Seminars in respiratory and critical care medicine
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Chronic obstructive pulmonary disease (COPD) is characterized and defined by limitation of expiratory airflow. This can result from several types of anatomical lesions, including loss of lung elastic recoil and fibrosis and narrowing of small airways. Inflammation, edema, and secretions also contribute variably to airflow limitation. ⋯ COPD is not only a disease of the lungs but is also a systemic inflammatory disorder. Muscular weakness, increased risk for atherosclerotic vascular disease, depression, osteoporosis, and abnormalities in fluids and electrolyte balance may all be consequences of COPD. Advances in understanding the pathogenesis of COPD have the potential for identifying new therapeutic targets that could alter the natural history of this devastating disorder.
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Pulmonary rehabilitation has been well established and increasingly recommended in disease management plans for patients with chronic obstructive pulmonary disease. Key elements include a multidisciplinary approach to care, focus on the individual patient, and attention to emotional and social as well as physical aspects of health. Appropriate candidates are symptomatic patients with chronic lung disease who are aware of their disability and motivated to participate actively in their own health care. ⋯ Program components include a careful patient evaluation, education, instruction in respiratory and chest physiotherapy techniques, exercise training, and psychosocial support. Benefits demonstrated in a growing body of evidence include improvement in symptoms, exercise tolerance, and quality of life and reduction in utilization of health care resources. Pulmonary rehabilitation has also been included as an adjunct to surgical programs such as lung transplantation and lung volume reduction surgery.
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Semin Respir Crit Care Med · Apr 2005
Review Comparative StudyRole of bronchodilators in chronic obstructive pulmonary disease.
The prevalence of chronic obstructive pulmonary disease (COPD) continues to be on the rise. Bronchodilators are first line agents for the symptomatic management of this disease and have proven to be effective in both stable disease status and exacerbations. The stepwise escalation of therapy for COPD according to severity has been outlined in international guidelines. ⋯ In contrast, the usage of theophylline, which used to be part of the mainstay of treatment for COPD, has declined, mainly secondary to a narrow therapeutic margin and side effects, but it is inexpensive and still has its role. New agents like phosphodiesterase-4-inhibitors are interesting substances that may become important adjuncts in COPD management, but there is limited experience so far. None of the bronchodilators have been shown to change outcome in COPD, but this issue is under active investigation.
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Semin Respir Crit Care Med · Apr 2005
Review Comparative StudySurgical therapy for chronic obstructive pulmonary disease.
Many patients with severe chronic obstructive pulmonary disease (COPD) experience incapacitating breathlessness and exercise limitation. Multiple surgical techniques have been utilized to achieve resection of giant, localized bullae with documented short-term benefit in pulmonary function and dyspnea in highly selected patients. The poorest long-term outcome has been noted in those with greater degrees of emphysema in the remaining lung, greater underlying chronic bronchitis, and a bulla occupying less than one third of the hemithorax, particularly if compressed normal lung is not evident. ⋯ Long-term results of lung transplantation are limited by significant complications that impair survival; an approximately 80% 1-year, 50% 5-year, and 35% 10-year survival has been reported. Bronchiolitis obliterans is the most important long-term complication of lung transplantation resulting in decreased pulmonary function. In general, a COPD patient can be considered an appropriate candidate for transplantation when the FEV (1) is below 25% predicted and/or the paCO (2) is > or = 55 mm Hg.
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Semin Respir Crit Care Med · Apr 2005
Review Comparative StudyNew concepts in the radiological assessment of COPD.
Chronic obstructive pulmonary disease (COPD) is a complex genetic disorder in which environmental factors, such as tobacco smoke, interact with genetic susceptibility to cause disease. Airway obstruction in COPD is due to an exaggerated inflammatory response that ultimately destroys the lung parenchyma (emphysema) and increases airway resistance by remodeling the airway wall. ⋯ This review describes some of the new CT techniques for quantitative assessment of lung structure. These techniques are extremely important to study the pathogenesis of COPD as well as differentiate patients with predominantly emphysema disease from those with airway wall remodeling, and to assess the effects of therapeutic interventions.