Chronic Obstructive Pulmonary Disease
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and progressive airflow obstruction. Tobacco smoking is the leading cause but not the only one. A postbronchodilator FEV1–FVC ratio less than 0.70 is required for a diagnosis of COPD. Inhaler therapy is the backbone of treatment and should be complemented by a multifaceted management strategy that includes counseling and pharmacotherapy for smoking cessation, pulmonary rehabilitation, treatment of comorbidities, administration of influenza and pneumococcal immunizations, and prescription of long-term oxygen therapy in hypoxemic patients.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Global Initiative for Chronic Obstructive Lung Disease website. Accessed at www.goldcopd.org on 10 January 2020.
2.
Qaseem A, Wilt TJ, Weinberger SE, et al; American College of Physicians. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155:179-91. [PMID: 21810710]. doi: 10.7326/0003-4819-155-3-201108020-00008
3.
U.S. Department of Veterans Affairs; U.S. Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Chronic Obstructive Pulmonary Disease. 2014. Accessed at www.healthquality.va.gov/guidelines/CD/copd on 12 January 2020.
4.
National Institute for Health and Care Excellence. Chronic Obstructive Pulmonary Disease in Over 16s: Diagnosis and Management. 2018. Accessed at www.nice.org.uk/guidance/ng115 on 12 January 2020.
5.
American Thoracic Society. ATS Official Documents. Accessed at www.thoracic.org/statements/copd.php on 10 January 2020.
6.
Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-128. [PMID: 23245604] doi: 10.1016/S0140-6736(12)61728-0
7.
Adeloye D, Chua S, Lee C, et al; Global Health Epidemiology Reference Group (GHERG). Global and regional estimates of COPD prevalence: systematic review and meta-analysis. J Glob Health. 2015;5:020415. [PMID: 26755942] doi: 10.7189/jogh.05-020415
8.
Centers for Disease Control and Prevention. Data and Statistics: COPD Death Rates in the United States. 2018. Accessed at www.cdc.gov/copd/data.html on 9 January 2020.
9.
Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet. 2009;374:733-43. [PMID: 19716966] doi: 10.1016/S0140-6736(09)61303-9
10.
Rennard SI, Vestbo J. COPD: the dangerous underestimate of 15%. Lancet. 2006;367:1216-9. [PMID: 16631861]
11.
Lamprecht B, McBurnie MA, Vollmer WM, et al; BOLD Collaborative Research Group. COPD in never smokers: results from the population-based Burden of Obstructive Lung Disease study. Chest. 2011;139:752-63. [PMID: 20884729] doi: 10.1378/chest.10-1253
12.
Perez-Padilla R, Fernandez R, Lopez Varela MV, et al. Airflow obstruction in never smokers in five Latin American cities: the PLATINO study. Arch Med Res. 2012;43:159-65. [PMID: 22475778] doi: 10.1016/j.arcmed.2012.03.007
13.
Siu AL, Bibbins-Domingo K, Grossman DC, et al; US Preventive Services Task Force (USPSTF). Screening for chronic obstructive pulmonary disease: US Preventive Services Task Force recommendation statement. JAMA. 2016;315:1372-7. [PMID: 27046365] doi: 10.1001/jama.2016.2638
14.
Soriano JB, Zielinski J, Price D. Screening for and early detection of chronic obstructive pulmonary disease. Lancet. 2009;374:721-32. [PMID: 19716965] doi: 10.1016/S0140-6736(09)61290-3
15.
Martinez FJ, Mannino D, Leidy NK, et al; High-Risk-COPD Screening Study Group. A new approach for identifying patients with undiagnosed chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017;195:748-56. [PMID: 27783539] doi: 10.1164/rccm.201603-0622OC
16.
Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005-12. [PMID: 14999112]
17.
Coleman JM 3rd, Wolfe LF, Kalhan R. Noninvasive ventilation in chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2019;16:1091-8. [PMID: 31185181] doi: 10.1513/AnnalsATS.201810-657CME
18.
Bafadhel M, Peterson S, De Blas MA, et al. Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease: a post-hoc analysis of three randomised trials. Lancet Respir Med. 2018;6:117-26. [PMID: 29331313] doi: 10.1016/S2213-2600(18)30006-7
19.
Rizkallah J, Man SFP, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis. Chest. 2009;135:786-93. [PMID: 18812453] doi: 10.1378/chest.08-1516
20.
American Thoracic Society. American Thoracic Society/European Respiratory Society statement: standards for the diagnosis and management of individuals with alpha-1 antitrypsin deficiency. Am J Respir Crit Care Med. 2003;168:818-900. [PMID: 14522813]
21.
Sandhaus RA, Turino G, Brantly ML, et al. The diagnosis and management of alpha-1 antitrypsin deficiency in the adult. Chronic Obstr Pulm Dis. 2016;3:668-82. [PMID: 28848891] doi: 10.15326/jcopdf.3.3.2015.0182
22.
Chapman KR, Burdon JG, Piitulainen E, et al; RAPID Trial Study Group. Intravenous augmentation treatment and lung density in severe a1 antitrypsin deficiency (RAPID): a randomised, double-blind, placebo-controlled trial. Lancet. 2015;386:360-8. [PMID: 26026936] doi: 10.1016/S0140-6736(15)60860-1
23.
