COPD has been graded according to airflow limitation:
|Stage||Severity||FEV1/FVC||FEV1 to normal|
|Stage I||Mild COPD||FEV1/FVC<0.70||FEV1 >80% normal|
|Stage II||Moderate COPD||FEV1/FVC<0.70||FEV1 50-79% normal|
|Stage III||Severe COPD||FEV1/FVC<0.70||FEV1 30-49% normal|
|Stage IV||Very severe COPD||FEV1/FVC<0.70||FEV1 >30% normal|
FEV1 = forced expiratory volume in one second (the volume in a one-second forced exhalation)
FVC = forced vital capacity (the total exhaled breath)
Emphysema is caused by injury to the alveolar epithelium, resulting in difficulties during exhaling but not during inhaling.
Patients may become “barrel chested” and are referred to as “pink puffers.”
Bronchitis is caused by bronchial wall injury due to inflammation and mucus production, resulting in difficulties during exhaling and inhaling.
Patients can easily become cyanotic and are referred to as “blue bloaters" or "blue puffers.”
Patients with COPD are susceptible to developing bacterial pneumonia, pulmonary hypertension, or cor pulmonale (right-sided heart failure).
Patients without shortness of breath at rest, without a productive cough, and with an oxygen saturation percentage above 91% are considered stabilized.
⚠️ Do not provide elective dental care for patients with low oxygen saturation levels.
There is no cure for COPD. Medications are used to increase bronchodilation and reduce inflammation. Glucocorticosteroids are sometimes used as anti-inflammatory agents.
For stable COPD patients with respiratory symptoms and FEV1 between 60% and 80%: treatment with inhaled bronchodilators may be used.
For stable COPD patients with respiratory symptoms and FEV1 <60%: treatment with inhaled bronchodilators.
For symptomatic patients with COPD and FEV1 <60%: treatment with monotherapy using either long-acting inhaled anticholinergics or long-acting inhaled ß-agonists.
For symptomatic patients with stable COPD and FEV1 <60%: treatment with combination inhaled therapies (long-acting inhaled anticholinergics, long-acting inhaled ß-agonists, or inhaled corticosteroids).
For symptomatic patients with FEV1 <50%, or exercise-limited patients with FEV1 >50%: treatment with pulmonary rehabilitation.
For patients with COPD and severe resting hypoxemia with <55 mm Hg arterial partial pressure of oxygen (PaO2) or <88% arterial oxygen saturation (SpO2), measured by arterial blood gas: treatment with continuous oxygen therapy.
- Medical Disorders
- Oral Health Care Considerations
- Basics about COPD. Centers for Disease Control and Prevention. June 9, 2021
- Bronchitis. National Heart, Lung, and Blood Institute.
- Chronic Bronchitis. MedlinePlus. U.S. National Library of Medicine. June 16, 2021.
- Chronic Obstructive Pulmonary Disease. MedlinePlus. U.S. National Library of Medicine. June 23, 2021.
- Chronic Obstructive Pulmonary Disease. National Heart, Lung, and Blood Institute.
- Emphysema. MedlinePlus. U.S. National Library of Medicine. June 16, 2021.
- Global Initiative for Chronic Obstructive Lung Disease. 2020 GOLD Report.
- Halpin D. GOLD COPD strategy: what’s new for 2021? Guidelines in practice. February 24, 2021.