Chronic Obstructive Pulmonary Disease (COPD), also known as chronic obstructive airway diseases (COAD), is a group of diseases characterized by the pathological limitation of airflow in the airway that is not fully reversible. It refers to an obstruction of airflow, which results in air becoming trapped in the lungs. COPD is the umbrella term for chronic bronchitis, emphysema and a range of other lung disorders. It is most often due to tobacco smoking,^[1] but can be due to other airborne irritants such as solvents, as well as congenital conditions such as alpha-1-antitrypsin deficiency. It is the 4th leading cause of death in the U.S.^[2] Recurrent Airway Obstruction, also known as Chronic Obstructive Pulmonary Disorder or broken wind is a respiratory disease in horses. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // J00-J99 - Diseases of the respiratory system (J00-J06) Acute upper respiratory infections (J00) Acute nasopharyngitis (common cold) (J01) Acute sinusitis (J02) Acute pharyngitis (J03) Acute tonsillitis (J04) Acute laryngitis and tracheitis (J05) Acute obstructive laryngitis (croup) and epiglottitis (J050) Acute obstructive laryngitis (croup) (J051) Acute epiglottitis (J06) Acute upper... // J00-J99 - Diseases of the respiratory system (J00-J06) Acute upper respiratory infections (J00) Acute nasopharyngitis (common cold) (J01) Acute sinusitis (J02) Acute pharyngitis (J03) Acute tonsillitis (J04) Acute laryngitis and tracheitis (J05) Acute obstructive laryngitis (croup) and epiglottitis (J050) Acute obstructive laryngitis (croup) (J051) Acute epiglottitis (J06) Acute upper... // J00-J99 - Diseases of the respiratory system (J00-J06) Acute upper respiratory infections (J00) Acute nasopharyngitis (common cold) (J01) Acute sinusitis (J02) Acute pharyngitis (J03) Acute tonsillitis (J04) Acute laryngitis and tracheitis (J05) Acute obstructive laryngitis (croup) and epiglottitis (J050) Acute obstructive laryngitis (croup) (J051) Acute epiglottitis (J06) Acute upper... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... This article is about the medical term. ... The airways are those parts of the respiratory system through which air flows, to get from the external environment to the alveoli. ... An umbrella term is a word that provides a superset or grouping of related concepts, also called a hypernym. ... Bronchitis is an inflammation of the bronchi (medium-size airways) in the lungs. ... The cigarette is the most common method of smoking tobacco. ... A substance is soluble in a fluid if it dissolves in the fluid. ... A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ... Alpha-1 antitrypsin deficiency is a genetic disorder that can cause lung disease in adults and liver disease in adults and children. ...

Signs and symptoms

The main symptoms of COPD are dyspnea (shortness of breath) lasting for months or perhaps years, possibly accompanied by wheezing, and a persistent cough with sputum production.^[3] It is possible the sputum may contain blood (hemoptysis) and become thicker, usually due to damage of the blood vessels of the airways. Severe COPD could lead to cyanosis (bluish decolorization usually in the lips and fingers) caused by a lack of oxygen in the blood. In extreme cases it could lead to cor pulmonale due to the extra work required by the heart to get blood to flow through the lungs.^[4] The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: A symptom can be a physical condition which shows that one has a particular illness or disorder (see e. ... Dyspnea (R06. ... Wheezes are continuous, coarse, whistling sounds produced in the respiratory airways during breathing. ... This article does not cite any references or sources. ... Hemoptysis (US English) or haemoptysis (International English) is the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e. ... Cyanosis refers to the bluish coloration of the skin due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface. ... This article is about the chemical element and its most stable form, or dioxygen. ... Cor pulmonale is a medical term used to describe a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. ...

COPD is particularly characterised by the spirometric measurement of a ratio of forced expiratory volume over 1 second (FEV₁) to forced vital capacity (FVC) being < 0.7 and the FEV₁ < 80% of the predicted value ^[5] as measured by a plethysmograph. Other signs include a rapid breathing rate (tachypnea) and a wheezing sound heard through a stethoscope. Pulmonary emphysema is not the same as subcutaneous emphysema, which is a collection of air under the skin that may be detected by the crepitus sounds produced on palpation.^[6] Flow-Volume loop showing successful FVC maneuver. ... Flow-Volume loop showing successful FVC maneuver. ... Flow-Volume loop showing successful FVC maneuver. ... A plethysmograph is an instrument for measuring changes in volume within an organ or whole body (usually resulting from fluctuations in the amount of blood or air it contains). ... In medicine, a sign is a feature of disease as detected by the doctor during physical examination of a patient. ... Tachypnea is a medical term for breathing which is more rapid than normal. ... Look up stethoscope in Wiktionary, the free dictionary. ... This article is about the medical term. ... Look up palpation in Wiktionary, the free dictionary. ...

