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COPD (& Emphysema) Explained Clearly – Pathophysiology & Treatment

October 9, 2019

Welcome to another MedCram lecture. We’re going to talk about emphysema today,
otherwise known as C.O.P.D. It seems as all these diseases have abbreviations
in medicine. This one is “chronic obstructive pulmonary
disease.” What is C.O.P.D.? It’s a common preventable and treatable lung
disease and the typical symptoms that you’ll see in patients with emphysema C.O.P.D. is
shortness of breath, and you’ll also see cough, and if it’s wet you’ll have sputum as well. These are very nonspecific symptoms, but they’re
very typical of what you see in C.O.P.D. How important of a disease is this? Couple of statistics that you should know
is it’s the third most common cause of death in the US; pretty significant. There’s a number 2 and there’s a number 1
above it and that’s heart disease and cancer and sometimes these, depending on how you
survey, will flip spots. There’s also number 4 and number 5. The key here is that this is the only cause
of death in the United States out of these 5 that have actually gone up from about 2007
to 2010 all the others have gone down in frequency except for this one. This is a pretty significant disease that
we’ve got to be concerned about. In addition to all of this, it’s also the
second leading cause of disability. Okay, so the bottom line here is that this
is a very important disease to know about. In case of course, you’re wondering how much
of this costs the US healthcare system in the United States every year, the answer is
about 50 B with a billion; 50 billion with a B. That’s quite a lot of money
As I mentioned, C.O.P.D or emphysema is a disease that affects the lungs. Specifically, if you were to take a look your
lungs, you of course know that your lungs have 2 sides and that there’s a major airway
call the trachea and it branches off into the right and left main-stem bronchus. From there it just goes down to smaller and
smaller branches, without getting into too much anatomy. If we were to take these very small bronchioles
or respiratory bronchioles they would eventually end in a grape like cluster called a alveolus. This essentially increases the surface area. This is what a normal respiratory bronchioles
would look like. If you were to take all these alveoli in the
entire lung and spread it out it would be about the size of a tennis court. It’s pretty big. These bronchioles of course allow the air
that you breathe in to go down and cause gas exchange. Now C.O.P.D. affects 2 main areas. It affects this bronchus, the small bronchial
and it also affects the alveolus in a bad way. What happens, is because the elastic fibers
are destroyed, we’ll get into that later, is that that airway becomes very collapsible
and essentially it becomes very small, and that’s where the obstruction in C.O.P.D. comes
from. Furthermore, you’re also going to get destruction
of the alveoli and you lose a lot of surface area, so instead of having a nice tennis court
you end up with maybe a badminton court or even a table tennis court here that you’re
working with. The surface area becomes much smaller and
all these changes happen throughout the lung, but mostly in the upper regions of the lung. As a result of that it’s hard to get the air
out. There’s an obstruction, that’s the key point
there is that air cannot get out of the lungs. That’s why it’s called chronic obstructive
pulmonary disease. In addition to that because these alveoli
are all destroyed and become areas of large balloons if you will, the long actually increases
in size and as a result of that you get these patients with large lungs but they’re full
of air and they can’t get the air out and that’s basically C.O.P.D.. The way that we diagnose C.O.P.D. is based
on this obstruction. We set them down in front of a spirometer,
that’s basically a machine where you breathe into it and it measures how much you breathe
out. We asked them to basically breathe out after
taking a deep breath in, breathe out as much air as they possibly can and we measure it. This represents how much air they can blow
out given enough time to blow it out, so we give them 6 to 10 seconds to blow it out enough
time that they need to blow everything that they possibly can out in the lung. We call that, by the way, the forced vital
capacity. Otherwise known as the FVC. That’s how much air they can blow out completely. We said that C.O.P.D. is an obstructive lung
disease so what we’re really looking for is how fast can they get that air out, because
if there’s an obstruction that’s going to impede their ability to get that air out as
fast as they possibly can. The next thing that we do is that we have
them do the same maneuver, but we measure how much comes out in 1 second, so there’s
kind of a timed proportion to this. How much can you blown out given an infinite
amount of time? And how much can you blow out in just 1 second? There’s a little bit of a velocity factor
involved there. What we do is, we call that by the way, the
forced expiratory volume in 1 second. This is otherwise known as the FEV1. Then we do a very simple calculation, we measure
and we see. We take this number, the forced expiratory
volume and we divide it by the forced vital capacity number and we come up with a fraction. This is known as the FEV1 divided by the FVC
ratio. The definition that’s come up in the literature
is that .70, 0.70 is the cutoff. If the FEV1 divided by the FVC ratio is less
than .70 that means that you could get less than 70% of the air that you could normally
get out, given an infinite amount of time, out in the first second. That means you’ve got obstructive lung disease. If you can get more than .7 out that means
you don’t have obstructive lung disease. The question here is, can you get out at least
70% of the air that you could normally blowout in the first second, and if the answer is
yes then you don’t have obstructive lung disease. If the answer is no and it’s less than .7,
then you have obstructive lung disease. Of course, the lower this number is, the FEV1,
the worse your C.O.P.D. is going to be. Let’s review. C.O.P.D. is 1) common, it costs a lot; 2)
it’s the third leading cause of death and is the only 1 of the 5 that are actually increasing
in frequency; 3) causes difficulty with breathing out, that’s obstruction; 4) reduces the cross-sectional
surface area, causes drops in oxygen; 5) you diagnose it by spirometry, and then finally
6) the diagnosis is the FEV1 divided by the FVC is less than .7
Thank you for joining us.


