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  • Image not available.Chronic obstructive pulmonary disease (COPD) is a treatable and preventable disease characterized by progressive airflow limitation that is not fully reversible and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases.
  • Image not available. COPD is historically described as either chronic bronchitis or emphysema. Chronic bronchitis is defined in clinical terms, whereas emphysema is defined in terms of anatomic pathology. Because most patients exhibit some features of each disease, the appropriate emphasis of COPD pathophysiology is on small airway disease and parenchymal damage that contributes to chronic airflow limitation.
  • Image not available. Mortality from COPD has increased steadily over the past three decades; it currently is the fourth leading cause of death in the United States.
  • Image not available. The primary cause of COPD is cigarette smoking, implicated in 85% of diagnosed cases. Other risks include a genetic predisposition, environmental exposures (including occupational dusts and chemicals), and air pollution.
  • Image not available. Smoking cessation is the only management strategy proven to slow progression of COPD.
  • Image not available. Oxygen therapy has been shown to reduce mortality in selected patients with COPD. Oxygen therapy is indicated for patients with a resting Pao2 of less than 55 mm Hg or a Pao2 of less than 60 mm Hg and evidence of right-sided heart failure, polycythemia, or impaired neurologic function.
  • Image not available. Bronchodilators represent the mainstay of drug therapy for COPD. Pharmacotherapy is used to relieve patient symptoms and improve quality of life. Guidelines recommend short-acting bronchodilators as initial therapy for patients with mild or intermittent symptoms.
  • Image not available. For the patient who experiences chronic symptoms, long-acting bronchodilators are appropriate. Either a β2-agonist or an anticholinergic offers significant benefits. Combining long-acting bronchodilators is recommended if necessary, despite limited data.
  • Image not available. The role of inhaled corticosteroid therapy in COPD is controversial. International guidelines suggest that patients with severe COPD and frequent exacerbations may benefit from inhaled corticosteroids.
  • Image not available. Acute exacerbations of COPD have a significant impact on disease progression and mortality. Treatment of acute exacerbations includes intensification of bronchodilator therapy and a short course of systemic corticosteroids.
  • Image not available. Antimicrobial therapy should be used during acute exacerbations of COPD if the patient exhibits at least two of the following: increased dyspnea, increased sputum volume, and increased sputum purulence.

Upon completion of the chapter, the reader will be able to:

  • 1. Relate pathophysiological feature of COPD to clinical features exhibited by patients.
  • 2. Identify findings in the assessment of a COPD patient to clinical diagnosis or staging.
  • 3. Describe the role of pharmacotherapy in the management of a COPD patient.
  • 4. Review the major management strategies for patients with COPD.
  • 5. Discuss the role of behavioral change and pharmacotherapy in successful tobacco cessation.
  • 6. Identify appropriate immunizations for patients with COPD.
  • 7. Discuss the stepwise approach for pharmacotherapy of COPD.
  • 8. Identify appropriate outcome measures in monitoring the patient with COPD.
  • 9. Describe the benefits of long-acting bronchodilators in COPD management.
  • 10. Discuss the role of inhaled corticosteroids in chronic management of COPD.
  • 11. Review major ...

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