• Rainer Burkhardt and Wulf Pankow.
• Lower Saxony State Association of Statutory Health Insurance Physicians, Office Oldenburg, Vivantes Klinikum Berlin-Neukölln, Department of Internal Medicine, Pneumology, and Infectious Diseases.
• Dtsch Arztebl Int. 2014 Dec 5; 111 (49): 834846834-45, quiz 846.

BackgroundEstimates of the prevalence of chronic obstructive pulmonary disease (COPD) in Germany range from 1.9% to 13.2%, depending on the population studied and the investigative methods used. About 30% of all patients already have severe airway obstruction by the time the condition is diagnosed.MethodsReview of pertinent literature retrieved by a selective search, including current guidelines and textbooks.ResultsSmoking is the main risk factor for COPD. The diagnosis is based on characteristic symptoms that patients at risk should be actively asked about-cough, dyspnea, diminished physical reserve, and frequent airway infections-together with abnormal pulmonary function tests. Spirometry usually suffices to document impaired air flow. The clinical evaluation and the treatment strategy are based on the severity of airway obstruction and dyspnea, and the frequency of exacerbations. According to a European study, dyspnea is present in 73% of persons with severe COPD, expectoration in 64%, cough in 59%, and wheezing in 42%. Asthma, congestive heart failure, and interstitial lung disease are the main differential diagnoses.ConclusionCOPD may begin with symptoms that are only mild at first even in a longstanding smoker. The available diagnostic techniques need better prospective validation with respect to relevant endpoints, including mortality, symptom progression, quality of life, and frequency of exacerbations.

18 keywords...

hide…