  • Reply Johan P May 31, 2015 at 9:01 am

    Clear and concise, as usual. Thanks, keep these vids coming.

  • Reply Jazmine Farmer June 16, 2015 at 9:36 pm

    huge help , thanks you ! Love the videos I have 30-40 % lung function am a COPD stage 3 or the new term is COPD C whichever it is BAD.

  • Reply andy Huang June 24, 2015 at 3:31 pm

    thank you very much

  • Reply Snap July 15, 2015 at 5:18 am

    Nice. Thanks for sharing!

  • Reply Brian Weigelt July 20, 2015 at 5:42 am

    Really appreciate all the videos in these series.  Would you be able to do a set on types and diagnosis of anemias?  Thanks!

  • Reply chizmo7 July 30, 2015 at 9:38 pm

    Great. More please.

  • Reply sam ball August 8, 2015 at 12:44 pm

    I am 15 and I have copd because I was born 26 week

  • Reply Shelley May August 25, 2015 at 12:58 am

    hi i just came out of the hospital and my doctor gave me my test results back i got early signs of epysema and C.O.P.D and im only 38 my doctors was amazazed by that they never saw that in a young age but i have the signs of c.o.p.d it really opened my eyes amd i am a smoker just very differcalt to stop i am little afraid now that i have it my parents and family very scared i lost my two aunts who had epysema sorry for the wrong spelling of it but im taking inhalers for it for now and going to get more tests . and i have a qusetion for you, i was caughing up blood is that normal or is that a part or another spymtom to c.o.p.d?

  • Reply waleed alqahtani August 29, 2015 at 11:14 am

    thanks alot

  • Reply Mohsen Bayat September 13, 2015 at 5:10 pm

    really thanks clear and understandable

  • Reply Brittaney Khong November 9, 2015 at 9:45 am

    Great explanation!
    Thank you!

  • Reply Phoenix November 21, 2015 at 11:39 am

    Why do you show a spoon of sugar as an icon? What does it mean?

  • Reply DE51B0Y December 8, 2015 at 3:50 am

    Very informative

  • Reply Mohit Gangrade December 8, 2015 at 11:04 pm

    Hey, nice video but u shld give importance to the physiological part more!!!!!! Anyway it was great

  • Reply Mohammed Khabori January 4, 2016 at 10:25 pm

    really good explanation. Better than my lecturers 😛

  • Reply o-o TWISTED o-o January 11, 2016 at 2:42 pm

    I think this just cured me of smoking lol

  • Reply Paul VanGogh January 14, 2016 at 2:40 am

    I'd love to see what is the mechanism of bronchioles obstructive and destruction of alveolies

  • Reply C.A. Long February 4, 2016 at 7:27 am

    $50B… Good grief!

