Current Respiratory Medicine Reviews - Volume 9, Issue 6, 2013

Chronic Obstructive Pulmonary Disease (COPD), being a major cause of morbidity and mortality worldwide, is a major problem for public health. It is predicted that its burden will continuously expand over the next years. This article is an up-to-date review of both non-pharmacologic and pharmacologic management of COPD, which is now based on new staging systems, able to predict prognosis and the response to different treatment approaches. Non-pharmacologic therapies, such as smoking cessation, vaccinations and pulmonary rehabilitation are covered briefly. Current pharmacologic management covers short acting beta-agonists (SABA), short acting muscarinic antagonists (SAMA), long acting beta agonists (LABA), long acting antimuscarinics (LAMA), inhaled corticosteroids (ICS), LABA/ICS combinations, xanthines, specific phosphodiesterase 4 (PDE4) inhibitors and oxygen therapy.

COPD is the third leading cause of death worldwide and a major cause of morbidity. Infection complicates COPD, both when patients are stable and during exacerbations. Exacerbations drive disease progression, lung function decline and premature death, therefore understanding and targeting airway infection are considered crucial. The interactions of bacteria, viruses and airway inflammation have all been shown to be a factor in stable COPD and in exacerbations. New molecular microbiology techniques are changing our view of COPD, identifying new bacterial species and a diverse microbiome which can be disturbed in chronic lung disease. Bronchiectasis is increasingly recognized in COPD, and may be a distinct sub-type or “phenotype” of disease associated with greater bacterial colonization and inflammation. Increasingly, severe infections, and particularly pneumonia are recognized as common in COPD, and the role of inhaled corticosteroids in provoking bacterial colonization and development of pneumonia requires careful consideration. Long term antibiotic therapies are being explored as a means to prevent exacerbations and disease progression in COPD. This paper brings together the current knowledge related to the role of infection in COPD.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide. Disease severity evaluation was based on airflow limitation for many years. However, it is now obvious that no single parameter can describe the complexity of COPD and a more holistic approach should be utilised. For this reason, newer classifications of the disease are based on multiple clinical characteristics or biomarkers that can predict different clinically meaningful outcomes, such as symptoms, frequency of exacerbations, progression of disease, response to different medications and mortality. Ongoing research highlights such biomarkers, while guidelines have already incorporated them, as the basis of clinical phenotypes. GOLD highlights the need for more intensive treatment of frequent exacerbators and COPD patients whose disease significantly burdens their quality of life. Moreover, a COPD-asthma overlap syndrome with a different prognosis and potentially different therapeutic approach is also recognised. Spanish guidelines also group frequent exacerbators to predominantly emphysematic versus predominantly bronchitic. Another approach aims to create scoring systems, or multidimensional indices, based on multiple biomarkers which evaluate different aspects of the disease. The recognition of all these prognostic and therapeutic patient subgroups lead to a more personalised approach to each patient and also provides data to the –omics to uncover the pathogenetic background of this diversity and develop new targeted treatments.

Despite optimal pharmacologic treatment, smoking cessation and pulmonary rehabilitation, patients with severe COPD remain significantly disabled with impaired quality of life. Lung volume reduction surgery has been an alternative intervention to the treatment of selected end stage cases offering improved quality of life. However, its increased early mortality, risks and patient burden led to the development of new therapeutic modalities. Over the last years, interventional bronchoscopies have made considerable progress in the minimal invasive treatment of emphysema with the application of endobronchial valves and endobronchial recoils. In this paper we will review the clinical outcomes, benefits, risks and complications of these two modalities.