• Shortness of breath (dyspnea) persisting for months to years
• Wheezing
• Decreased exercise tolerance
• Cough with or without phlegm^[7]

Etiology

Cigarette smoking

A primary risk factor of COPD is chronic tobacco smoking. In the United States, around 80 to 90% of cases of COPD are due to smoking.^[8] Not all smokers will develop COPD, but continuous smokers have at least a 25% risk, after 25 years.^[9]

Occupational pollutants

Some occupational pollutants, such as cadmium and silica, have shown to be a contributing risk factor for COPD. Coal workers who smoke have increased risk for concomitmant pneumoconiosis and emphysema. Asbestos workers who smoke are at increased risk for concomitant emphysema, asbestosis and mesothelioma. General Name, Symbol, Number cadmium, Cd, 48 Chemical series transition metals Group, Period, Block 12, 5, d Appearance silvery gray metallic Standard atomic weight 112. ... The chemical compound silicon dioxide, also known as silica, is the oxide of silicon, chemical formula SiO2. ... Pneumoconiosis, also known as coal workers pneumoconiosis, miners asthma, or black lung disease, is a lung condition caused by the inhalation of dust, characterized by formation of nodular fibrotic changes in lungs. ... Asbestosis is a chronic inflammatory medical condition affecting the parenchymal tissue of the lungs. ...

Air pollution

Urban air pollution may be a contributing factor for COPD as it is thought to impair the development of the lung function. In developing countries indoor air pollution, usually due to biomass fuel, has been linked to COPD, especially in women.^[1] Air pollution is the modification of the natural characteristics of the atmosphere by a chemical, particulate matter, or biological agent. ... A developing country is a country with low average income compared to the world average. ... Biofuel is any fuel that derives from biomass - recently living organisms or their metabolic byproducts, such as manure from cows. ...

Genetics

Very rarely, there may be a deficiency in a trypsin antagonist known as alpha 1-antitrypsin which causes a form of COPD.^[10] Trypsin (EC 3. ... RNA expression pattern Orthologs Human Mouse Entrez Ensembl Uniprot Refseq Location Pubmed search alpha 1-Antitrypsin or α1-antitrypsin (A1AT) is a glycoprotein and generally known as serum trypsin inhibitor. ...

Other risk factors

Increasing age, male gender, allergy, repeated airway infection and general impaired function are also related to the development of COPD. Allergy is an abnormal reaction to a substance foreign to the body that is acquired, predictable and rapid. ... An infection is the detrimental colonization of a host organism by a foreign species. ...

COPD as an autoimmune disease

Main article: Autoimmunity

There is mounting evidence that there may be an autoimmune component in individuals with COPD. This is evidenced by the presence of autoreactive T-cells and autoantibodies found in patients. In addition, many individuals who have stopped smoking continue to have chronic inflammation and decline in lung function. ^[11][12][13] Autoimmunity is the failure of an organism to recognize its own constituent parts (down to the sub-molecular levels) as self, which results in an immune response against its own cells and tissues. ...

Pathophysiology

Chronic bronchitis

Chronic bronchitis is defined in clinical terms as a cough with sputum production on most days for 3 months of a year, for 2 consecutive years.^[14]

