Managing COPD by Richard EK Russell

By Richard EK Russell

The booklet comprises thoughts for COPD from released guidance (eg, the GOLD, ATS, and great directions) and offers them within the context of proper scientific remedy matters. this is often an in-depth consultant at the administration of COPD, targeting the influence of COPD on a sufferer in addition to how healthcare execs can intrude and teach the sufferer at an early level and thereby sluggish the onset of critical symptoms.

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Example text

Approximately 10% of patients with stable COPD show some symptomatic and objective improvement with oral corticosteroids. These patients may have concomitant asthma, as both diseases are very common. Furthermore, they have elevated sputum eosinophils (>3%) and exhaled nitric oxide, which are features of asthmatic inflammation. Long-term treatment with high doses of inhaled corticosteroids fails to reduce disease progression, even at the early stages of the disease. However, there is a small protective effect against acute exacerbations in patients with severe disease (~20% reduction).

The area within the lungs that is available for diffusion is 70 m2, about the same as a tennis court. Each section of lung tissue has a network of pulmonary arteries and veins intimately associated with it — the respiratory bronchiole. This normal structure is deformed in COPD, and emphysema occurs when the alveoli become enlarged and damaged with loss of elastic recoil. This in turn results in a loss of surface area for gas exchange and ventilatory and perfusion mismatching. It is unclear how this process occurs, although the finding of large numbers of inflammatory cells in emphysematous lungs suggests that the process is an abnormal response to injury.

In COPD, the trigger is cigarette smoke, which irritates the airway epithelium and airway macrophages, causing a neutrophilic inflammatory response coordinated by macrophages and CD8+ T-lymphocytes with comparatively little mast cell activation. Asthma may begin early in life and persist or may wax and wane through childhood and adulthood. In contrast, COPD is a disease that has an insidious onset in adult life and is strongly related (at least in the developed world) to cigarette smoke. The breathlessness of asthma is variable and may change with trigger factors and treatment.

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