Chronic Obstructive Pulmonary Disease – A Contemporary View

Chronic Obstructive Pulmonary Disease – A Contemporary View

Klein Lorenzo W, Scanlon Paul D
Citation: European Respiratory Disease 2009;5(1):25-28
Published: October 2009
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Abstract
Chronic obstructive pulmonary disease (COPD) is a major health challenge worldwide. Recent advances in our understanding of this condition accompanied by increased funding for research have led to improved and novel treatment approaches. The purpose of this article is to familiarise practitioners with the current treatment guidelines for COPD, including supportive interventions such as pulmonary rehabilitation. We point out common errors and misconceptions in the treatment of COPD, in particular underutilisation of long-acting bronchodilators and overuse of inhaled corticosteroids. COPD is a chronic yet treatable disease, with important benefits for patients in terms of quality and longevity of life when current treatment options are applied appropriately.

Keywords
Chronic obstructive pulmonary disease (COPD), pulmonary disease, chronic obstructive, bronchodilator agents, long-acting bronchodilators, salmeterol, tiotropium, COPD exacerbation

Disclosure: Lorenzo W Klein has no conflicts of interest to declare. Paul D Scanlon receives salary support from clinical research studies sponsored by Boehringer Ingelheim, Dey L.P. Pharmaceutical, GlaxoSmithKline, Novartis AG and Pfizer Inc. He has no related investments and receives no other income related to the subject of this manuscript.
Acknowledgement: Reprinted with permission from Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: Updated 2007 – Executive Summary. Global Initiative for Chronic Obstructive Lung Disease (GOLD)™, © 2006 Medical Communications Resources, Inc., www.goldcopd.com/ Guidelineitem.asp?l1=2&l2=1&intId=996
Received: 19 August 2008 Accepted: 8 July 2009
Correspondence: Paul D Scanlon, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, US. E: pscanlon@mayo.edu

Chronic obstructive pulmonary disease (COPD) is very common and is increasing in prevalence, particularly in the developing world. In the US it is the fourth leading cause of death and was responsible for 119,000 deaths in 2000 alone. It has a similar impact throughout the economically developed world. In developing countries, its adverse impact is growing rapidly. It is expected to be the fifth leading cause of death worldwide by 2020.1 Until recently, an inappropriate nihilistic attitude has prevailed regarding COPD. It is often stated that COPD is not curable; however, this is true of many, perhaps most, diseases encountered in internal medicine. It is not a cause for despair. COPD is a treatable and preventable disease. With appropriate treatment, symptoms, pulmonary function, exercise capacity and quality of life can be improved and the frequency of exacerbations reduced. Recent evidence even indicates improved survival with therapy for advanced disease. The vast majority of persons with COPD have mild or moderate disease and need little or no medical intervention to stabilise their lung function. Persons with COPD, particularly those in the early stages, are more likely to die of other diseases, particularly lung cancer and cardiovascular disorders.2 Until recently, research in COPD has been chronically underfunded. In the past few years, the National Heart, Lung, and Blood Institute (NHLBI) and other research funding agencies have increased funding for research into COPD. The research community has responded by improving its understanding of the disease and by beginning further development in treatment.

Treatment of Chronic Obstructive Pulmonary Disease
The management of COPD has been refined in recent years with rapid evolution of the evidence base for therapy. Evidence- and consensus-based guidelines have been developed. Two are widely used, and are concordant in important details. They include the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines (www.goldcopd.com/) and the Standards for the Diagnosis and Management of Patients with COPD by the American Thoracic Society (ATS) and the European Respiratory Society (ERS) (www.thoracic.org/sections/copd/index.html). The GOLD guidelines were updated in 2007,3 and the ATS/ERS guidelines in 2004. There is still a gap in understanding and compliance with these guidelines.

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Keywords:
Chronic obstructive pulmonary disease (COPD), pulmonary disease, chronic obstructive, bronchodilator agents, long-acting bronchodilators, salmeterol, tiotropium, COPD exacerbation

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