What Is Chronic Obstructive Pulmonary Disease?

COPD is a progressive inflammatory lung disease which is frequently associated with a history of smoking. Airflow obstruction is due to a combination of chronic bronchitis and emphysema, whose contributions vary in different patients.

Patients frequently present with shortness of breath and/or persistent cough. A chest X-ray can be useful for eliminating other diagnoses, and in some cases a chest HRCT may help in the differential diagnosis. Dyspnea may worsen as the condition progresses, and lung function is assessed by spirometry (FEV₁, FVC and their ratio). In moderate COPD changes such as airway mucus, expiratory flow limitation, and hyperinflation may develop. In 2008 the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines were updated, and serve as a valuable resource for assessment and management of COPD.

Therapy for COPD includes bronchodilators such as beta agonists and anticholinergics, methylxanthines, and glucocorticoids. Several large clinical trials have recently finished, including BRONCUS (N-acetylcysteine), TORCH and INSPIRE (salmeterol/fluticasone propionate), SHINE and SUN (budesonide/formoterol), and UPLIFT (tiotropium). In addition to long-acting beta agonist (LABA), steroid, and long-acting muscarinic antagonist (LAMA) treatments, there are methods to manage COPD such as pulmonary rehabilitation, supplemental oxygen, and surgical procedures, as well as emerging pharmaceutical strategies such as monoclonal antibodies, retinoids, stem cell therapy, and PDE4 selective inhibitors.

Other non-pharmacological tools to help patients improve their quality of life include smoking cessation resources, patient support groups, recognition of anxiety and depression, and exercise training/pulmonary rehabilitation.

References

Global Strategy for Diagnosis, Management, and Prevention of COPD (GOLD Report). Available at: http://www.goldcopd.com/. Accessed February 2009.

Doherty DE. A review of the role of FEV₁ in the COPD paradigm. COPD. 2008;5(5):310-318.

Barnes PJ. Emerging pharmacotherapies for COPD. Chest. 2008;134(6):1278-1286.

Bourbeau J, Bartlett SJ. Patient adherence in COPD. Thorax. 2008;63(9):831-838.