International journal of chronic obstructive pulmonary disease
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Int J Chron Obstruct Pulmon Dis · Jan 2006
Review Comparative Study Historical ArticleThe history of COPD.
The evolution of knowledge concerning COPD and its components--emphysema, chronic bronchitis, and asthmatic bronchitis--covers 200 years. The stethoscope and spirometer became important early tools in diagnosis and assessment. Spirometry remains the most effective means of identification and assessment of the course of COPD and responses to therapy, and is grossly underused for this purpose. ⋯ Surgery benefits a select few. Today, COPD is a steadily growing global healthcare problem, with increasing morbidity and mortality. Early identification and prevention, and treatment of emerging stages of disease through smoking cessation and a growing number of bronchoactive drugs promises to change the outcome.
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Int J Chron Obstruct Pulmon Dis · Jan 2006
Comparative StudyIs there a role for mask continuous positive airway pressure in acute respiratory failure due to COPD? Lessons from a retrospective audit of 3 different cohorts.
Exacerbations of COPD that result in acute respiratory failure requiring intubation and mechanical ventilation have high morbidity and mortality. This study is a retrospective observational study that compared the outcomes of 237 patients with COPD and acute respiratory failure requiring intensive care unit (ICU) admission according to modality of initial therapy: mask continuous positive airway pressure (CPAP), medical therapy, or intubation. ⋯ When compared with mask CPAP, and after adjusting for potentially confounding differences, mortality was significantly higher if patients were initially intubated (adjusted odds ratios [OR] 15.7; 95% confidence interval [CI] 4.2, 59) or given medical therapy (OR 5.1; CI 1.2, 20.8). In COPD patients with acute respiratory failure, initial treatment with mask CPAP was associated with significantly better outcomes than other treatment modalities, even after adjusting for potentially confounding differences in disease severity.
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Int J Chron Obstruct Pulmon Dis · Jan 2006
Comparative StudyDiagnosis of airway obstruction in primary care in the UK: the CADRE (COPD and Asthma Diagnostic/management REassessment) programme 1997-2001.
Asthma and COPD require different management strategies, but differentiation in primary care is difficult. This primary care support initiative observed the impact of spirometry and clinical assessment on the diagnosis of airway disease. ⋯ In this study, a clinical review supplemented by additional information including spirometry highlights apparent mislabeling of significant numbers of patients with chronic obstructive disease in general practice with significant implications for individual treatment and healthcare provision. This study shows that the addition of more clinical information can have a major effect on diagnostic tendency in patients with airway disease. An initial diagnosis of COPD seems less likely to change following review than an asthma diagnosis. While it is likely that greater information leads to a more accurate diagnosis, the differential effect of new information on diagnostic labeling highlights the insecurity of the diagnostic process in primary care in the UK.
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Chronic obstructive pulmonary disease (COPD) is characterized by poorly reversible airflow limitation. The pathological hallmarks of COPD are inflammation of the peripheral airways and destruction of lung parenchyma or emphysema. The functional consequences of these abnormalities are expiratory airflow limitation and dynamic hyperinflation, which then increase the elastic load of the respiratory system and decrease the performance of the respiratory muscles. ⋯ Two of the best methods to measure flow limitation are to superimpose a flow-volume loop of a tidal breath within a maximum flow-volume curve, or to use negative expiratory pressure technique. Likely this method is more accurate and can be used during spontaneous breathing. A definitive definition of dynamic hyperinflation is lacking in the literature, but serial measurements of inspiratory capacity during exercise will document the trend of end-expiratory lung volume and allow establishing relationships with other measurements such as dyspnea, respiratory pattern, exercise tolerance, and gas exchange.