الفهرس 
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Abstract
Chronic Obstructive Pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. It includes emphysema and/or chronic obstructive bronchitis. It affects middle aged people and it is thought to be more prevalent among men than women. The WHO estimates that in 2000, 2.74 million people died of COPD worldwide.
Emphysema is defined as abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of the walls and without obvious fibrosis. Chronic bronchitis is defined clinically as the presence of a chronic productive cough for 3 months during each of 2 consecutive years. The primary risk factors for developing COPD are Cigarette smoking, air pollution, and occupational dust or chemical exposures. Alpha1- antitrypsin (AAT) deficiency, as a genetic factor is a significant cause of emphysema in nonsmokers and influences susceptibility to disease in smokers. COPD is characterized by chronic inflammation throughout the airways, parenchyma, and pulmonary vasculature. An imbalance of proteinases and antiproteinases in the lung, and oxidative stress are two other processes thought to be important in the pathogenesis of COPD.
There is no single diagnostic test for COPD. A diagnosis of COPD will be considered in anyone over the age of 30 who has a risk factor and one or more of the following symptoms: breathlessness on exertion, persistent cough, regular sputum production, frequent winter bronchitis. Diagnosis is confirmed by Spirometry. Multiple measurements are obtained from the spirometer. Those most commonly used for interpretation of COPD are: (1) forced expiratory volume after 1 second [FEV1], and (2) forced vital capacity [FVC].
Dyspnea can be defined as ”an uncomfortable sensation or awareness of breathing... patients may describe the feeling as shortness of breath, inability to get enough air or suffocation.” It is the most common symptom of COPD. It is the major reason that patients with chronic obstructive pulmonary disease (COPD) seek medical attention. Numerous methods have been employed to assess dyspnea in COPD in clinical trials, but no single measurement predominates and no single assessment tool considers all the different components of dyspnea, and the final choice will depend on the purpose of the assessment.