Key Points

Because of the global spread of tobacco addiction, chronic obstructive pulmonary disease (COPD) will become the world's third leading cause of death by 2020.

Quitting smoking reduces progressive loss of pulmonary function in patients with COPD, even in long-time smokers. The 6-minute walk test correlates strongly with quality of life and functional limitations in patients with COPD and other chronic lung diseases.

Nocturnal home oxygen therapy improves symptoms and survival in patients with hypoxia at rest. Pulmonary rehabilitation improves symptoms but not survival.

• Inhaled corticosteroids, long-acting p2-agonists, and long-acting anticholinergics (tiotropium) each decrease exacerbation rates by 20% to 25% in patients with moderate to severe COPD, although patients may differ in their response to each therapy.

Consensus statements from the Global Initiative for Chronic Obstructive Lung Disease (GOLD standards, 2005) define chronic obstructive pulmonary disease as a postbron-chodilator FVC of less than 80% of predicted in a patient with evidence of airway obstruction (FEVj/FVC ratio <70%) that is not completely reversible. Although some patients with asthma, especially those who smoke, can progress to varying degrees of irreversibility consistent with COPD, the underlying pathophysiology and inflammatory mechanisms in asthma are distinct from those found in patients with COPD.

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