Chronic obstructive pulmonary disease

Acute exacerbations of underlying COPD are a common cause of respiratory deterioration. Developments have been made in preventive measures, but admission to hospital for acute exacerbations can be expected to remain common. Several expert consensus guidelines have been published to define the appropriate management of COPD patients. These consensus guidelines generally agree, but all acknowledge a lack of large well-controlled clinical studies, especially studies focusing on the management of acute exacerbations. Consequently, many potential controversies exist about the details of managing patients with acute exacerbations. Although studies of many fundamental aspects of management are still needed, the results of controlled clinical trials are sufficient to emphasise the importance of a careful clinical assessment, supplemental oxygen, inhaled bronchodilators to partially improve airway obstruction, corticosteroids to decrease the likelihood of treatment failures and to speed recovery, antibiotics, especially in severe patients, and non-invasive positive-pressure ventilation for treatment of acute ventilatory failure in selected patients.     

Chronic obstructive pulmonary disease: new opportunities for drug development

Chronic obstructive pulmonary disease (COPD) is common and there is an increasing worldwide prevalence. There are no available treatments to prevent the progression of airflow obstruction, but greater understanding of the molecular and cellular mechanisms involved in COPD has identified many new therapeutic targets, including inflammatory mediators, proteases and adhesion molecules. In this review, Peter Barnes considers potential new drugs for this neglected disease.     

Chronic obstructive pulmonary disease in horses in Louisiana

OBJECTIVE: To evaluate chronic obstructive pulmonary disease of horses in Louisiana by assessing the signalment, history, environmental factors, clinical signs, and treatment of such horses. DESIGN: Epidemiologic mail survey. SAMPLE POPULATION: 83 of 240 veterinarians contacted by mail agreed to take part in the survey. Veterinarians contacted were listed as mixed-animal or equine practitioners in the 1991/1992 directory of the Louisiana Veterinary Medical Association or had submitted a specimen from a horse to the Louisiana Veterinary Medical Diagnostic Laboratory within the past 2 years. PROCEDURE: The survey contained 47 questions designed to elicit information from owners and veterinarians about horses reported to have chronic obstructive pulmonary disease (COPD). Questions were included to evaluate age, breed, sex, vaccination history, respiratory disease history, environment of primary activity, level of exercise, primary residence (pasture or stall), condition of pasture or barn, type and condition of feed, clinical signs, concurrent conditions, and treatment regimen prescribed. Information from the returned forms was analyzed by using a microcomputer program designed for epidemiologic data. RESULTS: Of the 83 veterinarians who agreed to participate, 31 returned 71 completed questionnaires for horses affected with COPD. Most affected horses were mature in age, kept on pasture, and had developed clinical signs during the summer months. The most consistent clinical signs were dry coughing, slight serous nasal discharge, labored expiratory effort, and flaring nostrils. CLINICAL IMPLICATIONS: Summer pasture-associated obstructive pulmonary disease appears to be precipitated by factors different than those associated with the traditionally diagnosed form of COPD and, thus, successful management measures may also vary.     

Chronic obstructive pulmonary disease and '150 years of blowing'

Spirometry is now an established and important aspect of investigation of many lung diseases. This article considers the history of spirometry, how we come to use the current indices of dynamic lung function, and the role of spirometry in the management of patients with chronic obstructive pulmonary disease.     

Chronic obstructive pulmonary disease: effects of hypoxia on neurological and neuropsychological measures

Eighteen patients with chronic obstructive pulmonary disease (COPD) were administered a series of pulmonary, neurological, and neuropsychological measures to test if there was an effect of COPD on neurological and cognitive functioning. Overall, there was no evidence of general dementia in this sample. Measures of immediate and delayed memory, complex attention, and speed of information processing correlated highly with arterial carbon dioxide partial pressure and, to a lesser extent, with oxygen partial pressure. Measures of language abilities, perceptual-motor functioning, and simple attention generally were not related to arterial gas pressures. A similar pattern of findings was obtained when group differences were examined between participants classified as severely hypoxic or mildly hypoxic, although group differences were mitigated by premorbid IQ differences. Hypoxia in COPD results in a relatively focused pattern of impairment in measures of memory function and tasks requiring attention allocation. The memory dysfunction may be related to involvement of limbic memory regions necessary for explicit memory. The attentional deficits were attributed to diffuse brain involvement resulting in reduced resource allocation. Early diagnosis and treatment of the hypoxia is essential.     

