Reduced mucociliary clearance | GORD | Airway colonization | Immune deficiency | Aspiration | GOLD D treatment |
---|---|---|---|---|---|
Direct injury by tobacco smoke | Increased frequency of Hiatus Hernia [4] and GORD [6] leading to chemical, food and microbial aspiration | H Influenzae S pneumonia M catarrhalis P aeruginosa | Innate immunity impaired- shortening of cilia, squamous cell metaplasia, goblet-cell hyperplasia, loss of tight junction from toxic effects of smoking | Swallowing normally performed in exhalation. In COPD pts swallowing can be immediately before or after inspiration heightening aspiration -risk considerably [12] | •LAMA/LABA •ICS •Azithromycin •Roflumilast •Influenza Vacc •Pneumococcal Vacc •Pulmonary rehabilitation within 6 weeks of hospital discharge for AECOPD |
Chronic airway inflammation ± bronchiectasis |  | Adenovirus Influenza B Coronovirus Rhinovirus | Adaptive immunity- fewer CD4 + T central memory cells and CD8 + T effector memory cells [8] |  |  |
Recent exacerbation | Â | Â | Primary Immune deficiency disease-hypogammaglobulinaemia, specific antibody deficiency, selective IgA deficiency [9] | Â | Â |
Airways obstruction | Â | Â | Immunosenescence- cellular senescence, stem cell exhaustion, increased oxidative stress, alteration in extracellular matrix, reduction in endogenous anti-ageing molecules [10] | Â | Â |
Dynamic expiratory collapse | Â | Â | Supressed antiviral immune response [11] | Â | Â |
↑Mucus tenacity |  |  |  |  |  |
Expiratory muscle weakness—sarcopenia, altered pulmonary dynamics |  |  |  |  |  |