Emerging concepts and therapies for chronic obstructive pulmonary disease

Abstract

REVIEW ARTICLE Emerging concepts and therapies for chronic obstructive pulmonary disease 303 Diagnosis and symptom identification The cornerstone for the diagnosis of chronic obstructive pulmonary disease (COPD) remains evidence of airflow obstruction on spirometry with the forced expiratory volume in 1 second (FEV 1 ) to forced vital capacity ratio of less than 70%.1 Patients with compatible symptoms require spirometry to confirm airway obstruction, and FEV 1 is still used as the marker of the grade of COPD to guide treatment.The assessment, however, should not end there. A careful history of symptoms, such as dyspnea, cough, and sputum production, should also be included in the initial assessment. New tools such as the COPD assessment test (CAT) questionnaire have been shown to be useful in identifying the importance of a variety of symptoms in COPD and can be responsive to functional changes. It is a questionnaire that the patient can self-administer with 8 questions graded on a scale from 0 to 5, with a total score that can be monitored for changes over time. The CAT has been shown to deteriorate with exacerbations and is a tool that was developed to assess symptoms on a longitudinal basis. 2,3 The components of CAT may even be helpful to identify those who have COPD in the general population. 4Exacerbations are increasingly being identified as pivotal events in the disease course of a patient with COPD. The history of having an exacerbation is the single best predictor of having a subsequent exacerbation; thus, the history and frequency of exacerbations should be assessed at every visit. 5 More recent data has looked at the long-term outcome of patients after suffering their first severe exacerbation requiring hospitalization. Suissa et al. 6 investigated 73,106 patients during a 17-year follow-up. The risk of subsequent exacerbations rose 3-fold after the second serious exacerbation, and it seemed that the optimal time to intervene would be after the first exacerbation to prevent any subsequent exacerbations. REVIEW ARTICLE AbsTRACTChronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. Although considerable advances have been made in the diagnosis and treatment of COPD, much remains to be done both to alleviate symptoms and reduce mortality associated with this condition. Previously, diagnosis, management, and research all centred on staging based on the forced expiratory flow in 1 second. It is now becoming apparent that this is inadequate to truly capture current disease burden and future deterioration. Fortunately, new approaches to care are constantly being identified. It is now known that symptoms and, in particular, exacerbations represent pivotal events in the patient's life that should trigger optimization of care. Much work is currently underway to identify various phenotypes in COPD because it has become obvious that this is a heterogeneous disease and applying the same management algorithms for all patients is insufficient. Several new me...

To study indication’s outcomes and complications of non-invasive ventilation in acute respiratory failure

“…14 De Mi chelis et al and Raghavan et al in their study showed a significant reduction in ICU admissions, length of hospital stay, increase in survival rates, and decrease in the number of tracheostomies related to COPD exacerbations. 15,16 Therefore, NIV is effective in management of acute exacerbation of chronic obstructive pulmonary disease along with antibiotics and bronchodilators.…”