Scribd Logo
Upload

Welcome to Scribd!

  • 13 views

    First Page PDF

    Uploaded by

    Ebenezer Ude
    This document discusses chronic obstructive pulmonary disease (COPD), defining it as a preventable and treatable chronic lung condition characterized by airflow limitation that is not fully reversible. It notes COPD is increasingly a major global problem that places burdens on patients and healthcare resources. The document outlines some of the challenges in defining and diagnosing COPD, as it is a heterogeneous collection of syndromes with overlapping manifestations. It provides definitions for chronic bronchitis and emphysema, both of which can contribute to COPD, and discusses how the relative contributions of different abnormalities like airways disease and emphysema are difficult to determine in individual patients.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    First Page PDF

    Uploaded by

    Ebenezer Ude
    13 views1 page
    This document discusses chronic obstructive pulmonary disease (COPD), defining it as a preventable and treatable chronic lung condition characterized by airflow limitation that is not fully reversible. It notes COPD is increasingly a major global problem that places burdens on patients and healthcare resources. The document outlines some of the challenges in defining and diagnosing COPD, as it is a heterogeneous collection of syndromes with overlapping manifestations. It provides definitions for chronic bronchitis and emphysema, both of which can contribute to COPD, and discusses how the relative contributions of different abnormalities like airways disease and emphysema are difficult to determine in individual patients.

    Original Title

    first-page-pdf

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses chronic obstructive pulmonary disease (COPD), defining it as a preventable and treatable chronic lung condition characterized by airflow limitation that is not fully reversible. It notes COPD is increasingly a major global problem that places burdens on patients and healthcare resources. The document outlines some of the challenges in defining and diagnosing COPD, as it is a heterogeneous collection of syndromes with overlapping manifestations. It provides definitions for chronic bronchitis and emphysema, both of which can contribute to COPD, and discusses how the relative contributions of different abnormalities like airways disease and emphysema are difficult to determine in individual patients.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    13 views1 page

    First Page PDF

    Uploaded by

    Ebenezer Ude
    This document discusses chronic obstructive pulmonary disease (COPD), defining it as a preventable and treatable chronic lung condition characterized by airflow limitation that is not fully reversible. It notes COPD is increasingly a major global problem that places burdens on patients and healthcare resources. The document outlines some of the challenges in defining and diagnosing COPD, as it is a heterogeneous collection of syndromes with overlapping manifestations. It provides definitions for chronic bronchitis and emphysema, both of which can contribute to COPD, and discusses how the relative contributions of different abnormalities like airways disease and emphysema are difficult to determine in individual patients.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    7

    Section
    AIRWAY DISEASES

    Chapter 41
    Chronic Obstructive Pulmonary Disease:
    Epidemiology, Pathophysiology, and
    Clinical Evaluation
    William MacNee

    Chronic obstructive pulmonary disease (COPD) is a prevent- their airflow limitation. Indeed, some patients with asthma may
    able and treatable chronic lung condition characterized by develop COPD, or these two common conditions may coexist
    airflow limitation that is not fully reversible. COPD is increas- in the same individual. Therefore the problem often is not
    ingly recognized as a major global problem that places a burden whether the patient has asthma or COPD, but rather whether
    on both patients who suffer from this disabling condition and either asthma or COPD is present.
    health care resources. Despite significant advances in our Chronic bronchitis is defined clinically by the American Tho-
    understanding of the pathogenesis, physiology, clinical features, racic Society (ATS) and the United Kingdom (UK) Medical
    and management of COPD in recent years, much remains to Research Council as “the production of sputum on most days
    be discovered about this condition. for at least three months in at least two consecutive years when
    Although hidden by the generic term “chronic obstructive a patient with another cause of chronic cough has been
    pulmonary disease,” COPD is a heterogeneous collection of excluded.” This definition does not require the presence of
    syndromes with overlapping manifestations, which has led to airflow limitation. Chronic bronchitis results from inflamma-
    major difficulties in obtaining an acceptable definition of the tion in the larger airways, with bronchial gland hypertrophy
    condition. In addition, as with many chronic inflammatory and mucus cell hyperplasia.
    conditions, COPD is associated with extrapulmonary effects Emphysema is defined pathologically as “abnormal, perma-
    and comorbidities that affect both morbidity and mortality. nent enlargement of the distal air spaces, distal to the terminal
    The acceptance that symptoms of breathlessness, cough, and bronchioles, accompanied by destruction of their walls and
    sputum production are part of aging or an inevitable conse- without obvious fibrosis.” As with chronic bronchitis the defini-
    quence of cigarette smoking, and not related to a disease, results tion of emphysema does not require the presence of airflow
    in underdiagnosis despite the diagnosis of COPD being easily limitation. As emphysema progresses, the consequent loss
    made. This underdiagnosis is exacerbated by the belief, rein- of lung elastic recoil contributes to the airflow limitation
    forced by many definitions, that COPD is an “irreversible” in COPD.
    condition and that there is nothing “to reverse” with treat- Bronchiolitis or small airways disease also occurs in COPD,
    ment. This leads not only to underdiagnosis but also to where chronic inflammation in the smaller bronchi and bron-
    undermanagement. chioles less than 2 mm in diameter leads to airway remodeling,
    It is now well recognized that significant responses to treat- resulting in airflow limitation. Although relatively little is
    ment do occur, which has led to a much more positive approach known of the natural history, bronchiolitis may contribute
    to the diagnosis and treatment of COPD. Whereas previous increasingly, as it progresses, to the airflow limitation in COPD.
    treatments largely focused on patients at the severe end of the The relative contributions made by large or small airways
    disease spectrum, recent guidelines recognize that diagnosis abnormalities or emphysema to the airflow limitation, in indi-
    and treatment at an earlier stage can offer significant benefits vidual patients with COPD, is difficult to determine. Thus the
    for patients. Although unable to cure COPD, current treat- term “chronic obstructive pulmonary disease” was introduced
    ments can reduce symptoms, improve function, and reduce in the 1960s to describe patients with incompletely reversible
    exacerbations in patients as well as decrease the enormous airflow limitation caused by a combination of airways disease
    health care costs associated with COPD. and emphysema, without defining the contribution of these
    conditions to the airflow limitation.
    In the statement on the standards for diagnosis and care of
    DEFINITIONS AND DIAGNOSTIC CONSIDERATIONS
    patients with COPD by ATS and European Respiratory Society
    In defining COPD, several problems must be considered. First, (ERS), COPD is defined as “a preventable and treatable disease
    COPD is not just one disease but a group of diseases. Second, state characterized by airflow limitation that is not fully revers-
    it is difficult to differentiate COPD from asthma; the persistent ible. The airflow limitation is usually progressive and is associ-
    airways obstruction in older patients with chronic asthma is ated with an abnormal inflammatory response in the lungs to
    often difficult or even impossible to distinguish from that of noxious particles or gases, primarily caused by cigarette smoking.
    COPD patients, who may demonstrate partial reversibility of Although COPD affects the lungs, it also produces significant

    531

    You might also like