Chronic Obstructive Pulmonary Disease
Evaluation
General—progressive airflow limitation secondary to chronic inflammation of the lung and airways
This process that destroys the lung results in emphysema, chronic bronchitis, or both.
Emphysema—disease of small airways and alveoli with mucous gland hyperplasia
Chronic bronchitis—cough and sputum on most days for ≥3 months over 2 years
Mechanism—not fully understood, but perhaps due to chronic inflammation from inhaled irritants
Epidemiology—approximately 20% of adult Americans have COPD
Risk factors—irritants such as smoking; 90% of cases with smoking as their cause
Staging (as per the Global Initiative for Chronic Obstructive Lung Disease [GOLD]) (see Table 2.14.1)
Management of chronic obstructive pulmonary disease exacerbations
Clinical—worsening dyspnea, more purulent and increased sputum production
Etiology—infectious (most often), environmental irritants, congestive heart failure, noncompliance with medications
Common infectious causes
Treatment
Inhaled bronchodilators—use nebulizer; proper metered dose inhaler (MDI) use is difficult in an exacerbation.
Antibiotics
For mild-moderate exacerbations (which could be managed as an outpatient)
Patients older than 65 years or with more than four exacerbations per year, consider