  • Reply rahaf Bishtawi February 20, 2016 at 1:39 am

    thaaaannnnnnnnxxxxxxxxxxxx alot ;;;;;))))

  • Reply Fill My Cup February 26, 2016 at 3:45 pm

    I'm a newly qualified nurse in the UK (7 months in) and I'm constantly coming home to read up on situations that I need to understand more. Thank you so much for your videos. Even my tired mind gets it! You're a very gifted teacher. Of course, it goes without saying that I'm a new SUBBIE!!

  • Reply Katie Burris March 8, 2016 at 7:53 am

    very good explanation!!! thanks for doing this video. I subscribed and look foward to many more.

  • Reply andy d raybeem April 3, 2016 at 11:24 pm 2013

  • Reply andy d raybeem April 3, 2016 at 11:47 pm

    The fibrolin or Filiggrin is relative to Ecxema in Emphysema and Asthma both. Then the connection to these three diseases and the liver damage due to Loss of Alpha1 Antitrypsin. So then once the Chromosomal Lab does an examination with a small bool test they determine that the alleles have become shorter due to the damage from "live" SV40 in various vaccines made from 1940 – 1972. The correct vector is still the SV40 for adenovirus repairitive methodology and the chromosomes for repair are Chromosome 19 and the other three chromosomes for respiratory methodology. Once yo determine the link between these three things Asthma, Emphysema, Eczema then you will be able to loo the wr that already been accomplished and their cure rate is 95%.

  • Reply Vincenzo Lopresti April 9, 2016 at 3:19 pm

    Use Tiffenau index, fev1: static vital capacity(not forced), it is corrected by age. Using 0,7 as threshold you overstate an obstruction in elderly people and understate in young people. Anyway good explanation

  • Reply Vincenzo Lopresti April 9, 2016 at 3:19 pm

    Use Tiffenau index, fev1: static vital capacity(not forced), it is corrected by age. Using 0,7 as threshold you overstate an obstruction in elderly people and understate in young people. Anyway good explanation

  • Reply Daniel Dixon April 16, 2016 at 11:19 pm

    good video

  • Reply bimmjim April 17, 2016 at 5:01 am

    What about people like FireFighters, who suffer a burn to their lungs? Is there a different name for that? Are there different symptoms and treatments?

  • Reply Plain E Grace May 6, 2016 at 1:03 pm

    But this is only talking about emphysema, which is only one of the C.O.P. diseases — what about chronic bronchitis, which is not caused by smoking?

  • Reply Alex Mihail May 14, 2016 at 1:50 am

    I think I have COPD. I feel like running out of air, I inhale hardly and not enough, I can barely yawn. But I don't cough any kind of mucus. When i'm laying in bed, the breathing seems to come to normal, but once I start having activity, it gets really annoying taking deep breaths every couple of minutes.

  • Reply jazz4asahel May 20, 2016 at 4:12 am

    Claro. Thanks.

  • Reply Suresh Seurattan July 23, 2016 at 9:44 pm

    can you please do a video of cytochrome p450 inhibitors and inducers

  • Reply sooutstanding31 August 18, 2016 at 10:54 am

    just found out about this channel. thank you so much for taking out the time to do these videos. i hit the subscribe button

  • Reply MedCram - Medical Lectures Explained CLEARLY August 25, 2016 at 11:36 am

    See the whole series at along with other top quality videos including reviews in pulmonary, cardiology, infectious disease, and hematology!

  • Reply Ty Taylor October 7, 2016 at 2:09 am

    I was diagnosed with congestive heart failure in January. I have also been diagnosed with lung issues. Are the two intertwined?

  • Reply DOCTOR TAJIN HASNAT RIAD MBBS DMC October 9, 2016 at 6:27 am

    plz do lec on dpld and pleural effusion and cor pulmonale

  • Reply Steven Willhoite October 29, 2016 at 12:33 am

    34 years old just got told today i have emphysema news hit me hard as i have a young child hard to wrap my head around it

  • Reply Syed Rizvi November 14, 2016 at 3:38 am

    50 billion WITH A B!!!!!

  • Reply Roman Starostyshyn December 26, 2016 at 11:20 am

    Just grateful for the great lecture!

  • Reply Erlinda Cosido January 6, 2017 at 4:44 pm

    thanks for the explanation

  • Reply Betty Sue Stevens January 25, 2017 at 7:51 pm

    what about the pain??

