الفهرس | Only 14 pages are availabe for public view |
Abstract Chronic Obstructive Pulmonary Disease (COPD), a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients. Inhaled cigarette smoke and other noxious particles cause lung inflammation which may induce parenchymal tissue destruction (emphysema and disrupt normal repair and defense mechanisms. A clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, and a history of exposure to risk factors for the disease. Spirometry is required to make the diagnosis in this clinical context; the presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD. The goals of COPD assessment are to determine the severity of the disease, including the severity of airflow limitation, the impact on the patient‘s health status. Comorbidities occur frequently in COPD patients, including cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, depression, and lung cancer.Each pharmacological treatment regimen needs to be patient-specific, guided by severity of symptoms, risk of exacerbations, drug availability, and the patient‘s response. For both beta2-agonists and anticholinergics, longacting formulations are preferred over short-acting formulations. Based on efficacy and side effects, inhaled bronchodilators are preferred over oral bronchodilators. Long-term treatment with inhaled corticosteroids added to long-acting bronchodilators is recommended for patients at high risk of exacerbations. The phosphodiesterase-4 inhibitor roflumilast may be useful to reduce exacerbations for patients with FEV1 < 50% predicted, chronic bronchitis, and frequent exacerbations. An exacerbation of COPD is an acute event characterized by a worsening of the patient‘s respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication. The diagnosis of an exacerbation relies exclusively on the clinical presentation of the patient complaining of an acute change of symptoms (baseline dyspnea, cough, and/or sputum production) that is beyond normal day-to-day variation. Short-acting inhaled beta2-agonists with or without short-acting anticholinergics are usually the preferred bronchodilators for treatment of an exacerbation Systemic corticosteroids and antibiotics can shorten recovery time, improve lung function (FEV1) and arterial hypoxemia (PaO2), and reduce the risk of early relapse, treatment failure, and length of hospital stay. Oxygen therapy is a key component of hospital treatment of an exacerbation. Venturi masks (high flow devices) offer more accurate and controlled delivery of oxygen than do nasal prongs but are less likely to be tolerated by the patient. Ventilator support in an exacerbation can be provided by either non-invasive (nasal or facial mask) or invasive ventilation (oro-tracheal tube or trachestomy). |