Chronic obstructive pulmonary disease

2651: 2721: 1171: 358:. Chronic bronchitis is defined as a productive cough that is present for at least three months each year for two years. Both of these conditions can exist without airflow limitation when they are not classed as COPD. Emphysema is just one of the structural abnormalities that can limit airflow and can exist without airflow limitation in a significant number of people. Chronic bronchitis does not always result in airflow limitation. However, in young adults with chronic bronchitis who smoke, the risk of developing COPD is high. Many definitions of COPD in the past included emphysema and chronic bronchitis, but these have never been included in 1146:, COPD and lung cancer. A noted difference between marijuana use and tobacco was that respiratory problems were resolved with stopping usage unlike the continued decline with stopping tobacco smoking. Respiratory symptoms reported with marijuana use included chronic cough, increased sputum production and wheezing but not shortness of breath. Also these symptoms were typically reported ten years ahead of their affecting tobacco smokers. Another study found that chronic marijuana smokers even with the additional use of tobacco developed similar respiratory problems, but did not seem to develop airflow limitation and COPD. 53: 1814: 2445:

training (IMT, EMT) have been suggested and may provide some improvements when compared to no treatment. A combination of IMT and walking exercises at home may help limit breathlessness in cases of severe COPD. Additionally, the use of low amplitude high velocity joint mobilization together with exercise improves lung function and exercise capacity. The goal of spinal manipulation therapy is to improve thoracic mobility in an effort to reduce the work on the lungs during respiration, however, the evidence supporting manual therapy for people with COPD is very weak.

2418:

therapy; the use of high concentrations of oxygen without taking into account a person's oxygen saturations may lead to increased levels of carbon dioxide and worsened outcomes. In those at high risk of high carbon dioxide levels, oxygen saturations of 88–92% are recommended, while for those without this risk, recommended levels are 94–98%. Once prescribed long-term oxygen therapy, patients should be re-assessed after 60 to 90 days, to deteermine whether supplemental oxygen is still indicated and if prescribed supplemental oxygen is effective.

2173:(LABA), is better is unclear and trying each and continuing with the one that works best may be advisable. Both types of agent appear to reduce the risk of acute exacerbations by 15–25%. The combination of LABA/LAMA may reduce COPD exacerbations and improve quality-of-life compared to long-acting bronchodilators alone. The 2018 NICE guideline recommends use of dual long-acting bronchodilators with economic modelling suggesting that this approach is preferable to starting one long acting bronchodilator and adding another later. 1826: 503: 1838: 1790: 1523: 992:, that irritate the lung causing inflammation that interacts with a number of host factors. Such exposure needs to be significant or long-term. The greatest risk factor for the development of COPD is tobacco smoke. However, less than 50 percent of heavy smokers develop COPD, so other factors need to be considered, including exposure to indoor and outdoor pollutants, allergens, occupational exposure, and host factors. One of the known causes of COPD is the exposure to 1778: 2236:. Ipratropium is a short-acting muscarinic antagonist (SAMA), while tiotropium is long-acting (LAMA). Tiotropium is associated with a decrease in exacerbations and improved quality of life, and tiotropium provides those benefits better than ipratropium. It does not appear to affect mortality or the overall hospitalization rate. Anticholinergics can cause dry mouth and urinary tract symptoms. They are also associated with increased risk of heart disease and 1802: 489: 1456: 480:

it was the fourth biggest cause of death, responsible for approximately 5% of total deaths. The number of deaths is projected to increase further because of continued exposure to risk factors and an aging population. In the United States in 2010 the economic cost was put at US$ 32.1 billion and projected to rise to US$ 49 billion in 2020. In the United Kingdom this cost is estimated at £3.8 billion annually.

1350: 2463:(PEP) devices and other mechanical devices, may reduce the need for increased ventilatory assistance, the duration of ventilatory assistance and the length of hospital stay in people with acute COPD. In people with stable COPD, ACTs may lead to short-term improvements in health-related quality of life and a reduced long-term need for hospitalizations related to respiratory issues. 2862:

The increase in the developing world between 1970 and the 2000s is believed to be related to increasing rates of smoking in this region, an increasing population and an aging population due to fewer deaths from other causes such as infectious diseases. Some developed countries have seen increased rates, some have remained stable and some have seen a decrease in COPD prevalence.

3040:

expected to more than double by 2030. In Europe, COPD represents 3% of healthcare spending. In the United States, costs of the disease are estimated at $ 50 billion, most of which is due to exacerbation. COPD was among the most expensive conditions seen in U.S. hospitals in 2011, with a total cost of about $ 5.7 billion.

