Chapter 4. Chronic Obstructive Pulmonary Disease

Sidney S Braman, MD, FCCP
DOI: 10.1378/pulm.26.4
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COPD, like asthma, is inflammatory disease of the lungs. The number of patients with COPD has grown dramatically and it now ranks as the third leading cause of death in the United States. In the developed world, cigarette smoking is the leading cause of this disease. In underdeveloped areas of the world, indoor burning of fossil fuels for cooking and heating is another important cause. Lung damage is caused by (1) proinflammatory mediators, (2) oxidative stress, and (3) proteolytic digestion of lung tissue. The cumulative effect of this injury occurs slowly and silently over decades and causes progressive obstruction to airflow. When lung function reaches a critical level (approximately FEV1 of 50% predicted), shortness of breath impacts activities of daily living. Chronic bronchitis, daily cough, and sputum production are common among cigarette smokers and portend a worse prognosis. An acute worsening of COPD symptoms is called acute exacerbation of COPD. It is most commonly caused by a viral or bacterial infection. Frequent exacerbations are associated with a more rapid decline in lung function, poor quality of life, more frequent hospitalizations, and mortality. Evidence-based interventions proven effective include influenza and pneumococcal immunizations, short- and long-acting β-agonists, long-acting anticholinergics, patient education, and, for severely affected patients, inhaled corticosteroids and phosphodiesterase inhibitors and pulmonary rehabilitation. Proinflammatory mediators are found in the blood of COPD patients.

  • Review the current definition of COPD that incorporates concepts of airway and systemic inflammation associated with this disease.

  • Explore the impact of COPD, including morbidity and mortality.

  • Review the risk factors for COPD.

  • Explore the natural history of COPD from its earlier asymptomatic stages to the late stages associated with high morbidity and mortality.

  • Explore the current understanding of the pathophysiology of COPD: the pathologic consequences of airway inflammation and parenchymal lung destruction.

  • Explore the systemic consequences of the disease and the comorbidities associated with COPD.

  • Review the current state of pharmacologic and nonpharmacologic therapy for COPD, including preventive measures such as smoking cessation and an integrated disease management approach.


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