The role of pulmonary surfactant in obstructive airways disease

The Spemann organizer is largely responsible for organizing and patterning the anteroposterior axis during the development of amphibians. In this report, we examine the degree of anteroposterior pattern in the earliest gastrula organizer of Xenopus using a combination of embryological and molecular techniques. When we divide the earliest gastrula organizer, a region measuring 20 cells high by 25 cells wide, into stereotyped anterior (vegetal) and posterior (animal) halves, each half not only has a distinct fate and state of specification, but also induces a unique set of region-specific neural genes. When wrapped in animal cap ectoderm, the anterior half induces only anterior-specific genes (XAG-1 and otxA), while the posterior half induces anterior (otxA and reduced levels of XAG-1) and posterior (Hox B9) neural genes, revealing early localization of neural posteriorizing activity to posterior mesendoderm. This is the earliest demonstration of regionalized neural induction by the Xenopus organizer. Additionally, based on the expression of gsc, Xbra, and Xnot, we show that the organizer is patterned both at the early gastrula stage and prior to the appearance of bottle cells.     

Pathophysiology of chronic obstructive pulmonary disease

The prevalence of COPD has increased as mortality from the two organ systems affected by the same risk factors of smoking, heart attacks and strokes, has decreased. Once diagnosed, COPD is progressive and may lead to disability, usually due to dyspnea, at a relatively early age (60 to 80 years of age). COPD is usually caused by destruction of the lung parenchyma or by disease affecting the airways. In most patients both processes exist simultaneously. Less often recognized is the fact that the disease does not affect all portions of the lung alike, which causes different physiologic behaviors in different parts of the lung. This article integrates the pathologic changes of COPD with the known adaptive and maladaptive consequences of those changes. An understanding of these changes should result in an increased capacity to comprehend the different therapeutic strategies that have been developed to decrease the symptoms and improve the well-being of patients with COPD.     

Pharmacotherapy of chronic obstructive pulmonary disease

Despite a significant reduction in cigarette consumption, chronic obstructive pulmonary disease continues to be an important cause of mortality in the United States. COPD is characterized by progressive airflow obstruction which is punctuated by acute exacerbations. Nicotine substitution and use of bupropion have been shown to double long-term smoking cessation success. The combination of albuterol and ipratropium bromide produces a synergistic beneficial effect on pulmonary function and symptoms. Long-acting inhaled beta 2-agonists improve symptoms better than as needed albuterol. Oral corticosteroids appear to be helpful during acute exacerbations; however, the chronic use of steroids benefits only a minority of patients. Broad- spectrum antibiotics are indicated during acute exacerbations if there is increased sputum volume and purulence. System-oriented administration of pneumococcal and influenza vaccinations is more successful than provider or client-oriented approaches.     

Radiology of chronic obstructive pulmonary disease

This article reviews the radiologic manifestations and complications of chronic obstructive pulmonary disease, particularly those seen in association with emphysema. Current concepts on the pathogenesis of chronic obstructive pulmonary disease are discussed and related to findings on high-resolution CT scan and histologic examinations. Controversial issues concerning the detection and grading of emphysema using radiologic and physiologic tests are also addressed.     

Pathophysiology of chronic obstructive pulmonary disease

Emphysema with bullae is a common feature of patients with chronic obstructive pulmonary disease. Central to the pathophysiology of emphysema is the presence of airflow obstruction and lung and chest hyperinflation. Because of the increased ventilatory demand and the need to maintain gas exchange, patients with emphysema increase their work of breathing. This article reviews the adaptive and maladaptive consequences of these changes. A rationale is given as to the possible mechanism by which surgery aimed at resecting hyperinflated portions of the lungs may be effective.     

Lung cancer and chronic obstructive pulmonary disease

Spirometry can predict lung health and monitor disease and response to therapy. This noninvasive test can and should be done regularly by primary care providers. It can identify patients at risk for lung cancer as well as heart attack and stroke. Patients with abnormal spirometric findings can be warned that airflow obstruction has begun, which may provide the motivation to quit smoking. Abnormal spirometry measurements correlate with all-cause mortality. Approaches to early diagnosis of lung cancer continue to expand. For example, use of the new fluorescent bronchoscope can increase diagnostic accuracy in lung cancer by highlighting lesions that are malignant or likely to be malignant. For now, however, identification of airflow obstruction with spirometry and follow-up with sputum cytology provide the widest benefit.     

Inpatient management of chronic obstructive pulmonary disease

Community research and clinical practice have shown that alcohol and drug use and depression are interrelated. Among Hispanics, acculturation may play a role in these relationships. To investigate these relationships as well as alcohol-related problems, we interviewed 288 Puerto Rican, Dominican, and Colombian men in early adulthood. No significant differences emerged in the proportions of abstainers across the three groups. Colombians drank significantly more frequently and had more alcohol-related problems than Dominicans. Dominicans were at least risk for and least likely to have alcohol-related problems. Puerto Ricans were much more likely to use drugs than the other Hispanic men. Drug use was associated with an increased likelihood of heavy drinking which, in turn, increased the risk of drug use and depression. Acculturation decreased the risk of drug use. Results are discussed in terms of implications for community psychology research and interventions.