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KEY POINTS

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  • Unlike asthma, the airflow limitation caused by chronic obstructive pulmonary disease (COPD) is not fully reversible.

  • The single most important intervention for prevention and treatment of COPD is smoking cessation. Medication therapy management providers should work with patients to incorporate a strategy for smoking cessation into the medication action plan.

  • Adherence to pharmacotherapy is key in reaching treatment goals, and guidelines for COPD emphasize the importance of routine assessment and discussion of the therapeutic regimen with patients. Through provision of medication therapy management, MTM providers can assist patients as well as other providers in improving treatment and achieving therapeutic goals.

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INTRODUCTION TO CHRONIC OBSTRUCTIVE PULMONARY DISEASE

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Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation that is usually progressive.1 This airflow limitation is most often caused by a mixture of small airway disease and parenchymal destruction (Figure 17-1).

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Figure 17-1.

Mechanisms for Developing Chronic Airflow Limitation in COPD1

Source: Global Initiative for Chronic Lung Disease: global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2013). Available at http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013_Feb20.pdf. Accessed July 17, 2014.

Bourdet SV, Williams DM. Chronic Obstructive Pulmonary Disease. In: DiPiro JT, Talbert RL, Yee GC, et al. eds. Pharmacotherapy: A Pathophysiologic Approach. 9th ed. New York, NY: McGraw-Hill; 2014: Chap 16. Available at http://accesspharmacy.mhmedical.com/book.aspx?bookID=689. Accessed April 29, 2014.

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The etiology of COPD is an enhanced chronic inflammatory response of the airways and lungs to noxious particles or gases. Exposure to tobacco smoke is the most common cause of chronic inflammation in COPD, accounting for 85% to 90% of cases. Other environmental risk factors include occupational dusts, chemicals, and air pollution (Table 17-1). A variety of host factors also contribute to the risk of developing COPD following exposure to these environmental risk factors.

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Table 17-1.Risk Factors for Development of Chronic Obstructive Pulmonary Disease
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Chronic obstructive pulmonary disease patients may experience symptoms that include cough, excess mucus production, chest tightness, breathlessness, difficulty sleeping, and fatigue. The term chronic obstructive pulmonary disease has often been used interchangeably with the terms chronic bronchitis and emphysema. However, the terms are not synonymous. Chronic bronchitis is defined as the presence of cough and ...

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