Presse Med
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A spirometry with bronchodilator test is needed for the diagnosis of COPD. It is recommended to detect COPD only in subjects with symptoms (dyspnoea and/or chronic cough and/or chronic sputum production) and a history of exposure to risk factors for the disease (tobacco smoking and/or occupational exposure). ⋯ Specialist referral is often useful in the diagnosis of COPD, to establish the presence of incompletely reversible airflow obstruction, assess severity (using clinical questionnaires, plethysmography, exercise testing and arterial blood gases when indicated) and define future management. The level of FEV1 is associated with individualized assessment of symptoms and evaluation of exacerbation risk in the management strategy of stable COPD.
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COPD is a pulmonary disease with a systemic impact. The goals of COPD assessment are to determine the severity of the disease to guide management. Smoking cessation is a prime objective at all the stages of the disease to modify the long-term decline in lung function, reduce the COPD symptoms, and the frequency of exacerbations, improve health status and reduce mortality. ⋯ Pulmonary rehabilitation is a multidisciplinary and tailored management of the COPD patients which enable to optimize exercise capacity, social reintegration, autonomy, reduce health care costs by decreasing the exacerbation rate, urgent visits and duration of hospitalisation. The rehabilitation is not just focusing on the improvement of exercise capacity, but also seeks sustained behavioural changes that are needed to achieve real improvement in health status and quality of life. Pulmonary rehabilitation is also an excellent opportunity for education which is critical in the healthcare pathway.
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COPD is characterized by incompletely reversible airflow limitation (FEV1/FVC < 70%). The historical classification of COPD, which was based on the severity of airflow limitation assessed by the level of FEV1, did not take into account the various aspects of COPD patients. ⋯ Recent identification of clinical COPD phenotypes (i.e., subgroups of COPD patients sharing not only clinical characteristics, but also natural history and/response to therapy) could result in progresses in the pathophysiology of the disease, in the development of specific biomarkers, and could facilitate evaluation of drugs in clinical trials. The development of simple algorithms, using easily available clinical data, will allow identification of phenotypes in clinical practice and may lead to individualized therapies.
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The Société de pneumologie de langue française defines acute exacerbation of chronic obstructive pulmonary disease (AE COPD) as an increase in daily respiratory symptoms, basically duration ≥ 48h or need for treatment adjustment. Etiology of EA COPD are mainly infectious, viral (rhinovirus, influenzae or parainfluenzae virus, coronavirus, adenovirus and respiratory syncytial virus) or bacterial (Haemophilus influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis). Pollutant exposure can also lead to AE COPD, such as NO2, SO2, ozone or particulates (PM10 and PM2.5). ⋯ During hospitalization, oxygen supplementation and thromboprophylaxis could be prescribed. The main interest in non-invasive ventilation is persistent hypercapnia despite optimal medical management. During ambulatory management or hospitalization, clinical assessment at 48-72 h is mandatory.