Chronic bronchitis is hallmarked by hyperplasia (increased number) and hypertrophy (increased size) of the goblet cells (mucous gland) of the airway, resulting in an increase in secretion of mucus which contributes to the airway obstruction. Microscopically there is infiltration of the airway walls with inflammatory cells, particularly neutrophils. Inflammation is followed by scarring and remodeling that thickens the walls resulting in narrowing of the small airway. Further progression leads to metaplasia (abnormal change in the tissue) and fibrosis (further thickening and scarring) of the lower airway. The consequence of these changes is a limitation of airflow.^[15] Bronchitis is an inflammation of the bronchi (medium-size airways) in the lungs. ... Hyperplasia (or hypergenesis) is a general term referring to the proliferation of cells within an organ or tissue beyond that which is ordinarily seen in e. ... Hypertrophy is the increase of the size of an organ or in a select area of the tissue. ... Goblet cells are glandular epithelial cells that are specifically designed to secrete mucus. ... Exocrine glands are glands that secrete their products into ducts. ... A microscope (Greek: (micron) = small + (skopein) = to look at) is an instrument for viewing objects that are too small to be seen by the naked or unaided eye. ... Infiltration is the diffusion or accumulation (in a tissue or cells) of substances not normal to it or in amounts in excess of the normal. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Neutrophil granulocytes (commonly referred to as neutrophils) are a class of white blood cells and are part of the immune system. ... Metaplasia is the replacement of one differentiated cell type with another differentiated cell type. ... Fibrosis is the formation or development of excess fibrous connective tissue in an organ or tissue as a reparative or reactive process, as opposed to a formation of fibrous tissue as a normal constituent of an organ or tissue. ...

Emphysema

Main article: Emphysema

Emphysema is defined histologically as the enlargement of the air spaces distal to the terminal bronchioles, with destruction of their walls.^[14] A thin section of lung tissue stained with hematoxylin and eosin. ... In zootomy, several terms are used to describe the location of organs and other structures in the body of bilateral animals. ... A terminal bronchiole is a bronchiole at the end of the respiratory zone. ...

The enlarged air sacs (alveoli) of the lungs reduces the surface area available for the movement of gases during respiration. This ultimately leads to dyspnea in severe cases. The exact mechanism for the development of emphysema is not understood, although it is known to be linked with smoking and age.(D.A.ASIR JOHN SAMUEL M.D) The alveoli (singular:alveolus), tiny hollow sacs which are continuous with the airways, are the sites of gas exchange with the blood. ... Area is the measure of how much exposed area any two dimensional object has. ... Among quadrupeds, the respiratory system generally includes tubes, such as the bronchi, used to carry air to the lungs, where gas exchange takes place. ...

Diagnosis

The diagnosis of COPD is suggested by symptoms; it is a clinical diagnosis and no single test is definitive. A history is taken of smoking and occupation, and a physical examination is done. Measurement of lung function with a spirometer can reveal the loss of lung function. A spirometer is an apparatus for measuring the volume of air inspired and expired by the lungs. ...

The severity of COPD can be classified as follows using post-bronchodilator spirometry (see above)^[16]:

Flow-Volume loop showing successful FVC maneuver. ...

Exams and Tests

An examination often reveals increased work involved in breathing: nasal flaring may be evident during air intake, and the lips may be pursed (the shape lips make when you whistle) while exhaling.

During a flare of disease, chest inspection reveals contraction of the muscles between the ribs during inhalation (intercostal retraction) and the use of accessory breathing muscles. The respiratory rate (amount of breaths per minute) may be elevated, and wheezing may be heard through a stethoscope.

A chest X-ray can show an over-expanded lung (hyperinflation) and a flattened diaphragm while a chest CT scan may show emphysema.

A sample of blood taken from an artery (arterial blood gas) can show low levels of oxygen (hypoxemia) and high levels of carbon dioxide (respiratory acidosis). Pulmonary function tests show decreased airflow rates while exhaling and over-expanded lungs. ^[17]

Physical examination

A systematic review has concluded that no single medical sign or symptom can adequately exclude the diagnosis of COPD.^[18] One study found that the presence of either "a history of smoking more than 30 pack-years, diminished breath sounds, or peak flow less than 350 L/min" has a sensitivity of 98 percent.^[19] Systematic reviews are named as the highest level of medical evidence, by evidence based medicine professionals. ... In medicine, a sign is a feature of disease as detected by the doctor during physical examination of a patient. ... A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ...

Management

Although COPD is not curable, it can be controlled in a variety of ways. Clinical practice guidelines by Global Initiative for Chronic Obstructive Lung Disease (GOLD), a collaboration including the American National Heart, Lung, and Blood Institute and the World Health Organization, are available.^[16] Clinical practice guidelines are collections of practical information for use by doctors and other medical professionals. ...

