability. Pneumonia, pulmonary hypertension, cor pulmonale, and chronic respiratory failure characterize the late stage of COPD. Death usually occurs during an exacerbation of illness in association with acute respiratory failure.

Clinical findings may be completely absent early in the course of COPD. As the disease progresses, two symptom patterns tend to emerge, historically referred to as "pink puffers" and "blue bloaters". These patterns have been thought to represent pure forms of emphysema and bronchitis, respectively, but this is a simplification of the anatomy and pathophysiology. Most COPD patients have pathologic evidence of both disorders, and their clinical course may reflect other factors such as central control of ventilation and concomitant sleep-disordered breathing.

Type A: Pink Puffer (Emphysema Predominant) : Major complaint is dyspnea, often severe, usually presenting after age 50. Cough is rare, with scant clear, mucoid sputum. Patients are thin, with recent weight loss common. They appear uncomfortable, with evident use of accessory muscles of respiration. Chest is very quiet without adventitious sounds. No peripheral edema.
Type B: Blue Bloater (Bronchitis Predominant) : Major complaint is chronic cough, productive of mucopurulent sputum, with frequent exacerbations due to chest infections. Often presents in late 30s and 40s. Dyspnea usually mild, though patients may note limitations to exercise. Patients frequently overweight and cyanotic but seem comfortable at rest. Peripheral edema is common. Chest is noisy, with rhonchi invariably present; wheezes are common.