Chronic obstructive pulmonary disease (COPD) is highly prevalent worldwide. Its morbidity and mortality are increasing and it is predicted to be the third leading cause of death by 2020. COPD and cardiovascular disease (CVD) are chronic conditions that share many risk factors and a complex pathophysiology. Current literature has closely focused on the relationship between these two diseases and today COPD is considered to be an independent risk factor for CVD, which is the leading cause of death in approximately 50% of COPD patients. Coronary artery disease, congestive heart failure, pulmonary hypertension, cardiac arrhythmias, peripheral artery and cerebrovascular disease have been documented to present more frequently in COPD patients than in individuals without COPD. Moreover, despite the fact that the exact pathophysiologic mechanism linking COPD to CVD is not yet found, systemic inflammation is one of the most likely protagonists of this connection, as atherosclerosis is directly associated with inflammation. Finally, the aim of this review is to assess the prevalence of cardiovascular comorbidities on COPD patients, to detect the possible pathophysiological mechanisms and to discuss the available therapeutic options aimed at managing these comorbidities and reducing the COPD associated cardiovascular risk.

Chronic Obstructive Pulmonary Disease (COPD) is the fourth recognized cause of death worldwide. Smoking is known as the most important risk factor for COPD with nicotine abstinence being the most effective COPD prophylaxis. Smoking cessation programs are less effective and may be considered as disease secondary prevention actions with smoking cessation slowing down lung function decline. Severe exacerbations, if not treated, on time are responsible for the highest number of lung related deaths among COPD patients. As the definition of COPD exacerbation may be subjective, diagnosing a COPD exacerbation can be difficult, especially among less educated patients. This problem may be even more important in areas where the doctor/patient ratio is small and where patients need to travel long distances to obtain consultation and medical help. For these reasons COPD telemonitoring programs are being tested in some countries. This review is an overview of the current scientific evidence regarding patient education and telemonitoring in COPD. The evidence provided, herein, is presented to help identify the effectiveness of education and telemonitoring in COPD in societies with different economies.

Background: Hemoptysis occurs commonly in patients with Cystic Fibrosis, and massive bleeding requiring emergent intervention occurs in a subset. Bronchial artery embolization (BAE) is recommended in clinically unstable CF patients with massive hemoptysis (MH); however, no consensus exists regarding selective versus extensive embolization, and recommendations of targets are scant. Objective: We sought to characterize the frequency of abnormal bronchial circulation in MH in CF in order to suggest interventional approach for BAE. Methods: A retrospective chart review of BAE for MH was performed. Characterization of angiography was described, and CF and non-CF patients were compared. Results: 10 CF and 7 non-CF patients with MH were identified. Dilated, tortuous bronchial vessels were ubiquitous in CF, and 70% had non-bronchial collaterals. CF patients required more extensive BAE and 50% had >1 collateral. Anomalous supplies were described, and a correlation between the volume of hemoptysis and number of collaterals was determined. Conclusion: Anomalous bronchial arteries origin and supply should be suspected in CF. Angiographic approach in CF should include arch aortograms to demonstrate entire supply of the bronchial arterial field.

This review addresses the need for greater awareness, timely and accurate diagnoses, as well as effective management of mild-to-moderate COPD in the primary care setting. A PubMed literature search was used to identify the epidemiology of undiagnosed COPD, and the potential benefits of early diagnosis that may result in improved outcomes for these patients. Lung function impairment and disabling symptoms have been detected in patients with mild undiagnosed COPD, with these patients showing significant limitations and physical impairment, which worsen over time. The 2014 GOLD guidelines emphasize the need for early detection, prevention, and approaches to management of COPD, including smoking cessation, early pharmacotherapy, and pulmonary rehabilitation, and recommend using a fixed forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of <0.70 in addition to symptoms and exacerbation risk to confirm diagnosis. Screening may represent a feasible approach to identify patients with mild-to-moderate disease. Screening tools, i.e. questionnaires and targeted spirometry, can aid early detection of COPD in people identified as at risk. Pharmacologic and non-pharmacologic interventions have been shown to improve patient care and quality of life; however, to date, only smoking cessation has been shown conclusively to slow COPD disease progression. Primary care professionals are in an excellent position to identify and diagnose COPD, and implement recommended treatment programmes, before it becomes advanced.