Definition, epidemiology and natural history of COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is the fifth cause of morbidity and mortality in the developed world and represents a substantial economic and social burden. Patients experience a progressive deterioration up to end-stage COPD, characterised by very severe airflow limitation, severely limited and declining performance status with chronic respiratory failure, advanced age, multiple comorbidities and severe systemic manifestations/ complications.COPD is frequently underdiagnosed and under-treated. Today, COPD develops earlier in life and is less gender specific. Tobacco smoking is the major risk factor for COPD, followed by occupation and air pollution. Severe deficiency for a 1 -antitrypsin is rare; several phenotypes are being associated with elevated risk for COPD in the presence of risk factor exposure. Any patient presenting with cough, sputum production or dyspnoea should be assessed by standardised spirometry. Continued exposure to noxious agents promotes a more rapid decline in lung function and increases the risk for repeated exacerbations, eventually leading to end-stage disease.Without major efforts in prevention, there will be an increasing proportion of end-stage patients who can live longer through long-term oxygen therapy and assisted ventilation, but with elevated suffering and huge costs. Smoking prevention and smoking cessation are the most important epidemiological measurements to counteract chronic obstructive pulmonary disease epidemics.

Under‐report and underdiagnosis of chronic respiratory diseases in an African country

“…Unfortunately, asthma severity was not assessed in our population. The concomitant diagnosis of asthma, chronic bronchitis or emphysema is common, particularly in adults aged over 50 years (21,22). The lack of agreement between diseases and airways obstruction could also be because of underreporting of the diseases in our population.…”

Managing COPD Exacerbations with Telemedicine

“…Chronic obstructive pulmonary disease currently affects some 210 million people worldwide 1 and is one of the major chronic diseases in terms of both morbidity and mortality. COPD affects airways and lungs, decreasing lung capacity and obstructing airways, thus interfering with normal breathing.…”

“…Specifically acute deterioration has a profound impact on patient well-being and on health-care cost [1]. These exacerbations are mainly caused by infections resulting in symptom worsening [6].…”

“…Chronic obstructive pulmonary disease, or COPD for short, is a chronic lung disease with high impact on patient well-being and with considerable health-care related costs [1]. Exacerbations -acute events of worsening of symptoms -are important events in the progression of COPD, such that monitoring patients in a home setting to detect exacerbation onset may be warranted [2].…”

Translating guidelines into community practice: signs and symptoms are not enough

“…For most COPD patients without a current or recent exacerbation this will be a gradual change. [8][9][10] One of the common and consistently expressed beliefs of both the average primary care clinician (or respiratory expert) is that COPD diagnoses are often delayed because the patients and physicians fail to appreciate slow increases in breathlessness or slow decline in exercise or activity capabilities due to breathlessness (Yawn and others 10 ). Without some scale to assess the level of breathlessness or activity or exercise limitation, it is not evident that this type of assessment will be any clearer or easier to make after a COPD diagnosis is made compared to before the COPD was identified.…”