Chen W, Thomas J, Sadatsafavi M, et al. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3:631-9. [PMID: 26208998] doi: 10.1016/S2213-2600(15)00241-6
24.
Yohannes AM, Alexopoulos GS. Depression and anxiety in patients with COPD. Eur Respir Rev. 2014;23:345-9. [PMID: 25176970] doi: 10.1183/09059180.00007813
25.
Woodruff PG, van den Berge M, Boucher RC, et al. American Thoracic Society/National Heart, Lung, and Blood Institute asthma-chronic obstructive pulmonary disease overlap workshop report. Am J Respir Crit Care Med. 2017;196:375-81. [PMID: 28636425] doi: 10.1164/rccm.201705-0973WS
26.
Anthonisen NR, Skeans MA, Wise RA, et al; Lung Health Study Research Group. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142:233-9. [PMID: 15710956]
27.
Jiménez-Ruiz CA, Andreas S, Lewis KE, et al. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J. 2015;46:61-79. [PMID: 25882805] doi: 10.1183/09031936.00092614
28.
Cho-Reyes S, Celli BR, Dembek C, et al. Inhalation technique errors with metered-dose inhalers among patients with obstructive lung diseases: a systematic review and meta-analysis of U.S. studies. Chronic Obstr Pulm Dis. 2019;6:267-80. [PMID: 31342732] doi: 10.15326/jcopdf.6.3.2018.0168
29.
Tashkin DP, Celli B, Senn S, et al; UPLIFT Study Investigators. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008;359:1543-54. [PMID: 18836213] doi: 10.1056/NEJMoa0805800
30.
Vogelmeier C, Hederer B, Glaab T, et al; POET-COPD Investigators. Tiotropium versus salmeterol for the prevention of exacerbations of COPD. N Engl J Med. 2011;364:1093-103. [PMID: 21428765] doi: 10.1056/NEJMoa1008378
31.
Oba Y, Keeney E, Ghatehorde N, et al. Dual combination therapy versus long-acting bronchodilators alone for chronic obstructive pulmonary disease (COPD): a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2018;12:CD012620. [PMID: 30521694] doi: 10.1002/14651858.CD012620.pub2
32.
Lipson DA, Barnhart F, Brealey N, et al; IMPACT Investigators. Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med. 2018;378:1671-80. [PMID: 29668352] doi: 10.1056/NEJMoa1713901
33.
Chapman KR, Hurst JR, Frent SM, et al. Long-term triple therapy de-escalation to indacaterol/glycopyrronium in patients with chronic obstructive pulmonary disease (SUNSET): a randomized, double-blind, triple-dummy clinical trial. Am J Respir Crit Care Med. 2018;198:329-39. [PMID: 29779416] doi: 10.1164/rccm.201803-0405OC
34.
Albert RK, Connett J, Bailey WC, et al; COPD Clinical Research Network. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365:689-98. [PMID: 21864166] doi: 10.1056/NEJMoa1104623
35.
Martinez FJ, Calverley PM, Goehring UM, et al. Effect of roflumilast on exacerbations in patients with severe chronic obstructive pulmonary disease uncontrolled by combination therapy (REACT): a multicentre randomised controlled trial. Lancet. 2015;385:857-66. [PMID: 25684586] doi: 10.1016/S0140-6736(14)62410-7
36.
Poole PJ, Chacko E, Wood-Baker RW, et al. Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006:CD002733. [PMID: 16437444]
37.
Centers for Disease Control and Prevention (CDC). Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010;59:1102-6. [PMID: 20814406]
38.
Matanock A, Lee G, Gierke R, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019;68:1069-75. [PMID: 31751323] doi: 10.15585/mmwr.mm6846a5
39.
Walters JA, Tang JN, Poole P, et al. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017;1:CD001390. [PMID: 28116747] doi: 10.1002/14651858.CD001390.pub4
40.
Wedzicha JA, Miravitlles M, Hurst JR, et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017;49. [PMID: 28298398] doi: 10.1183/13993003.00791-2016
41.
Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987;106:196-204. [PMID: 3492164]
42.
Sethi S. Infectious exacerbations of chronic bronchitis: diagnosis and management. J Antimicrob Chemother. 1999;43 Suppl A:97-105. [PMID: 10225579]
43.
Walters JA, Tan DJ, White CJ, et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014:CD001288. [PMID: 25178099] doi: 10.1002/14651858.CD001288.pub4
44.
Leuppi JD, Schuetz P, Bingisser R, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA. 2013;309:2223-31. [PMID: 23695200] doi: 10.1001/jama.2013.5023
45.
McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015:CD003793. [PMID: 25705944] doi: 10.1002/14651858.CD003793.pub3
46.
Puhan MA, Gimeno-Santos E, Cates CJ, et al. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2016;12:CD005305. [PMID: 27930803] doi: 10.1002/14651858.CD005305.pub4
47.
Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Intern Med. 1980;93:391-8. [PMID: 6776858]
48.
Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema. Report of the Medical Research Council Working Party. Lancet. 1981;1:681-6. [PMID: 6110912]
49.
Albert RK, Au DH, Blackford AL, et al; Long-Term Oxygen Treatment Trial Research Group. A randomized trial of long-term oxygen for COPD with moderate desaturation. N Engl J Med. 2016;375:1617-27. [PMID: 27783918]
50.
Fishman A, Martinez F, Naunheim K, et al; National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003;348:2059-73. [PMID: 12759479]
51.
Criner GJ, Sue R, Wright S, et al; LIBERATE Study Group. A multicenter randomized controlled trial of Zephyr Endobronchial Valve treatment in heterogeneous emphysema (LIBERATE). Am J Respir Crit Care Med. 2018;198:1151-64. [PMID: 29787288] doi: 10.1164/rccm.201803-0590OC
52.
Criner GJ, Delage A, Voelker K, et al. Improving lung function in severe heterogenous emphysema with the Spiration Valve System (EMPROVE). A multicenter, open-label randomized controlled clinical trial. Am J Respir Crit Care Med. 2019;200:1354-62. [PMID: 31365298] doi: 10.1164/rccm.201902-0383OC
53.
Weill D, Benden C, Corris PA, et al. A consensus document for the selection of lung transplant candidates: 2014—an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2015;34:1-15. [PMID: 25085497] doi: 10.1016/j.healun.2014.06.014
54.
Siddiqui FM, Diamond JM. Lung transplantation for chronic obstructive pulmonary disease: past, present, and future directions. Curr Opin Pulm Med. 2018;24:199-204. [PMID: 29227305] doi: 10.1097/MCP.0000000000000452
55.
Thabut G, Christie JD, Ravaud P, et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet. 2008;371:744-51. [PMID: 18313503] doi: 10.1016/S0140-6736(08)60344-X
56.
Cerón Navarro J, de Aguiar Quevedo K, Ansótegui Barrera E, et al. Functional outcomes after lung transplant in chronic obstructive pulmonary disease. Arch Bronconeumol. 2015;51:109-14. [PMID: 25151535] doi: 10.1016/j.arbres.2014.06.012
57.
Borro JM, Delgado M, Coll E, et al. Single-lung transplantation in emphysema: retrospective study analyzing survival and waiting list mortality. World J Transplant. 2016;6:347-55. [PMID: 27358780] doi: 10.5500/wjt.v6.i2.347
58.
Schaffer JM, Singh SK, Reitz BA, et al. Single- vs double-lung transplantation in patients with chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis since the implementation of lung allocation based on medical need. JAMA. 2015;313:936-48. [PMID: 25734735] doi: 10.1001/jama.2015.1175
59.
Wedzicha JA, Calverley PMA, Albert RK, et al. Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2017;50. [PMID: 28889106] doi: 10.1183/13993003.02265-2016
60.
Press VG, Au DH, Bourbeau J, et al. Reducing chronic obstructive pulmonary disease hospital readmissions. an official American Thoracic Society workshop report. Ann Am Thorac Soc. 2019;16:161-70. [PMID: 30707066] doi: 10.1513/AnnalsATS.201811-755WS
Comments
Sign In to Submit A CommentInformation & Authors
Information
Published In
Annals of Internal Medicine
Volume 173 • Number 3 • 4 August 2020
Pages: ITC17 - ITC32
History
Published online: 4 August 2020
Published in issue: 4 August 2020
Keywords
Copyright
© 2020 American College of Physicians.
Authors
Metrics & Citations
Metrics
Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
Download article citation data for:
Chronic Obstructive Pulmonary Disease. Ann Intern Med.2020;173:ITC17-ITC32. [Epub 4 August 2020]. doi:10.7326/AITC202008040
Chronic Obstructive Pulmonary Disease. Ann Intern Med.2020;173:ITC17-ITC32. [Epub 4 August 2020]. doi:10.7326/AITC202008040
View More
Login Options:
Purchase
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.
Create your Free Account
You will be redirected to acponline.org to create an account that will provide access to Annals.
Importance of physical diagnosis
We would like to add physical findings associated with chronic obstructive pulmonary disease (COPD) from our comprehensive list (1). These include short trachea, accessory muscle hypertrophy, barrel chest, Hoover sign, and so forth. We could rapidly and accurately estimate pretest probability based on these findings before obtaining pulmonary function test result. This would be important to examine new patients with respiratory symptoms in urgent care clinics or emergency departments where pulmonary function test could not be usually performed.
We declare there are no conflicts of Interest.
References
1: Yasuharu Tokuda, Seishirou Miyagi. Physical diagnosis of chronic obstructive pulmonary disease. Internal Medicine 46 (23), 1885-1891, 2007
Disclosures:
The author has nothing to disclose.
Clarification
In your section on treatment you refer to antimuscarinics but the accompanying chart is labeled " anticholinergics".
For the sake of clarity consistent nomenclature would help. Thank you
Authors' Response to Zeveloff
“We appreciate the reader’s careful attention to detail. We will adjust the accompanying chart in a future revision for consistent nomenclature.”