Chronic obstructive pulmonary disease
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines chronic obstructive pulmonary disease (COPD) as a “heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration, exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.”
How prevalent is COPD?
COPD is the third highest cause of death globally and affects around 12% of the general population.
What are the risk factors for COPD?
Risk factors for COPD include:
- Smoking
- Ambient air pollution, including nitrogen dioxide
- A low body mass index (BMI)
- Indoor biomass burning
- Childhood asthma
- Occupational dust exposure
- Diet
- Genetic abnormalities, such as α1 antitrypsin deficiency
How is COPD diagnosed?
Spirometry is necessary to diagnose COPD by determining the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC). A post-bronchodilator FEV1/FVC of <0.7 indicates the presence of persistent airflow obstruction and confirms a diagnosis of COPD. Further investigation is undertaken to assess symptoms, disease severity, and risk of exacerbations (ECOPD), which is defined as “an event characterized by dyspnea and/or cough and sputum that worsen over <14 days.”
How can COPD be managed without pharmacological therapy?
Non-pharmacological approaches include:
- Avoiding active and passive smoking
- Limiting exposure to air pollution
- Maintaining a physical activity routine
- Pulmonary rehabilitation programs
What pharmacological therapies are available for COPD?
Currently available pharmacological therapies aim to improve airflow with bronchodilators (β2-adrenoceptor agonists or muscarinic receptor antagonists), suppress inflammation with corticosteroids or phosphodiesterase 4 (PDE4) inhibitors, or reduce exacerbations with antibiotics. Numerous therapies, including biologics that target cytokines known to be involved in type 2 inflammation, are under clinical investigation for reducing exacerbations or mortality in COPD.
