Table of Contents

Title Page

Copyright

Contributors

Foreword

Chapter 1: Definition, Epidemiology and Risk Factors

Definition

Epidemiology

Risk Factors

Chapter 2: Pathology and Pathogenesis

Introduction

Pathology

Pathogenesis

Pathophysiology

Pathology, Pathogenesis and Pathophysiology of Exacerbations

Chapter 3: Diagnosis

Clinical Features

Investigations

Chapter 4: Spirometry

Introduction

What is Spirometry?

Why Perform Spirometry?

Types of Spirometer

Spirometric Indices

Interpretation and Classification of Spirograms

Bronchodilator Reversibility Testing

Severity of Airflow Obstruction in COPD

Flow/volume Measurement

How to Perform Spirometry

Contraindications to Spirometry

Accuracy and Quality of Traces

Equipment Maintenance and Calibration

Infection Control

Training

Chapter 5: Smoking Cessation

Effects of Cigarette Smoking

Primary Prevention of COPD

Smoking Cessation

Helping Patients with COPD Stop Smoking

Implementing Smoking Cessation in Routine Care

Chapter 6: Non-pharmacological Management

Pulmonary Rehabilitation

Immunisation

Anxiety and Depression

Surgery

Chapter 7: Pharmacological Management (I) – Inhaled Treatment

Physiological Effects of Inhaled Bronchodilators

Short-acting Bronchodilators

Long-acting Bronchodilators

Inhaled Corticosteroids

Combined Inhaled Corticosteroid Plus Long-acting β2-agonist Inhalers

Triple Therapy

Summary of Inhaled Treatment

Chapter 8: Pharmacological Management (II) – Oral Treatment

Theophylline

Oral Corticosteroids

Mucolytics

Other Drugs

Chapter 9: Inhalers

Choosing the Correct Inhaler

Different Types of Inhalers

Nebulisers

Chapter 10: Oxygen

Oxygen Physiology

Pulse Oximetry

Oxygen During Exacerbations of COPD

Long-term Oxygen Therapy

Ambulatory Oxygen

Short Burst Oxygen

Air Travel and Oxygen

Chapter 11: Exacerbations

Definition

Aetiology

Impact

Investigations

Management

Assisted Hospital Discharge

Monitoring While in Hospital

Outpatient Follow-up

Frequent Exacerbations

Prevention of Exacerbations

Chapter 12: Non-invasive Ventilation

How Non-invasive Ventilation Works

When to Use Non-invasive Ventilation in COPD

Setting

How to Use Non-invasive Ventilation

Monitoring Non-invasive Ventilation

Other Measures

Problems with Non-invasive Ventilation

Domiciliary Non-invasive Ventilation

Mechanical Ventilation

Chapter 13: Primary Care

Identification of Patients

Spirometry

Follow-up of Stable COPD in the Community

Organisation of Care at a Practice Level

National Strategy

Smoking Cessation

Referral for Specialist Opinion

Management of Stable Disease

Management of Acute Exacerbations

Chapter 14: Death, Dying and End-of-Life Issues

Maintaining Quality of Life

When Do Patients Enter a Palliative Phase?

Symptoms

Advanced Care Planning

Advance Refusal of Treatment

End-of-life Care

Chapter 15: Future Treatments

The Continuing Challenge of Drug Development

New Bronchodilators

More Effective Smoking Cessation Strategies

Treating Pulmonary Inflammation

Lung Repair

Route of Delivery

Index

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Library of Congress Cataloging-in-Publication Data

ABC of COPD / edited by Graeme P. Currie.—2nd ed.

p. cm.—(ABC series)

Includes bibliographical references and index.

ISBN 978-1-4443-3388-6

1. Lungs—Diseases, Obstructive. I. Currie, Graeme P. II. Series: ABC series (Malden, Mass.)

[DNLM: 1. Pulmonary Disease, Chronic Obstructive. WF 600]

RC776.O3A23 2011

616.2′4—dc22

2010029198

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9781444329476; ePub 9781444329483

1 2011

Contributors

Foreword

Chronic obstructive pulmonary disease (COPD) is a major global epidemic. It already is the fourth commonest cause of death in high income countries and is predicted to soon become the third commonest cause of death worldwide. In the United Kingdom, the mortality from COPD in women now exceeds that from breast cancer. COPD is also predicted to become the fifth commonest cause of chronic disability, largely because of the increasing levels of cigarette smoking in developing countries in conjunction with an ageing population. It now affects approximately 10% of men and women over 40 years in the United Kingdom and is one of the commonest causes of hospital admission. Because of this, COPD has an increasing economic impact, and direct healthcare costs now exceed those of asthma by more than threefold. Despite these startling statistics, COPD has been relatively neglected and is still underdiagnosed in primary care settings. This is in marked contrast to asthma, which is now recognised and well managed in the community. The new NHS National Strategy seeks to improve diagnosis and management of COPD in the community and reduce hospital admissions.

Highly effective treatment is now available for asthma, which has in turn transformed patients' lives. Sadly, this is not the case with COPD, where management is less effective and no drug has so far been shown to convincingly slow progression of the disease. However, we do now have effective bronchodilators and non-pharmacological treatments, which can improve the quality of life of patients. Many patients, however, are not diagnosed or undertreated, so increased awareness of COPD is needed. There are advances in understanding the underlying inflammatory disease, so this may lead to more effective use of existing treatment and the development of new drugs in the future. In this second edition of the ABC COPD monograph, Graeme Currie and colleagues provide a timely update on the pathophysiology, diagnosis, and modern management of COPD. It is vital that COPD is recognised and treated appropriately in general practice where the majority of patients are managed, and this book provides a straightforward overview of the key issues relating to this important condition.

Peter J. Barnes FRS, FMedSci

Head of Respiratory Medicine

National Heart & Lung Institute

Imperial College London

London, UK