Smoking cessation

Main article: Smoking cessation

Smoking cessation is one of the most important factors in slowing down the progression of COPD. Even at a late stage of the disease it can reduce the rate of deterioration and prolong the time taken for disability and death.^[15] A No Smoking sign Smoking cessation (commonly known as quitting, or kicking the habit) is the effort to stop smoking tobacco products. ... A No Smoking sign Smoking cessation (commonly known as quitting, or kicking the habit) is the effort to stop smoking tobacco products. ...

Occupational change

Workers may be able to transfer to a significantly less contaminated area of the company depending on circumstances. Often however, workers may need complete occupational change.

Pharmacotherapy

Bronchodilators

There are several types of bronchodilators used clinically with varying efficacy: β₂ agonists, M₃ antimuscarinics, leukotriene antagonists, cromones and xanthines.^[20] These drugs relax the smooth muscles of the airway allowing for improved airflow. The change in FEV₁ may not be substantial, but changes in the vital capacity are significant. Many patients feel less breathless after taking bronchodilators. Wikipedia does not yet have an article with this exact name. ... RNA expression pattern Orthologs Human Mouse Entrez Ensembl Uniprot Refseq Location Pubmed search The beta-2 adrenergic receptor (β2 adrenoreceptor), also known as ADRB2, is an beta-adrenergic receptor, and also denotes the human gene encoding it. ... Orthologs Human Mouse Entrez Ensembl na Uniprot na Refseq Location na Pubmed search The muscarinic acetylcholine receptor M3, also known as the cholinergic receptor, muscarinic 3 (CHRM3), is a human gene. ... Smooth muscle is a type of non-striated muscle, found within the walls of hollow organs; such as blood vessels, bladders, uteri. ... Flow-Volume loop showing successful FVC maneuver. ... Vital capacity is the maximum volume of air that a person can exhale after maximum inhalation. ...

β₂ agonists

There are several highly specific β₂ agonists available. Salbutamol (Ventolin) is the most widely used short acting β₂ agonist to provide rapid relief and should be prescribed as a front line therapy for all classes of patients. Other β₂ agonists are Bambuterol, Clenbuterol, Fenoterol, and Formoterol. Long acting β₂ agonists (LABAs) such as Salmeterol act too slowly to be used as relief for dypsnea so these drugs should be used as maintenance therapy in the appropriate patient population. The TORCH study showed that LABA therapy reduced COPD exacerbation frequency over a 3 year period, compared to placebo.^[21] An increased risk is associated with long acting β₂ agonists due to decreased sensitivity to inflammation so generally the use of a concomitant corticosteroid is indicated[2][3][4]. Salbutamol (INN) or albuterol (USAN) is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and COPD. Salbutamol sulphate is usually given by the inhaled route for direct effect on bronchial smooth muscle. ... Bambuterol (INN, marketed by AstraZeneca under the trade names Bambec® and Oxeol®) is a long acting beta-adrenoceptor agonist used in the treatment of asthma. ... Clenbuterol is a drug prescribed to sufferers of breathing disorders as a decongestant and bronchodilator. ... Formoterol belongs to the family of prescription-only medicines known as beta 2-agonists. ... Salmeterol is a long-acting beta2-adrenergic receptor agonist drug that is currently prescribed for the treatment of asthma and chronic obstructive pulmonary disease COPD. It is currently available in both dry-powder inhalers (DPIs) and pressurised metered dose inhalers (pMDIs). ... Dyspnea (R06. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ...

M₃ muscarinic antagonists (anticholinergics)

Specific antimuscarinics were found to provide effective relief to COPD. Inhaled antimuscarinics have the advantage of avoiding endocrine and exocrine M₃ receptors. The quaternary M₃ muscarinic antagonist Ipratropium is widely prescribed with the β₂ agonist salbutamol. [5]. Ipratropium formerly was offered combined with salbutamol (Combivent) and with fenoterol (Duovent) but due to the CFC propellant, these products have been withdrawn. ... The endocrine system is a control system of ductless endocrine glands that secrete chemical messengers called hormones that circulate within the body via the bloodstream to affect distant organs. ... Exocrine gland refers to glands that secrete their products via a duct. ... Ipratropium (as ipratropium bromide, trade name Atrovent) is an anticholinergic drug administered by inhalation for the treatment of obstructive lung diseases. ... Salbutamol (INN) or albuterol (USAN) is a short-acting β2-adrenergic receptor agonist used for the relief of bronchospasm in conditions such as asthma and COPD. Salbutamol sulphate is usually given by the inhaled route for direct effect on bronchial smooth muscle. ...

