Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a major cause of death and disability worldwide. Recognition that the burden of this disorder will continue to increase over the next 20 years despite medical intervention has stimulated new research into the underlying mechanisms, leading to a rational basis for evaluation of existing therapies, and has suggested novel treatment approaches. Tobacco exposure remains the main but not exclusive cause of COPD. Whether the lung is injured by changes in the balance of proteases and antiproteases, tissue damage by oxidative stress, or a combination of the two is still not known. The genetic basis of susceptibility to COPD is now being studied as is the role of computed tomography in the identification of structural damage in individuals with less symptomatic disease. Clinical diagnosis still relies heavily on an appropriate history confirmed by abnormal spirometry. Smoking cessation is possible in a substantial proportion of individuals with symptoms but is most effective if withdrawal is supported by pharmacological treatment. Treatment with long-acting inhaled bronchodilators and, in more severe disease, inhaled corticosteroids reduces symptoms and exacerbation frequency and improves health status. Rehabilitation can be even more effective, at least for a year after the treatment. Recent guidelines have made practical suggestions about how to optimise these treatments and when to consider addition of oxygen, surgery, and non-invasive ventilation. Regular review of this guidance is important if future management advances are to be implemented effectively.

[1]  N. Douglas,et al.  TRANSIENT HYPOXÆMIA DURING SLEEP IN CHRONIC BRONCHITIS AND EMPHYSEMA , 1979, The Lancet.

[2]  J Dosman,et al.  The relations between structural changes in small airways and pulmonary-function tests. , 1978, The New England journal of medicine.

[3]  P. Poole,et al.  Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary disease: systematic review , 2001, BMJ : British Medical Journal.

[4]  M. Cosio,et al.  Loss of alveolar attachments in smokers. A morphometric correlate of lung function impairment. , 1985, The American review of respiratory disease.

[5]  A. Grassino,et al.  Control of breathing in patients with chronic obstructive lung disease. , 1978, Clinical science and molecular medicine.

[6]  M. Tobin,et al.  A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation , 1991 .

[7]  Life quality of patients with chronic obstructive pulmonary disease. , 1982, Archives of internal medicine.

[8]  W. Knaus,et al.  Hospital and 1-Year Survival of Patients Admitted to Intensive Care Units With Acute Exacerbation of Chronic Obstructive Pulmonary Disease , 1995 .

[9]  K. Finucane,et al.  Pulmonary conductance and elastic recoil relationships in asthma and emphysema. , 1973, Journal of applied physiology.

[10]  P E Pepe,et al.  Occult positive end-expiratory pressure in mechanically ventilated patients with airflow obstruction: the auto-PEEP effect. , 1982, The American review of respiratory disease.

[11]  M. Tobin,et al.  Dose-response to bronchodilator delivered by metered-dose inhaler in ventilator-supported patients. , 1996, American journal of respiratory and critical care medicine.

[12]  M. Becklake,et al.  Relationship between chronic dyspnea and expiratory flow limitation in patients with chronic obstructive pulmonary disease. , 1996, American journal of respiratory and critical care medicine.

[13]  D. Górecka,et al.  Effect of long-term oxygen therapy on survival in patients with chronic obstructive pulmonary disease with moderate hypoxaemia. , 1997, Thorax.

[14]  J C Yernault,et al.  Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. , 1995, The European respiratory journal.

[15]  R. P. O'Neill,et al.  The progress of chronic airway obstruction in relation to measurements of airway resistance and lung elastic recoil. , 1970, The American review of respiratory disease.

[16]  Ciro Casanova,et al.  The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. , 2004, The New England journal of medicine.

[17]  A. Corrado,et al.  Breathing pattern and carbon dioxide retention in severe chronic obstructive pulmonary disease. , 1996, Thorax.

[18]  M. Decramer,et al.  Peripheral muscle weakness contributes to exercise limitation in COPD. , 1996, American journal of respiratory and critical care medicine.

[19]  J. Wedzicha,et al.  Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis , 2003, BMJ : British Medical Journal.

[20]  L. Fabbri,et al.  Effect of smoking cessation on airway inflammation in chronic bronchitis. , 1995, American journal of respiratory and critical care medicine.

[21]  iorgio,et al.  NONINVASIVE VENTILATION FOR ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE , 2000 .

[22]  W. McNicholas,et al.  Compliance at night with low flow oxygen therapy: a comparison of nasal cannulae and Venturi face masks. , 1995, Thorax.

[23]  P. Corris,et al.  Variability of inspired oxygen concentration with nasal cannulas. , 1992, Thorax.

[24]  S. C. Yang,et al.  Nebulized ipratropium bromide in ventilator-assisted patients with chronic bronchitis. , 1994, Chest.

[25]  R. Chapela,et al.  Exposure to biomass smoke and chronic airway disease in Mexican women. A case-control study. , 1996, American journal of respiratory and critical care medicine.

[26]  P. Calverley,et al.  Effect of carbon dioxide on diaphragmatic function in human beings. , 1984, The New England journal of medicine.

