Clinical Management of Chronic Obstructive Pulmonary Disease, Second Edition

by Rennard; Stephen I

Edition: 2nd

ISBN13: 9780849375873

ISBN10: 0849375878

Format: Hardcover

Pub. Date: 2007-11-19

Publisher(s): CRC Press

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Summary

Since the publication of the first edition chronic obstructive pulmonary disease (COPD), as a public health issue, has continually increased in line with the predictions of the World Health Organization - unfortunately, this trend is increasing, and by the year 2020 COPD will become one of the main killers of human life. With several important large scaled trials becoming available and our knowledge of COPD's determinants rapidly growing, it was essential to update Clinical Management of Chronic Obstructive Pulmonary Disease with a second edition that will enable physicians to stay informed, aid in the clinical diagnosis, and the proper treatment of COPDWithin this text expert analysis will examineÂ· New treatments and combative strategies developed from recent and current clinical trailsÂ· The pathological and physiological mechanisms of chronic obstructive pulmonary diseaseÂ· Current and up to date information from developing worlds faced with the COPD epidemicÂ· The burden COPD has and will have in the future for patients, treatments and society

Introduction	p. v
Foreword	p. vii
Foreword	p. ix
Preface	p. xv
Contributors	p. xix
Understanding COPD and Its Impact
The Burden of COPD?	p. 1
Introduction	p. 1
Definition and Clinical Features of COPD	p. 1
The Prevalence of COPD	p. 3
Functional Impairment and Office Visits for COPD	p. 6
Emergency Room Visits and Hospitalizations	p. 6
Mortality	p. 7
Economic Burden	p. 7
Natural History	p. 9
The Relevance of Stage 0 Disease	p. 10
Risk Factors	p. 11
Summary	p. 16
Conclusions	p. 17
Acknowledgments	p. 17
References	p. 17
Smoking Cessation	p. 23
Introduction	p. 23
Cigarette Smoking	p. 23
Smoking Cessation: Behavioral Intervention	p. 26
Smoking Cessation: Pharmacotherapy	p. 27
Special Considerations for the COPD Patient	p. 34
Harm Reduction	p. 35
Conclusion	p. 36
References	p. 36
The Relationship of Tobacco Smoking to COPD: Histopathogenesis	p. 43
Introduction	p. 43
The Inflammatory Immune Response	p. 44
The Adaptive Immune Response	p. 45
Tissue Remodeling	p. 48
Chronic Bronchitis	p. 51
Chronic Airflow Limitation	p. 53
Small Airway Obstruction	p. 54
Emphysema	p. 56
The CLE and Panacinar Forms of Emphysema	p. 57
Other Forms of Emphysema	p. 58
Pulmonary Hypertension	p. 58
Summary	p. 61
References	p. 61
COPD as a Systemic Disease	p. 67
Introduction	p. 67
Systemic Inflammation	p. 67
Nutritional Abnormalities and Weight Loss	p. 69
Skeletal Muscle Dysfunction	p. 69
Cardiovascular Effects	p. 70
Nervous System Effects	p. 71
Osteoskeletal Effects	p. 71
Conclusions	p. 71
References	p. 72
Assessing COPD
Early Diagnosis of COPD: Usefulness, Tools, and Actors	p. 77
Introduction	p. 77
Burden of COPD and the Need for Early Diagnosis	p. 78
Currently Available Tools for Prevention and Early Diagnosis of COPD	p. 79
Actors Awaiting Prime Time	p. 85
Summary	p. 85
References	p. 86
Assessment of Symptoms and Quality of Life in the COPD Patient	p. 89
Introduction	p. 89
Why Make Measurements of Symptoms and Quality of Life?	p. 89
Symptoms and Health Status	p. 90
Instruments for Symptoms	p. 95
Instruments for Health Status	p. 98
Factors that Are Related to Health Status in COPD	p. 102
Bronchodilators	p. 107
Specific Issues about Symptoms and Health Status Assessment	p. 110
References	p. 112
Measuring Ventilatory and Respiratory Impairment in COPD	p. 119
Introduction	p. 119
Exercise Testing	p. 120
Maximal Incremental Exercise Testing	p. 120
How to Interpret the Maximal Exercise Test	p. 121
Exercise Endurance Tests	p. 124
Respiratory Muscle Testing	p. 126