  • Reply Hamid Jnane March 1, 2017 at 7:18 am

    Great video .. keep posting new topics plz .. I am RN and used your video to reinforce my medical knowledge.

  • Reply Dick Piano March 17, 2017 at 2:39 am

    i just realized your ending credits song is the same as the intro for wreckless eating…i was expecting a "lets go princess" at the end hahaha

  • Reply Melissa Joseph April 26, 2017 at 8:40 pm

    Has COPD gone up in deaths due to smoking??

  • Reply Becky Tlau July 25, 2017 at 7:20 am

    I'm watching this coz I have copd 🙁

  • Reply Hashem October 14, 2017 at 7:41 pm

    Emphysema is not COPD, it is a subset of COPD diseases.

  • Reply Mohan K Cavale October 19, 2017 at 12:27 pm

    Superb… Crystal clear!

  • Reply Matthew Clements October 26, 2017 at 8:19 pm

    Do you guys have sources for this? I'm not doubting the information, I'm writing a presentation and want to check the source material to make sure I'm understanding everything properly.

  • Reply Eclectic_1 November 9, 2017 at 10:55 am

    Nurse Practitioners are taking over

  • Reply Roger H March 8, 2018 at 11:29 am

    we haven't truly understood this if we don't have a cure

  • Reply Levi Jasper March 19, 2018 at 7:07 am

    I am 59 now. I was diagnosed with COPD in March of 2013. I had been a heavy smoker, got a cold I couldn't get rid of, ended up in the hospital, on a ventilator. I should have known it was coming, but like most smokers, thought it would never happen to me. I don't smoke now and never will again, but, I still want to. My life has changed drastically. I had to stop working, sold my home (couldn't afford it without a salary),the COPD disease has kept down since diagnosed if not for the herbal formula of Total cure herbal foundation i would have been in hospital with the use oxygen managing my condition,total cure herbal foundation finally get rid of my disease with their natural herbal products in just 14 weeks of usage which i have been on other medication for ages but am really glad now that my lungs has return to it normal position.
    [email protected]

  • Reply Sathyapriya Rengasamy May 27, 2018 at 8:11 am

    Thanks a ton!;)

  • Reply Core Cubed2 June 7, 2018 at 10:46 pm

    Excellent information. Additional resources, including breathing exercises for those with COPD, can be found here:

  • Reply Suresh Choudhary June 9, 2018 at 11:58 am

    Please don't use black background screen. If you use white background then I will watch your all video

  • Reply Alka Rana July 10, 2018 at 8:01 pm

    Fantastic , nicely explained,far from boredom

  • Reply mymona mkeess July 23, 2018 at 3:10 pm

    Great ♡

  • Reply Avery Manson August 5, 2018 at 8:53 am

    I stopped smoking weed because I am convinced I have COPD.😩

  • Reply George Dowell August 8, 2018 at 1:41 am

    My name is George I have COPD in and lawn disease I wanted to know could anybody tell me do it breaks sores on your face and on your body some time cuz I have wash my face and 7 my skin came off my face

  • Reply たまちゃん August 11, 2018 at 12:49 pm


  • Reply George Georgiou August 29, 2018 at 1:27 am

    The comment about if your FEV1/FVC isnt < 0.70 then you don't have COPD is not necessarily true. I have a number of 0.90ish and I have COPD as confirmed by a CT scan. My FEV1 is 2.4ltrs and my FVC is 2.64ltrs.

  • Reply Lok Yee Chan September 16, 2018 at 1:31 am

    I like how you simplify those confusing concepts into simple diagrams… 😃😃 It really helps in terms of understanding and memorising 😀

  • Reply David September 17, 2018 at 10:28 am


  • Reply David September 17, 2018 at 10:30 am


  • Reply Charyl Liss October 18, 2018 at 4:43 am

    COPD due to Lupus is not a preventable disease.

  • Reply David November 4, 2018 at 10:15 am

    So sorry to hear about you mom, I feel your pain. I also lost 4 family members, mom, dad, brother and sister so I can relate to the pain you feel. I was not trying to say that COPD was only caused from smoking, however many people get it from smoking. I thought I may have had COPD but thank goodness I do not. I have silent reflex, but that's another story. I was trying to tell everyone who smokes to quit now not once its too late, you can't stop it once it starts. Live life as healthy as you can. It is hard to quit, but its harder to die. Please do whatever you have to to quit quit quit NOW… Please God help these people who need you now. Pay it forward to those who are not strong right now but will be once they quit. Good luck to all of you, ask God to help and believe he will.

