Chapter three Chronic Obstructive Pulmonary Diseases (COPD) Chronic Bronchitis Obstructive Pulmonary Emphysema Definition of COPD  Including chronic bronchitis and pulmonary emphysema Chronic airflow limitation progressing slowly Partial reversibility Abnormal inflammatory response of the lungs to noxious particles or gases  Classification of COPD by Severity  Stage 0 ( at risk)  Chronic cough and sputum production Contact with harmful factors FEV1/FVC > 70% Stage I( mild) FEV1/FVC < 70% FEV1 ≥80 % predicted usually, but not always, chronic cough and sputum production  Classification of COPD by Severity  Stage II( moderate) IIA : FEV1/FVC < 70% 50%≤FEV1 < 80% predicted IIB: FEV1/FVC < 70%  30%≤FEV1 < 50% predicted 		 With or without symptom Classification of COPD by Severity  Stage III( Severe) FEV1/FVC < 70% FEV1 ≤30 % predicted 	or with respiratory failure or cardiac failure 一. Chronic bronchitis  ( 一) Definition Chronic nonspecific inflammation in mucosa and its peripheral tissues of trachia and bronchus （二）Etiology 1. Smoking Epidemical information Pathological examination Effects of giving up smoking Animal experiment  （二）Etiology 2. Airway infection Virus Bacteria Mychoplasma （二）Etiology 3. physical and chemical factors Air pollution Occupational contamination Indoor and outdoor fumes 4.Climate Cold weather Variation of atmospheric temperature （二）Etiology 5. Atopy 6.Immunological and defensive disturbance 7.Imbalance between sympathetic and  parasympathetic nerves systems 8.Deficiency of Vit C and A （三）Pathology Epithelial cells Mucosa and submucosa Goblet cells and mucous gland Smooth muscles Cartilage Fibrous tissues (四) Pathophysiological Changes 1. Early stage 	Abnormal small airway function 	CV  CC V50 V25  2.Obstructive ventilatory defect FVC