Tiotropium provides improved specificity for M₃ muscarinic receptors. It is a long acting muscarinic antagonist that has shown good efficacy in the reduction of exacerbations of COPD, especially when combined with a LABA and inhaled steroid.^[22] Tiotropium (IPA: ) is a long-acting anticholinergic bronchodilator used in the management of chronic obstructive pulmonary disease (COPD). ...

Cromones

Cromones are mast cell stabilizers that are thought to act on a chloride channel found on mast cells that help reduce the production of histamine and other inflammatory factors. Chromones are also thought to act on IgE-regulated calcium channels on mast cells. Cromoglicate and Nedocromil, which has a longer half-life, are two chromones available.^[23] The structural formula of chromone Chromone (or 1,4-benzopyrone) is a derivative of benzopyran with a substituted keto group on the pyran ring. ... Mast cell stabilizers are medications used to prevent or control certain allergic disorders. ... Ion channels are present in the membranes that surround all biological cells. ... A mast cell (or mastocyte) is a resident cell of connective tissue that contains many granules rich in histamine and heparin. ... This article or section does not cite any references or sources. ... Another, unrelated ion channeling process is part of ion implantation. ... Cromoglicate (INN) (also referred to as cromolyn (USAN) or cromoglycate (former BAN)) is traditionally described as a mast cell stabilizer, and is commonly marketed as the sodium salt sodium cromoglicate. ... The introduction to this article provides insufficient context for those unfamiliar with the subject matter. ...

Leukotriene antagonists

More recently leukotriene antagonists block the signalling molecules used by the immune system. Montelukast, Pranlukast, Zafirlukast are some of the leukotrienes antagonists.^[24]These agents have not been tested in good, controlled trials, ^[25] and as such, there is no data to support the use of these agents in COPD.^[26] Leukotrienes are autocrine and paracrine eicosanoid lipid mediators derived from arachidonic acid by 5-lipoxygenase. ... Montelukast is a leukotriene receptor antagonist (LTRA) used for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies. ... Pranlukast is a cysteinyl leukotriene receptor-1 antagonist. ... Zafirlukast is an oral leukotriene receptor antagonist (LTRA) for the maintenance treatment of asthma. ...

Xanthines

Theophylline is the prototype of the xanthine class of drug. Teas are natural sources of methylxanthines, xanthines and caffeine while cocoa is a natural source of theobromine. Caffeine is approximately 16% metabolized into theophylline. Nebulized theophylline is used in the EMR for treatment of dyspnea (Difficulty in breathing). Patients need continual monitoring as theophylline has a narrow therapeutic range. More aggressive EMR interventions include IV H₁ antihistamines and IM dexamethasone. Theophylline is a methylxanthine drug used in therapy for respiratory diseases such as COPD or asthma under a variety of brand names. ... Xanthines are a group of alkaloids that are commonly used for their effects as mild stimulants and as bronchodilators, notably in treating the symptoms of asthma. ... For other uses, see Caffeine (disambiguation). ... For other uses, see Cocoa (disambiguation). ... Theobromine, also known as xantheose,[1] is a bitter alkaloid of the cacao plant. ... For other uses, see Caffeine (disambiguation). ... Dyspnea (R06. ... The therapeutic index (also known as therapeutic ratio or margin of safety), is a comparison of the amount of a therapeutic agent that causes the therapeutic effect to the amount that causes toxic effects. ... An H1 antihistamine is a histamine antagonist which serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions, through action at the H1 receptor. ... Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid hormones. ...

Theophylline antagonizes phosphodiesterase, and small reductions in COPD exacerbation rates have been demonstrated.^[27] The investigative phosphodiesterase-4 antagonists, roflumilast and cilomilast have completed Phase-2 clinical trials. Theophylline is a methylxanthine drug used in therapy for respiratory diseases such as COPD or asthma under a variety of brand names. ... A phosphodiesterase (PDE) is an enzyme that catalyzes the hydrolysis of phosphodiester bonds. ...

