So, complications and associations of
COPD. Well, bear in mind that somebody with
COPD has smoked, and therefore they are at
risks of all other smoking related disease and
that means that they could have cardiovascular
disease, bladder disease, esophageal disease
and peripheral vascular disease. All these
other issues that may be related to smoking.
Associated with COPD by itself, weight loss
and muscle wasting occurs in some patients
and it's called respiratory cachexia.
Respiratory failure we discussed, it could be acute or
chronic, type 1 or type 2. You do develop
cor pulmonale with end stage respiratory failure
and including those related to COPD. We discussed
bullae and then bronchiectasis is also an
overlap syndrome between COPD and bronchiectasis.
If you do a CT. scan on patients with severe
COPD, about a quarter will have evidence of
bronchiectasis and some of those patients
will present with bronchiectatic type symptoms
of chronic purulent phlegm production and
recurrent infections affecting the lung.
Pneumothorax can occur in patients with COPD
and pneumonia; they are at much increased
risk to a free-fall compared to the normal
population of developing pneumonia.
Lung cancer clearly is a very important overlap
with smoking. If you smoke, you've got a high
risk of lung cancer, if you smoke you have
a high risk of COPD, but more than that, if
you have smoked and have COPD, your risk of
lung cancer is much more than if you have
smoked and don't have COPD. Cardiovascular
disease is probably the commonest cause of
death in patients with COPD and should not
be forgotten about. And of course, the disease
itself, by making the patient unable to exercise
to any significant degree, and that means
walking to the shops for example, that leads
to depression, anxiety and social isolation.
Right, briefly at the end, I'll discuss other
causes of chronic irreversible airways obstruction.
So COPD is irreversible airways obstruction
and most patients with irreversible airways
obstruction in the West will have COPD. However,
not all patients with irreversible airways
obstruction will have COPD, there are a range
of other causes. Chronic asthma, which I've
discussed in the asthma lecture can lead to
irreversible airways obstruction. Bronchiecstasis
and cystic fibrosis both lead to airways obstruction
and in cystic fibrosis, the mode of death
is irreversible airways obstruction. Allergic
bronchopulmonary aspergillosis which is a
complication of asthma and bronchiectasis can
also lead to irreversible airways obstruction.
Some instances of lung diseases are associated
with mixed restrictive obstructive pathogens
such as sarcoid and hypersensitivity pneumonitis
where you get a degree of airways obstruction
but they obviously have another disease the
CT scan and chest X rays clearly shows they
have interstitial lung disease, so that's
not readily confused with COPD.
Recurrent aspirations thought to cause airways obstruction
and as a range of autoimmune diseases that
lead to obliteration of your bronchi and obliterative
bronchiolitis which leads to small airways
obstruction, and this is most commonly associated
with rheumatoid arthritis, that can occur
in other situations, after stem cell transplant,
or lung transplantation for example. And then
there are some drugs that can cause airways
obstruction, penicillamine would be the best
example. And we do know that previous infection
can lead to airways obstruction so severe
childhood viral infection can lead to chronic
obstructive airways disease of some description
and previous tuberculosis is often associated
with chronic obstructive irreversible airways
changes in the lung function testing.