1452:. The destruction of the connective tissue of the lungs leads to emphysema, which then contributes to the poor airflow and finally, poor absorption and release of respiratory gases. General muscle wasting that often occurs in COPD may be partly due to inflammatory mediators released by the lungs into the blood. 896:, evident in emphysema and lacking in chronic bronchitis. This terminology was no longer accepted as useful, as most people with COPD have a combination of both emphysema and airway disease. These are now recognized as the two major phenotypes of COPD — emphysematous phenotype and chronic bronchitic phenotype. 2617:

Both of these techniques are associated with adverse effects including persistent air leaks and cardiovascular complications. Thermal vapor ablation has an improved profile. Heated water vapor is used to target lobe regions which leads to permanent fibrosis and volume reduction. The procedure is able

2417:

and death. In those with normal or mildly low oxygen levels, oxygen supplementation (ambulatory) may improve shortness of breath when given during exercise, but may not improve breathlessness during normal daily activities or affect the quality of life. During acute exacerbations, many require oxygen

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is recommended by NICE. GOLD also supports the use of some mucolytics that are advised against when inhaled corticosteroids are being used and singles out erdosteine as having good effects regardless of corticosteroid use. Erdosteine also has antioxidant properties but there is not enough evidence to

2011:

are also managed. An action plan is drawn up and is to be reviewed. Providing people with a personalized action plan, an educational session and support for use of their action plan in the event of an exacerbation, reduces the number of hospital visits and encourages early treatment of exacerbations.

1952:

and dust control. Effective dust control can be achieved by improving ventilation, using water sprays and by using mining techniques that minimize dust generation. If a worker develops COPD, further lung damage can be reduced by avoiding ongoing dust exposure, for example by changing their work role.

1918:

is the only measure shown to slow down the worsening of COPD. Even at a late stage of the disease, it can reduce the rate of worsening lung function and delay the onset of disability and death. Often, several attempts are required before long-term abstinence is achieved. Attempts over 5 years lead to

786:

has been seen to affect up to fifty percent of those with COPD and significantly affects the outcomes. When comorbid with COPD there is more systemic inflammation. It is not known if it co-exists with COPD or develops as a consequence of the pathology. Metabolic syndrome on its own has a high rate of

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Globally, as of 2010, COPD is estimated to result in economic costs of $ 2.1 trillion, half of which occurring in the developing world. Of this total an estimated $ 1.9 trillion are direct costs such as medical care, while $ 0.2 trillion are indirect costs such as missed work. This is

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and improve exercise tolerance. Short-acting bronchodilators have an effect for four hours and for maintenance therapy long acting bronchodilators with an effect of over twelve hours are used. In times of more severe symptoms a short acting agent may be used in combination. An inhaled corticosteroid

1992:

COPD currently has no cure, but the symptoms are treatable and its progression can be delayed, particularly by stopping smoking. The major goals of management are to reduce exposure to risk factors including offering non-pharmacological treatments such as help with stopping smoking. Stopping smoking

1971:

Both indoor and outdoor air quality can be improved, which may prevent COPD or slow the worsening of existing disease. This may be achieved by public policy efforts, cultural changes and personal involvement. Many developed countries have successfully improved outdoor air quality through regulations

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due to decreased ventilation from airway obstruction, hyperinflation and a reduced desire to breathe. During exacerbations, airway inflammation is also increased, resulting in increased hyperinflation, reduced expiratory airflow and worsening of gas transfer. This can lead to low blood oxygen levels

1478:

Narrowing of the airways occurs due to inflammation and subsequent scarring within them. This contributes to the inability to breathe out fully. The greatest reduction in air flow occurs when breathing out, as the pressure in the chest is compressing the airways at this time. This can result in more

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Qaseem A, Wilt TJ, Weinberger SE, Hanania NA, Criner G, van der Molen T, et al. (August 2011). "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

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Being either underweight or overweight can affect the symptoms, degree of disability and prognosis of COPD. People with COPD who are underweight can improve their breathing muscle strength by increasing their calorie intake. When combined with regular exercise or a pulmonary rehabilitation program,

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is a program of exercise, disease management and counseling, coordinated to benefit the individual. A severe exacerbation leads to hospital admission, high mortality and a decline in the ability to carry out daily activities. Following a hospital admission pulmonary rehabilitation has been shown to

1137:

is the second most commonly smoked substance, but evidence linking its use to COPD is very limited. Limited evidence shows that marijuana does not accelerate lung function decline. A low use of marijuana gives a bronchodilatory effect rather than the bronchoconstrictive effect from tobacco use, but

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As of 2015, COPD affected about 174.5 million people (2.4% of the global population). It typically occurs in males and females over the age of 35–40. In 2019 it caused 3.2 million deaths, 80% occurring in lower and middle income countries, up from 2.4 million deaths in 1990. In 2021,

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Estimates of prevalence have considerable variation due to differences in analytical and surveying approach and the choice of diagnostic criteria. An estimated 384 million people aged 30 years or more had COPD in 2010, corresponding to a global prevalence of 12%. The disease affects men and women.