[27]  D. Geddes.  Chronic airflow obstruction. , 1984, Postgraduate medical journal.

[28]  P. Barnes,et al.  Differences in interleukin-8 and tumor necrosis factor-alpha in induced sputum from patients with chronic obstructive pulmonary disease or asthma. , 1996, American journal of respiratory and critical care medicine.

[29]  W. Bailey,et al.  Effects of Smoking Intervention and the Use of an Inhaled Anticholinergic Bronchodilator on the Rate of Decline of FEV1 , 1994 .

[30]  M. Newhouse,et al.  Efficiency of bronchodilator aerosol delivery to the lungs from the metered dose inhaler in mechanically ventilated patients. A study comparing four different actuator devices. , 1994, Chest.

[31]  M. Pearson,et al.  Effect of sustained inspiratory loading on respiratory sensation and CO2 responsiveness in normal humans. , 1996, Clinical science.

[32]  D. Brooks,et al.  Nutritional supplementation for stable chronic obstructive pulmonary disease. , 2002, The Cochrane database of systematic reviews.

[33]  F. Speizer,et al.  The relevance in adults of air-flow obstruction, but not of mucus hypersecretion, to mortality from chronic lung disease. Results from 20 years of prospective observation. , 1983, The American review of respiratory disease.

[34]  C. Poon,et al.  Optimization character of inspiratory neural drive. , 1992, Journal of applied physiology.

[35]  A. Esteban,et al.  A COMPARISON OF FOUR METHODS OF WEANING PATIENTS FROM MECHANICAL VENTILATION , 1995 .

[36]  M. Pandey.  Prevalence of chronic bronchitis in a rural community of the Hill Region of Nepal. , 1984, Thorax.

[37]  H. Gautier,et al.  Hypoxemia, hypercapnia, and breathing pattern in patients with chronic obstructive pulmonary disease. , 2015, The American review of respiratory disease.

[38]  J. Crowley,et al.  Controlled trial of oral prednisone in outpatients with acute COPD exacerbation. , 1996, American journal of respiratory and critical care medicine.

[39]  M. Pandey,et al.  Domestic smoke pollution and respiratory function in rural Nepal. , 1985, The Tokai journal of experimental and clinical medicine.

[40]  E. Wouters,et al.  Determinants of health-related quality of life in patients with chronic obstructive pulmonary disease. , 1996, Thorax.

[41]  L Goldman,et al.  Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) , 1996, American journal of respiratory and critical care medicine.

[42]  W. Gibbons,et al.  Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. , 1989, Chest.

[43]  J. Roca,et al.  Pulmonary Gas Exchange , 1995 .

[44]  C. Roberts,et al.  Comparison of the efficacy of a demand oxygen delivery system with continuous low flow oxygen in subjects with stable COPD and severe oxygen desaturation on walking. , 1996, Thorax.

[45]  Y. Okada,et al.  Collagenase expression in the lungs of transgenic mice causes pulmonary emphysema , 1992, Cell.

[46]  J. Barberà,et al.  Worsening of pulmonary gas exchange with nitric oxide inhalation in chronic obstructive pulmonary disease , 1996, The Lancet.

[47]  J. Ruiz,et al.  Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush. , 1995, American journal of respiratory and critical care medicine.

[48]  D. Flenley,et al.  Acute hypercapnic respiratory failure in patients with chronic obstructive lung disease: risk factors and use of guidelines for management. , 1992, Thorax.

[49]  P. Jones,et al.  A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. , 1992, The American review of respiratory disease.

[50]  D. Postma,et al.  Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home. , 1994, The European respiratory journal.

[51]  A. Peacock,et al.  Comparison of the acute effects on gas exchange of nasal ventilation and doxapram in exacerbations of chronic obstructive pulmonary disease. , 1996, Thorax.

[52]  M. Decramer,et al.  Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial , 2005, The Lancet.

[53]  N. Pride,et al.  Recent trends in physician diagnosed COPD in women and men in the UK , 2000, Thorax.

[54]  G. Gibson,et al.  Pulmonary hyperinflation a clinical overview. , 1996, The European respiratory journal.

[55]  L. A. Engel,et al.  Chest wall mechanics during exercise in patients with severe chronic air-flow obstruction. , 1984, The American review of respiratory disease.

[56]  L. Brochard,et al.  Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. , 1994, American journal of respiratory and critical care medicine.

[57]  L. Fabbri,et al.  Airway eosinophilia and expression of interleukin‐5 protein in asthma and in exacerbations of chronic bronchitis , 1996, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[58]  T. De,et al.  Parenteral nutrition before gastrointestinal surgery. , 1982 .

[59]  R. Peto,et al.  The natural history of chronic airflow obstruction. , 1977, British medical journal.

[60]  G. Guyatt,et al.  Randomised controlled trial of respiratory rehabilitation , 1994, The Lancet.

[61]  P. Moayyedi,et al.  Comparison of nebulised salbutamol and ipratropium bromide with salbutamol alone in the treatment of chronic obstructive pulmonary disease. , 1995, Thorax.