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Review
. 2012 Apr 7;379(9823):1341-51.
doi: 10.1016/S0140-6736(11)60968-9. Epub 2012 Feb 6.

Chronic obstructive pulmonary disease

Marc Decramer  1 , Wim Janssens, Marc Miravitlles
Affiliations
Review

Chronic obstructive pulmonary disease

Marc Decramer et al. Lancet. .

Abstract

Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction that is only partly reversible, inflammation in the airways, and systemic effects or comorbities. The main cause is smoking tobacco, but other factors have been identified. Several pathobiological processes interact on a complex background of genetic determinants, lung growth, and environmental stimuli. The disease is further aggravated by exacerbations, particularly in patients with severe disease, up to 78% of which are due to bacterial infections, viral infections, or both. Comorbidities include ischaemic heart disease, diabetes, and lung cancer. Bronchodilators constitute the mainstay of treatment: β(2) agonists and long-acting anticholinergic agents are frequently used (the former often with inhaled corticosteroids). Besides improving symptoms, these treatments are also thought to lead to some degree of disease modification. Future research should be directed towards the development of agents that notably affect the course of disease.

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Figures

Figure 1
Figure 1
Comparison of airway features in a healthy individual and in a patient with chronic obstructive pulmonary disease (A) Normal airway. (B) In chronic obstructive pulmonary disease airways are narrowed by infiltration of inflammatory cells, mucosal hyperplasia, and deposition of connective tissue in the peribronchiolar space.
Figure 2
Figure 2
Schematic representation of the mechanisms involved in the pathogenesis of chronic obstructive pulmonary disease The process is essentially characterised by a decline in FEV1 with increasing age. FEV1=forced expiratory volume in 1 s.
Figure 3
Figure 3
Hypothetical cycle of infection and inflammation in COPD COPD=chronic obstructive pulmonary disease. Reproduced from reference 59 by permission of Massachusetts Medical Society.
Figure 4
Figure 4
Comorbidities of chronic obstructive pulmonary disease
Figure 5
Figure 5
FEV1 decline in relation to increasing age in patients with COPD in GOLD stages 2–4 treated with a combined long-acting β2 agonist and inhaled corticosteroid or tiotropium Data from the TORCH and UPLIFT studies are plotted on a Fletcher-Peto diagram. The black dashed line represents the original Fletcher-Peto curve. GOLD=Global Initiative on Obstructive Lung Disease. SFC=salmeterol and fluticasone combined. FEV1=forced expiratory volume in 1 s. Reproduced from reference 117 by permission of BMJ Publishing Group Ltd.
Figure 6
Figure 6
General approach to management of exacerbations in chronic obstructive pulmonary disease
See this image and copyright information in PMC

References

    1. Global Initiative for Chronic Obstructive Lung Disease Global strategy for the diagnosis, management, and prevention of COPD: updated 2010. http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf (accessed Oct 20, 2011).
    1. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. Lancet. 2007;370:741–750. - PubMed
    1. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007;370:765–773. - PubMed
    1. Menezes AM, Perez-Padilla R, Jardim JR, et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet. 2005;366:1875–1881. - PubMed
    1. WHO World health statistics 2008. http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf (accessed Oct 20, 2011).

MeSH terms