Acknowledgments	p. 128
References	p. 128
Imaging of Lung Morphology and Function in COPD	p. 133
Introduction	p. 133
Chest Radiography	p. 133
Computed Tomography	p. 138
Nuclear Medicine	p. 153
MR Imaging	p. 154
References	p. 156
Assessing the Systemic Consequences of COPD	p. 165
Introduction	p. 165
Extrapulmonary Disorders Associated with COPD	p. 165
The Impact of Systemic Consequences of COPD on Mortality	p. 180
Conclusion	p. 181
Acknowledgments	p. 182
References	p. 182
The Pulmonary Vasculature of COPD	p. 189
Introduction	p. 189
Epidemiology	p. 189
Pathology	p. 191
Pathophysiology and Natural History of Pulmonary Hypertension	p. 192
Pathobiology	p. 195
Evaluation and Diagnosis of Pulmonary Hypertension in COPD	p. 197
Treatment	p. 200
References	p. 205
How the COPD Patient Should Be Assessed for Comorbidities	p. 211
Introduction	p. 211
Gold and ATS/ERS Guidelines	p. 212
Comorbidities in General: Definitions	p. 213
Mechanisms on Tobacco and Other Risk Factors	p. 214
Brief on Systemic Inflammation	p. 215
Measurements of Comorbidities in COPD	p. 215
Comorbidities as Specific Causes of Death in COPD Patients	p. 218
Comorbidities by Severity of COPD	p. 219
Comorbidities in Women with COPD	p. 219
Review of Organ-Specific Comorbidities	p. 220
Assessment of Comorbidities in Primary Care	p. 226
Assessment of Comorbidities in Respiratory Medicine	p. 227
Treatment Considerations in COPD	p. 228
Concluding Remarks	p. 231
References	p. 232
Goals of COPD Treatments and Measurement of Their Efficacy: From Clinical Trials to Real-World Practice	p. 239
Introduction	p. 239
Outcomes in Epidemiological and Clinical Studies	p. 239
Outcomes in Clinical and Physiological Studies	p. 244
Conclusion	p. 257
References	p. 257
Pharmacological Treatments of COPD
Choosing the Right Bronchodilator	p. 263
Introduction	p. 263
Goals of Treatment	p. 264
Long-Acting [beta subscript 2]-Agonists	p. 264
Long-Acting Muscarinic Antagonist	p. 266
Effect of Long-Acting Bronchodilators on Goals of Treatment	p. 266
Comparison of Long-Acting [beta subscript 2]-Agonists and Tiotropium	p. 273
Combining Long-Acting [beta subscript 2]-Agonists and Tiotropium as Maintenance Therapy	p. 274
Theophylline	p. 274
Summary	p. 275
References	p. 276
When Should We Use Glucocorticoids in COPD?	p. 281
Introduction	p. 281
Pharmacology and Mechanisms Action	p. 281
Corticosteroids as an Aid to Diagnosis	p. 284
Corticosteroids in Exacerbations of COPD	p. 285
Corticosteroids in Stable Disease	p. 286
Combination Therapy	p. 290
Side Effects	p. 292
Conclusion	p. 293
References	p. 294
Treating and Preventing Infections	p. 297
Introduction	p. 297
Definition and Severity of Exacerbations	p. 298
Pathogenesis of Exacerbations	p. 299
Microbial Pathogens in COPD	p. 299
Pathogenesis of Infectious Exacerbations	p. 302
Treatment of Exacerbations	p. 303
Antibiotics in the Treatment of Exacerbations	p. 304
Risk Stratification of Patients	p. 308
Risk-Stratification Approach to Antibiotic Therapy in Exacerbation	p. 310
Antiviral Therapy for Exacerbations	p. 312
Prevention of Exacerbations	p. 312
Chronic Infection in COPD	p. 314
Community-Acquired Pneumonia in Patients with COPD	p. 317
Conclusions	p. 318
References	p. 318
Phosphodiesterase 4 Inhibitors, Mucolytics, and Emerging Pharmacotherapies for COPD	p. 323
Introduction	p. 323
PDE4 Inhibitors	p. 323
Mucolytics	p. 339
Other New Chemical Entities for COPD	p. 341
Concluding Remarks	p. 341
Acknowledgments	p. 342
References	p. 342
Managing Exacerbations: An Overview	p. 347
Introduction	p. 347
Pathophysiology	p. 348
Prevention of Exacerbations	p. 349
Prevention of Infective Exacerbations	p. 350
Anti-inflammatory Treatment	p. 351
Long-Acting Inhaled Bronchodilators	p. 352
Combination Therapy (LABAs Plus ICs)	p. 354
Triple Combination Therapy (Tiotropium Plus LABA Plus ICs)	p. 354
