Chronic Obstructive Pulmonary Disease 9781003420316, 1003420311

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Chronic obstructive Second Edition

pulmonary disease

Chronic obstrudive pulmonary disease Second Edition Peter J Barnes, MA, DM, DSc, FRCP Professor of Thoracic Medicine National Heart and Lung Institute Imperial School of Medicine London, UK Simon Godfrey, MD, PhD, FRCP Director, Institute of Pulmonology Hadassah University Hospital Jerusalem, Israel

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CRC Press

Taylor & Francis Group Boca Raton London New York

CRC Press is an imprint of the Tay lor & Francis Group, an informa business

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DOI: 10.1201/9781003420316

Contents

What is COPD?1 Clinical features and

investigation8

Principles of treatment and management guidelines25 Drug delivery systems33 Bronchodilators39 Antibiotics44 Other

drug therapies47

Oxygen therapy50

Management of complications53 Surgery58 Future trends60 Further

reading63

Appendix: Index70

doses of COPD medications65

What is COPD?

Definitions

Chronic obstructive pulmonary disease (CORD), sometimes called chronic obstructive airways disease, is a major health burden and accounts for 10% of all working days lost and over 15 000 deaths each year in the United Kingdom (UK). COPD is the third commonest cause of death in the UK and USA. Chronic

bronchitis is defined by a productive cough on least 3 months for at least 2 consecutive years and cannot be attributed to other pulmonary or cardiac causes. It is a consequence of mucous hyperplasia and is not necessarily related

simple most days for at

to

-

airway obstruction.

Chronic obstructive bronchitis is due to obstruction of peripheral airways as a result of an inflammatory response -

(bronchiolitis). is a pathological diagnosis characterized by destruction of alveolar walls, resulting in abnormal enlargement of airspaces and loss of lung elasticity, with consequent obstruction of

Emphysema

-

peripheral airways. is defined physiologically as chronic airflow obstruction and may be due to a mixture of emphysema and peripheral airway obstruction from chronic obstructive bronchitis. Extensive pulmonary damage occurs before the patient is aware of symptoms, such as exertional dyspnoea, owing to the slowly progressive nature of the airflow obstruction and various coping manoeuvres. There may be a small degree of reversibility in airway obstruction (70 50-69

Moderate