Hogeschool Rotterdam

College 1: Pathofysiologie & Diagnostiek bij COPD

Thema 10
Doelstellingen College:

•Aan het eind van dit college kan de deelnemer:

•- Het pathofysiologische proces van COPD beschrijven.

•- De symptomen en verschijnselen bij COPD verklaren.

•- De medische diagnostiek beschrijven.

•- De ernst van de luchtwegobstructie classificeren.

Definitie & overview (1/2)

►Chronic Obstructive Pulmonary Disease (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 most common respiratory symptoms include dyspnea, cough and/or

sputum production. These symptoms may be under-reported by patients.

►The main risk factor for COPD is tobacco smoking but other environmental
exposures such as biomass fuel exposure and air pollution may contribute.

© 2020 Global Initiative for Chronic Obstructive Lung Disease

Definitie & overview (2/2)

►Besides exposures, host factors predispose individuals to develop COPD.

These include genetic abnormalities, abnormal lung development and
accelerated aging.

►COPD may be punctuated by periods of acute worsening of respiratory

symptoms, called exacerbations.

►In most patients, COPD is associated with significant concomitant chronic

diseases, which increase its morbidity and mortality.

© 2020 Global Initiative for Chronic Obstructive Lung Disease

COPD comprises pathological changes in four different compartments of the lungs (central airways, peripheral
airways, lung parenchyma and pulmonary vasculature), which are variably present in individuals with the disease.

Airflow limitation in COPD is caused by the presence of an inflammatory cellular infiltrate in the small airways,
remodelling and thickening of the airway wall.

The destruction of alveoli and enlargement of airspaces, which are anatomical hallmarks of emphysema, contribute
to the loss of elastic recoil and the loss of outward traction on the small airways, leading to their collapse on
expiration. These result in airflow obstruction, air trapping and hyperinflation.

In general, the inflammatory and structural changes in the airways increase with disease severity and persist even
after smoking cessation.

Naar: Palange & Simonds 2013 – European Respiratory Society

Anatomie longen; Luchtweg vertakkingen
Pathofysiologie COPD
Pathofysiologie: Air trapping
Pathofysiologie: Hyperinflatie
COPD: Tekens & Symptomen
COPD medische Diagnostiek

 Anamnese

 Lichamelijk onderzoek

 Meten luchtwegobstructie  (FEV1 & FVC) zie GOLD criteria voor COPD

 Vragenlijsten m.b.t. de mate van kortademigheid en de symptoomlast (mMRC, CAT, CCQ,)

 Maximale inspanningstest (Cardio Pulmonary Exercise Test=CPET)

Medische Diagnostiek: Spirometrie
FEV1 = Forced Expiratory Volume in 1 seconde

1. Nodig voor GOLD indeling COPD

•diagnose (FEV1 / FVC)

•stadium (ernst bronchusobstructie)

2. Nodig om effect medicatie te bepalen

“Spirometry is required to assess the degree of airflow limitation as it is the most widely available
and reproducible lung function test.”

“The presence of a post-bronchodilator FEV 1 /FVC ratio < 0.70 confirms the presence of airflow
obstruction, and thus of COPD.”
GOLD Indeling:
ABCD assessment tool

© 2020 Global Initiative for Chronic Obstructive Lung Disease

Modified Medical Research Council (mMRC) questionnaire
COPD assessment test (CAT)
Doelstellingen College:

•Aan het eind van dit college kan de deelnemer:

•- Het pathofysiologische proces van COPD beschrijven.

•- De symptomen en verschijnselen bij COPD verklaren.

•- De medische diagnostiek beschrijven.

•- De ernst van de luchtwegobstructie classificeren.