  • Reply David November 4, 2018 at 10:26 am

    Smokin anything will cause one problem or another. Breathing in smoke from cigarettes, weed, diesel fuel, smoke from a camp fire, fumes from bleach, all of it will damage your body. Road pavers, railroad workers, firemen, truck drivers, all will suffer from what they inhale daily. Hey face it your health is the most valuable thing you will ever possess, and time is the second most valuable thing you will ever have. Live a long life.. do your body the very best, stay away from smoke……

  • Reply Alex Klatt November 18, 2018 at 7:38 am

    Over inflated lungs?

  • Reply daniel robertson November 22, 2018 at 12:45 am

    Where is the treatment?

  • Reply Cardboardbocs November 28, 2018 at 9:15 pm

    We were taught COPD is a combination of Emphysema and Chronic Bronchitis, has the definition changed from 2014 to now?

  • Reply chapmanmerchant January 4, 2019 at 4:28 pm

    So it’s a good thing that you’re not really paying for it then if it’s going to be 50 million hey.

  • Reply Lookingthruwolfeyes Windenmyhair January 13, 2019 at 11:52 am

    so why cant people get lung transplants,

  • Reply Susana Natareno February 12, 2019 at 7:47 am

    A good healthy diet( make sacrifices for your health), exercise, use eucalyptus, drink water and use a good quality air filter, to clean your house from dust, dust mites, fungus, mold, bacteria… ask me @ [email protected]

  • Reply Dhiraj Shukla February 21, 2019 at 11:45 pm

    Really good explanation .

  • Reply Doctor Robot February 23, 2019 at 7:33 pm

    COPD is a term includes emphysema and chronic bronchitis and one of them is predominant

  • Reply ben hobbs March 12, 2019 at 10:52 pm

    Hi medcram, emphysema is but one component of COPD, and is not an interchangeable term.

  • Reply M Detlef April 4, 2019 at 1:27 am

    There’s a VERY simple fix: Go back and UN-smoke 350,000 cigarettes. Works GREAT!!!!!!

  • Reply F Zulu April 14, 2019 at 4:53 am

    Well articulated and simplified ..Thanks

  • Reply CuriousCat April 19, 2019 at 9:24 pm

    thank you!

  • Reply salah hamad May 9, 2019 at 4:33 pm

    hello mister,my name is salah ,i'm copd so would you like to answers me if after a fund treatment which has improve your spirometry to normal level and your share tiffeneau will be 95% THE POURCENTAGE of obstruction of copd,after that resulth what is your futur therapy in purpose to kept this good state,my medecine actuel is symbicort 400 ug/2 per day and spiriva 1/ per day

  • Reply Aimee Saunders May 25, 2019 at 1:28 am

    In title says treatment is included in this video?

  • Reply ace crusader May 27, 2019 at 3:26 am

    so its gd nite viena if you have it

  • Reply REAL TRUTH June 29, 2019 at 3:11 am

    At 16 years old I was in Surgical labs at Harvard & Tufts from 1970- 73 , very advanced for my age , But eventually (9 years ) later I was Testing computers on special Projects for The moon , but Medical at H.P. (ultra sound ) SEAMENS ( Heart monitors) , ALLERGAN EYE Surgery and HOLOGIC ( BONE DENSITY , X-RAY , ULTRASOUND ) was more for Me , In fact I worked in 5 DEPARTMENTS , Running Cust, Ser on FLUOROSCAN , Help every third Month and Do a BONE DENSITY "A" System a DAY when No One did ONE a WEEK , Plus The ULTRA SOUND BOOT you may have Seen in a Will SMITH Movie , All This was Easy , so Much that New Management was UNHAPPY , But Then again I AM GOOD WILL HUNTING !!! They Just should Have Made the MOVIE with my NAME !!!

