Journal Article

Chronic obstructive pulmonary disease

Wouters, Emiel F. M., Wedzicha, Jadwiga A., Silverman, Edwin K., Celli, Bartolome R., Vestbo, Jørgen, Burney, Peter G. J., Barnes, Peter J.

2015

Overview

Chronic obstructive pulmonary disease (COPD) is a common disease with high global morbidity and mortality. COPD is characterized by poorly reversible airway obstruction, which is confirmed by spirometry, and includes obstruction of the small airways (chronic obstructive bronchiolitis) and emphysema, which lead to air trapping and shortness of breath in response to physical exertion. The most common risk factor for the development of COPD is cigarette smoking, but other environmental factors, such as exposure to indoor air pollutants — especially in developing countries — might influence COPD risk. Not all smokers develop COPD and the reasons for disease susceptibility in these individuals have not been fully elucidated. Although the mechanisms underlying COPD remain poorly understood, the disease is associated with chronic inflammation that is usually corticosteroid resistant. In addition, COPD involves accelerated ageing of the lungs and an abnormal repair mechanism that might be driven by oxidative stress. Acute exacerbations, which are mainly triggered by viral or bacterial infections, are important as they are linked to a poor prognosis. The mainstay of the management of stable disease is the use of inhaled long-acting bronchodilators, whereas corticosteroids are beneficial primarily in patients who have coexisting features of asthma, such as eosinophilic inflammation and more reversibility of airway obstruction. Apart from smoking cessation, no treatments reduce disease progression. More research is needed to better understand disease mechanisms and to develop new treatments that reduce disease activity and progression. Chronic obstructive pulmonary disease (COPD) is characterized by damage to the lungs and consequent obstruction of the airways, and is strongly associated with smoking. This Primer discusses the causes and mechanisms of COPD and approaches to its diagnosis and management.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/1807/1809 / 692/420/256/2515 / 692/699/1785 / Administration, Inhalation / Adrenal Cortex Hormones - administration & dosage / Airway management / Airway Obstruction - etiology / Bronchodilator Agents - administration & dosage / Bronchodilators / Cancer Research / Chronic obstructive pulmonary disease / Cigarette Smoking - adverse effects / Disease Progression / Epidemiology / Humans / Internal Medicine / Lung - physiopathology / Medical Microbiology / Medicine / Medicine & Public Health / primer / Prognosis / Pulmonary Disease, Chronic Obstructive - drug therapy / Pulmonary Disease, Chronic Obstructive - etiology / Pulmonary Disease, Chronic Obstructive - physiopathology / Quality of Life Research / Risk Factors / Smoking