Corticosteroids

Enteral and parenteral corticosteroid therapy has long been the mainstay of treatment of COPD, and is known to reduce length of stay in hospital. Similarly, inhaled corticosteroids (specifically glucocorticoids) act in the inflammatory cascade and improve airway function considerably,^[15] and have been shown in the ISOLDE trial to reduce the number of COPD exacerbations by 25%.^[28] Corticosteroids are often combined with bronchodilators in a single inhaler. Some of the more common inhaled steroids in use are beclomethasone, mometasone, and fluticasone. In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ... Beclometasone dipropionate is a corticosteroid drug. ... Mometasone furoate (also referred to as Mometasone) is a moderately potent glucocorticoid steroid used in the treatment of inflammatory skin disorders (such as eczema and psoriasis), allergic rhinitis (such as hay fever), and asthma for patients unresponsive to less potent corticosteroids. ... Fluticasone proprionate is a glucocorticoid often prescribed as treatment for asthma and allergic rhinitis. ...

Salmeterol and fluticasone are combined (Advair), however the reduction in death from all causes among patients with COPD in the combination therapy group did not reach the predetermined level of statistical significance.^[29][30]

TNF antagonists

Tumor necrosis factor antagonists (TNF) are the most recent class of medications designed to deal with refractory cases. Tumor necrosis factor-alpha is a cachexin or cachectin and is considered a so-called biological drug. They are considered immunosopressive with attendant risks. These rather expensive drugs include infliximab, adalimumab and etanercept.^[31]Infliximab has been trialled in COPD with no evidence of benefit, with the possibility of harm. This was a relatively small study (77-79 patients in each arm).^[32] In medicine, tumor necrosis factor alpha (TNFα, cachexin or cachectin) is an important cytokine involved in systemic inflammation and the acute phase response. ... Infliximab (brand name Remicade®) is a drug used to treat auto-immune disorders. ... Adalimumab (Humira®) is the third TNF antagonist (after infliximab and etanercept) to be approved in the US. Like infliximab and etanercept, adalimumab binds to TNFα, preventing it from activating TNF receptors; adalimumab was constructed from a fully human monoclonal antibody, while infliximab is a mouse-human chimeric antibody and etanercept... Etanercept (Enbrel®, co-marketed by Amgen and Wyeth) is a human recombinant, soluble tumor necrosis factor-alpha (TNFα) receptor. ...

Supplemental Oxygen

In general, long-term administration of oxygen is usually reserved for individuals with COPD who have arterial hypoxemia (PaO2 less than 55 mm Hg), or a PaO2 between 55 and 60 mm Hg with evidence of pulmonary hypertension, cor pulmonale, or secondary erythrocytosis (hematocrit >55%). In these patients, continuous home oxygen therapy (for >15 h/d) sufficient to correct hypoxemia has been shown to improve survival. ^[33] The use of low flow oxygen may be necessary in some patients because in the COPD patient, control of respiration is driven mainly by the blood oxygen level rather than the carbon dioxide level, increased oxygen delivery can diminish this response and cause respiratory failure. The American Thoracic Society Guidelines on COPD cover the use of oxygen therapy and its risks.^[34] // Hypoxemia (or hypoxaemia) is an abnormally low partial pressure of oxygen (PO2) in arterial blood (West J. Pulmonary Pathophysiology: The Essentials p22). ... In medicine, pulmonary hypertension (PH) is an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion. ... Cor pulmonale is a medical term used to describe a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. ... Control of ventilation (control of respiration) refers to the physiological mechanisms involved in the control of physiologic ventilation. ...

Vaccination

Patients with COPD should be routinely vaccinated against influenza, pneumococcus and other diseases to prevent illness and the possibility of death.^[20] A vial of the vaccine against influenza. ... Flu redirects here. ... Binomial name Streptococcus pneumoniae Streptococcus pneumoniae is a species of Streptococcus that is a major human pathogen. ...

Pulmonary rehabilitation

Pulmonary rehabilitation is a program of disease management, counseling and exercise coordinated to benefit the individual.^[35] Pulmonary rehabilitation has been shown to relieve difficulties breathing and fatigue. It has also been shown to improve the sense of control a patient has over their disease as well as their emotions.^[36]

Diet

A recent French study conducted over 12 years with almost 43,000 men concluded that eating a Mediterranean diet "halves the risk of serious lung disease like emphysema and bronchitis". [6] For cuisine, see Cuisine of the Mediterranean. ...

