Presse Med
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Acute exacerbation of chronic obstructive pulmonary disease (COPD) is defined by modification of the usual COPD symptoms, dyspnea, coughing and sputum, beyond daily variations, with a sudden onset, and requiring modification of the usual treatment. Exacerbations stud the course of COPD. Their frequency is variable, averaging 1-2 per year. ⋯ Noninvasive ventilation improves dyspnea and respiratory acidosis, diminishes respiratory frequency, intubation, duration of hospitalization, nosocomial infections, and mortality. Pulmonary follow-up is necessary after an exacerbation, especially to prevent the recurrence of exacerbations by measures that have been demonstrated to be effective, including help in smoking cessation, adaptation of COPD treatment, vaccination against influenza and pneumonia (pneumococci), and respiratory rehabilitation. Early diagnosis and rapid treatment of exacerbations can limit their impact, improve quality of life, and reduce the risk of hospitalization.
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The diagnosis of chronic obstructive pulmonary disease (COPD) relies on the presence of chronic airflow limitation poorly reversible or not reversible at all, defined by an FEV1/FVC ratio less than 70%. Stages of severity of COPD are defined according to the level of post-bronchodilator FEV1: > 80% of the predicted value (stage I); 50-80% (stage II); 30-50% (stage III); < 30% (stage IV). Accordingly, the measurement of pulmonary volumes (spirometry) is required for the diagnosis but also for the follow-up of COPD patients. ⋯ For appreciating the severity of COPD and for the follow-up of patients it is recommended to evaluate other variables than FEV1: results of the 6MWT, level of dyspnea, body mass index. The results of FEV1 and of these variables are included in the recently developed BODE index. Measurement of CO transfer capacity is recommended in the presence of emphysema; cardiopulmonary exercise testing (bicycle) is recommended before initiating exercise training.
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The main indication of LTO is COPD with chronic respiratory failure, where it improves life expectancy. By extension, LTO may be proposed to other etiologies of CRF with chronic documented hypoxemia. ⋯ Non invasive ventilation (NIV) represents facial or nasal ventilation. Consensus indications of NIV are restrictive pulmonary diseases (chest wall and /or parenchmal sequelae, neuromuscular diseases, or obesity hypoventilation syndrome) Real role of NIV in log-term management of COPD remains controversial.
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Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by permanent and progressive airway obstruction. Cigarette smoking is the main cause responsible for COPD although only 15 to 25 % of smokers develop COPD. ⋯ Alveolar wall destruction (emphysema) also contributes to airway obstruction and to gas exchange abnormalities. Current knowledge related to molecular and cellular mechanisms responsible for these structural modifications are reviewed.
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The chronic obstructive pulmonary disease (COPD) is responsible for important morbidity, mortality and health costs. Projection in 2020 suggests that COPD will be the 3rd cause of world mortality (6th in 1990). Although active smoking remains the main risk factor other exposure may also be involved in the development of COPD associated with genetic predisposition. ⋯ A present, COPD is approximately responsible for 15,000 deaths per year. The major challenge in the near future rests on prevention and early detection of the disease. Smoking cessation allows a deceleration of the decline of the FEV1 and an improvement of total survival.