Mucolytics and Antioxidants	p. 356
Nonpharmacological Treatment	p. 356
Management of Exacerbations	p. 357
Treatment of Exacerbations	p. 359
HaH and Supported Discharge Services	p. 364
References	p. 364
Nonpharmacological Approaches in COPD
Exercise Training in COPD	p. 371
Introduction	p. 371
Exercise Limitation in Lung Disease	p. 372
Exercise Tolerance and Health-Related Quality of Life After Exercise Training	p. 374
The Exercise Training Intervention	p. 374
Pulmonary Rehabilitation: More Than Exercise Training	p. 380
References	p. 380
New Components of Pulmonary Rehabilitation in COPD	p. 385
Introduction	p. 385
New Modalities of Pulmonary Rehabilitation	p. 385
Supplements During Exercise Training	p. 390
Conclusions	p. 392
References	p. 392
Long-Term Oxygen Therapy for the Patient with COPD	p. 397
Introduction	p. 397
Beneficial Effects of LTOT in Hypoxemic COPD	p. 397
Indications of LTOT in COPD	p. 404
Home Oxygen Therapy	p. 408
References	p. 413
Noninvasive Ventilation in COPD	p. 419
Introduction	p. 419
Noninvasive Positive Pressure Ventilation in Exacerbations of COPD	p. 419
The Role of NPPV After IMV	p. 422
Longer Term Effects of NPPV in Exacerbations of COPD	p. 423
When Should NPPV be Discontinued?	p. 424
Where Should NPPV be Performed?	p. 425
Long-Term Domiciliary NPPV for Stable COPD	p. 426
Practical Problems Specific to Patients with COPD	p. 429
Conclusion	p. 430
References	p. 430
Surgical Therapy for COPD
Introduction	p. 435
History of Surgical Therapy for Emphysema	p. 435
Surgical Techniques	p. 436
What Are the Results of Surgery?	p. 437
Which Patients Should and Which Should Not Be Considered for Surgery?	p. 450
Conclusions	p. 462
References	p. 463
Perioperative Medical Management for Patients with COPD: The Anesthesiologist's View	p. 475
Introduction	p. 475
Risk Factors for Postoperative Mortality and Cardiopulmonary Morbidity	p. 479
Respiratory Consequences of Anesthesia and Surgery	p. 487
Principles of Perioperative Anesthetic Care in COPD Patients	p. 493
Conclusions	p. 503
References	p. 504
Providing Palliative and End-of-Life Care for Patients with COPD	p. 515
Introduction	p. 515
What Is Quality Palliative and End-of-Life Care?	p. 516
Do Patients with COPD Receive Less Palliative Care at the End of Life?	p. 517
Relationship Between the Trajectory Toward Death and End-of-Life Care	p. 518
Why Don't Physicians Discuss End-of-Life Care with Patients with Severe COPD?	p. 519
Frequency and Timing of End-of-Life Discussions	p. 521
What Common Symptoms and Conditions Do Patients with COPD Experience at the End of Life?	p. 522
Palliative Treatments for Dyspnea and Other Symptoms	p. 522
Does Patient Health Status Influence the Desire for Life-Sustaining Treatment?	p. 525
Decision Making in the Setting of Depression	p. 525
The Role of Advance Directives	p. 526
Summary	p. 526
Acknowledgments	p. 527
References	p. 527
Conclusion
A Global Strategy for a Global Disease	p. 531
Introduction	p. 531
The First Global COPD Initiative and Guideline: Gold	p. 531
Subsequent Global Initiatives for COPD	p. 533
Bold Project	p. 534
WHO Framework Convention on Tobacco Control	p. 534
Translation into Practice	p. 535
Is One Global COPD Guideline Enough?	p. 536
Are There Deficiencies in Current International COPD Guidelines?	p. 537
A Methodology for Appraising Clinical Practice Guidelines	p. 539
Should Guidelines Have a Standardized Format or Structure?	p. 539
What Are the Barriers to Effective Guideline Implementation?	p. 540
Evaluation of Implementation Strategies	p. 542
Advocacy	p. 543
Summary	p. 543
References	p. 544
Caring for the Patient with COPD: A Practical Summary of Guidelines for Clinicians	p. 547
Introduction	p. 547
Conclusion	p. 561
References	p. 562
Index	p. 565
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