Treatment

Treatment for COPD includes inhalers that dilate the airways (bronchodilators) and sometimes theophylline. The COPD patient must stop smoking. In some cases inhaled steroids are used to suppress lung inflammation, and, in severe cases or flare-ups, intravenous or oral steroids are given.

Antibiotics are used during flare-ups of symptoms as infections can worsen COPD. Chronic, low-flow oxygen, non-invasive ventilation, or intubation may be needed in some cases. Surgery to remove parts of the disease lung has been shown to be helpful for some patients with COPD.^{[citation needed]}

Lung rehabilitation programs may help some patients.

Lung transplant is sometimes performed for severe cases.

Support Groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems. ^[37]

Prognosis

A good prognosis of COPD relies on an early diagnosis and prompt treatment. Most patients will have improvement in lung function once treatment is started, however eventually signs and symptoms will worsen as COPD progresses. The median survival is about 10 years if two-thirds of expected lung function was lost by diagnosis.

"End Stages" of COPD are diagnosed as the normal ratio of carbon dioxide being inordinately higher than the volume of oxygen in the bloodstream. Although end stage COPD may mean death is imminent in cases dealing with degenerative diseases, forced oxygen therapy and other treatments may successfully be used to prolong life but have not been proven to be successful for the long run. These types of therapy may be successfully used in COPD cases caused by curable diseases such as bronchitis.

Bronchitis

Acute bronchitis usually resolves in 2-10 years. Bronchitis is an inflammation of the bronchi and may specifically refer to: Acute bronchitis, caused by viruses or bacteria and lasting several days or weeks Chronic bronchitis, a persistent, productive cough lasting at least three months in two consecutive years. ...

Emphysema

The outcome is better for patients with less damage to the lung who stop smoking immediately. Still, patients with extensive lung damage may live for many years so predicting prognosis is difficult. Death may occur from respiratory failure, pneumonia, or other complications. This article is about human pneumonia. ...

Pneumoconiosis

The outcome is good for patients with minimal damage to the lung. However, patients with extensive lung damage may live for many years so predicting prognosis is difficult. Death may occur from respiratory failure, pneumonia, cor pulmonale or other complications. Respiratory failure is a medical term for inadequate gas exchange by the respiratory system. ... This article is about human pneumonia. ... Cor pulmonale is a medical term used to describe a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. ...

Pulmonary neoplasms

The stage of the tumor(s) has a major impact on neoplasm prognosis. Staging is the process of determining tumor size, growth rate, potential metastasis, lymph node involvement, treatment options and prognosis. Two-year prognosis for limited small cell pulmonary neoplasms is twenty percent and for extensive disease five percent. The average life expectancy for someone with recurrent small cell pulmonary neoplasms is two to three months.[7] For malignant tumors specifically, see cancer. ... Neoplasia (literally: new growth) is sudden and abnormal growth in a tissue or organ. ... For the musical composition, see Metastasis (Xenakis composition). ...

The 5-year overall survival rate for pulmonary neoplasms is 14%.^[38]

Epidemiology

According to the World Health Organization (WHO), 80 million people suffer from moderate to severe COPD and 3 million died due to it in 2005. The WHO predicts that by 2030, it will be the 4th largest cause of mortality worldwide.^[39] WHO redirects here. ...

Since COPD is not diagnosed until it becomes clinically apparent, prevalence and mortality data greatly underestimate the socioeconomic burden of COPD.^[20] In the UK, COPD accounts for about 7% of all days of sickness related absence from work.^[15] Socioeconomics or Socio-economics is the study of the relationship between economic activity and social life. ...

Smoking rates in the industrialized world have continued to fall, causing rates of emphysema and pulmonary neoplasms to slowly decline.

References

The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... MedlinePlus (medlineplus. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

• National Heart, Lung and Blood Institute - COPD U.S. NHLBI Information for Patients and the Public page.
• Guidelines for Diagnosis And Treatment Of Stable COPD^{[dead link]}
• Chronic Respiratory Disease - leading research and articles on respiratory disease
• Global Initiative for Chronic Obstructive Lung Disease (GOLD)