- 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.
- 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.
- Mortality from COPD has increased steadily over the past three decades; it currently is the third leading cause of death in the United States.
- 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.
- Smoking cessation, and avoidance of other known toxins causing COPD, are the only management strategies proven to slow the progression.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
Identify key pathophysiologic features of COPD.
Describe the natural history of COPD.
Assess objective and subjective information to define the severity of COPD.
Discuss the goals of COPD management.
Compare and contrast the role of various pharmacotherapies used for treatment of COPD.
Develop a rational management plan for the COPD patient.
Discuss the recommended education and advice to provide to the patient with COPD.
Identify signs and symptoms of an exacerbation of COPD.
Describe key components for the appropriate management of COPD exacerbations.
Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow limitation that is not fully reversible and is both chronic and progressive.1 COPD is preventable and treatable and causes significant extrapulmonary effects that contribute ...