Unlike asthma, the airflow limitation caused by chronic obstructive pulmonary disease is not fully reversible.
The single most important intervention for prevention and treatment of chronic obstructive pulmonary disease is smoking cessation. Medication therapy management (MTM) 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 chronic obstructive pulmonary disease emphasize the importance of routine assessment and discussion of the therapeutic regimen with patients. Through provision of MTM, MTM providers can assist patients and other providers in improving treatment and achieving therapeutic goals.
INTRODUCTION TO CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation that is usually progressive.1 The airflow limitation is most often caused by a mixture of small airway disease and parenchymal destruction (Figure 17-1).
Mechanisms for developing chronic airflow limitation in COPD.1
The underlying etiology of COPD is due to an enhanced chronic inflammatory response of the airways and lungs to noxious particles or gases. The most common exposure leading to chronic inflammation in COPD is tobacco smoke, accounting for 85% to 90% of cases of COPD. Other environmental risk factors include occupational dusts, chemicals, and air pollution (Table 17-1). A variety of host factors also influence the risk of developing COPD following exposure to these environmental risk factors.
TABLE 17-1Risk Factors for Development of Chronic Obstructive Pulmonary Disease (COPD) |Favorite Table|Download (.pdf) TABLE 17-1 Risk Factors for Development of Chronic Obstructive Pulmonary Disease (COPD)
|Exposures ||Host Factors |
|Environmental tobacco smoke ||Genetic predisposition (Alpha-1-antitrypsin deficiency) |
|Occupational dusts and chemicals ||Airway hyperresponsiveness |
|Air pollution ||Impaired lung growth |
Patients with COPD may experience symptoms that include cough, excess mucus production, chest tightness, breathlessness, difficulty sleeping, and fatigue. The term COPD is often 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 sputum production for at least 3 months in each of 2 consecutive years, whereas emphysema is an increase in the size of the air spaces caused by irreversible expansion of the alveoli and/or destruction of alveolar walls. It is important to note that most COPD patients have some combination of both emphysema and chronic bronchitis. Clinical diagnosis of COPD requires persistent airflow limitation that is not fully reversible, as defined by a forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio of less than 0.70 post bronchodilator. Beyond this, COPD is further classified by risk of exacerbations and level of symptoms.