  • Reply Mouril Shah July 1, 2019 at 10:29 am

    Pathophysiology where are you

  • Reply Doogi Dunrite July 4, 2019 at 7:35 am

    Great video!!. The first time I took the test my Dr said I was at -60% lung capacity. 2 years of being on different inhalers I feel no better. I quit smoking and took the test 2 weeks later. She said I was at 81%. So does this mean I still have copd?? My Dr isn't very helpful when it comes to telling me what I need to do to fix what iv done to myself over the past 30years. She did however tell me. " U quit smoking and I'll have u breathing like a teenager again". Is that BS or can it be done??

  • Reply Toby Dog July 14, 2019 at 9:40 am

    There's something I just don't understand. Its been proven that stem cell therapy dramatically helps people with copd. Along with a good diet and exercise people could stay out of the hospital and cut down on medications. If this is the case then why won't the FDA help to pass the procedure for stem cells therapy. I just don't get it. This has been going for years and years. It's time to do something.

  • Reply Janette Davis July 16, 2019 at 5:43 am

    If you have C.O.P.D there is help Have you heard of Salt Rooms they are rooms with salt like beach sand beautiful relaxing too Some places call them salt baths but no they are chairs and salt all around.
    you will get a cough first few tries maybe four tries then you will notice you can walk further without stopping.
    They are very reasonable in price about 16$ for 45 minutes. Try one book in for 6 sessions. I know it helps me.

  • Reply Michael Symonds July 18, 2019 at 6:57 pm

    I know it's an incurable disease at the moment will that always be the case it looks medically impossible to cure no matter how far medicine evolves

  • Reply Gerald Corteza July 20, 2019 at 2:48 pm

    Very good resource, I'd say. Thanks!

  • Reply Martyr Messiah July 27, 2019 at 2:35 am

    It costs the health care system 50, 000, 000, 000, 000 dollars? I don't think so! the lying establishment likes to throw that "billion" word around a lot, like it is a normal currency. There's not even that much money in the world. You're a parrot programmer; you repeat the propaganda (bullshit) that you were programmed to repeat.

  • Reply Ryan Trainor August 1, 2019 at 7:41 am

    need to rename "patho and diagnosis" not "treatment"

  • Reply somoka elijah August 3, 2019 at 1:06 am

    Much appreciation your videos teach us a lot

  • Reply William Power August 7, 2019 at 1:04 am

    nbice diagrams dude im English and the doctors havent said anything. i thought it was nothing to worry about

  • Reply makeitsupersized August 7, 2019 at 5:56 pm

    Lincare is an evil company don't use them!

  • Reply Leigh Ann Allen August 12, 2019 at 9:01 pm

    Very helpful explanation. Thank you!

  • Reply UMBUBA August 18, 2019 at 7:28 pm

    Thank you for these awesome videos Doctor!

  • Reply Billy Maddox August 20, 2019 at 1:26 pm

    I have COPD but it took the doctors quite awhile to find it because the blockage was not in my lungs had to go to a specialist no cough lungs clear the blockage was in my legs so have the doc check your blood pressure in your legs

  • Reply 羅積康 September 8, 2019 at 10:39 am

    COPD can be effectively treated and reversed by God's mercy, nano-medication. Please

    If those toxic heavy metal as well as organic wastes from smoking can be cleared away from
    lung, how to effectively treat COPD? If endogenous adult stem cells can't be turned on
    for regeneration, COPD can't be reversed.

    All glory belongs to God !

  • Reply Kenneth Akin September 13, 2019 at 2:42 am

    50 billion dollars more the corporations are making off of curable diseases, yes there is a cure and it’s from common everyday items or foods and vitamins you don’t get enough of.

  • Reply Grenz45 September 16, 2019 at 3:59 pm

    Excellent videos. And you put them in terms I can understand. Regardless of the subject you approach.

  • Reply Washington McFarland September 29, 2019 at 6:43 pm

    what if brought on by Be4 sensitization/ HLA -DPB 1 & your diagnosed copd vs. CBD DPB13:01p

  • Reply R A October 5, 2019 at 7:51 pm

    I’ve heard that healthy people should walk a minimum of 3 miles per day. People who have COPD should try for a minimum of 2 miles a day and do more if they can. I live in a climate that can I have very harsh winters. I’m not supposed to be outside if the temperature is below 40°F. That’s a lot of days I cannot be outside. I do not have a treadmill. I have an exercise bike. How long/far should I ride that bike to get the benefit of walking 3 miles?

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