1203:

associated with an increased risk of hospitalization due to the exacerbations caused. Long-term exposure is indicated as an increased rate of mortality in COPD. Studies have shown that people who live in large cities have a higher rate of COPD compared to people who live in rural areas. Areas with

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with an increased rate of developing COPD shown in smokers and ex-smokers. Of those who smoke, about 20% will get COPD, increasing to less than 50% in heavy smokers. In the United States and United Kingdom, of those with COPD, 80–95% are either current or previous smokers. Several studies indicate

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In the UK, three million people are reported to be affected by COPD – two million of these being undiagnosed. On average, the number of COPD-related deaths between 2007 and 2016 was 28,600. The estimated number of deaths due to occupational exposure was estimated to be about 15% at

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as a first-line maintenance treatment in COPD cases with repeated exacerbations. Their regular use increases the risk of pneumonia in severe cases. Studies have shown that the risk of pneumonia is associated with all types of corticosteroids; is related to the disease severity and a dose-response

2433:

The optimal exercise routine, use of noninvasive ventilation during exercise and intensity of exercise suggested for people with COPD, is unknown. Performing endurance arm exercises improves arm movement for people with COPD and may result in a small improvement in breathlessness. Performing arm

1943:

A number of measures have been taken to reduce the likelihood that workers in at-risk industries—such as coal mining, construction and stonemasonry—will develop COPD. Examples of these measures include the creation of public policy, education of workers and management about the risks, promoting

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that promote respiratory symptoms. Workplace exposure is believed to be the cause in 10–20% of cases and in the United States, it is believed to be related to around 30% of cases among never smokers and probably represents a greater risk in countries without sufficient regulations. The negative

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Around three million people die of COPD each year. In some countries, mortality has decreased in men but increased in women. This is most likely due to rates of smoking in women and men becoming more similar. A higher rate of COPD is found in those over 40 years and this increases greatly with

2444:

exercises appear to be safe to practice for people with COPD and may be beneficial for pulmonary function and pulmonary capacity when compared to a regular treatment program. Tai Chi was not found to be more effective than other exercise intervention programs. Inspiratory and expiratory muscle

2296:

is a PDE4 inhibitor used orally once daily to reduce inflammation, it has no direct bronchodilatory effects. It is essentially used in treating those with chronic bronchitis along with systemic corticosteroids. Reported adverse effects of roflumilast appear early in treatment, become less with

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can be intermittent and may be swallowed or spat out depending on social or cultural factors and is therefore not always easy to evaluate. However, an accompanying productive cough is only seen in up to 30% of cases. Sometimes limited airflow may develop in the absence of a cough. Symptoms are

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that provides a protective coating for cells. It has been shown that on exposure to pollution the hyaluronan in the lungs breaks down into fragments causing irritation and activation of the immune system. There follows subsequent airway constriction and inflammation. The study showed that the

1711:

refers to a modified MRC scale that if used, needs to include other tests since it is simply a test of breathlessness experienced. Scores on CAT range from 0–40 with the higher the score, the more severe the disease. Spirometry may help to determine the severity of airflow limitation. This is

1035:

is a filter for harmful substances and any variant has the potential to disrupt this. A variation has been found to be associated with the development of chronic bronchitis and another with the development of emphysema. A branch variant in the central airway is specifically associated with an

7170:

Knox-Brown B, Potts J, Santofimio VQ, Minelli C, Patel J, Abass NM, Agarwal D, Ahmed R, Mahesh PA, Bs J, Denguezli M, Franssen F, Gislason T, Janson C, Juvekar SK, Koul P, Malinovschi A, Nafees AA, Nielsen R, Paraguas SN, Buist S, Burney PG, Amaral AF (November 2023). "Isolated small airways

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advancing age with the highest rate found in those over 60 years. Sex differences in the anatomy of the respiratory system include smaller airway lumens and thicker airway walls in women, which contribute to a greater severity of COPD symptoms like dyspnea and frequency of COPD exacerbation.

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and mucus secretion, which results in narrowing the airways. In those with COPD these nerves are overactive, usually as a result of smoking damage and the constant mucus secretion and airway constriction leads to the symptoms of cough, shortness of breath, wheeze and tightness of the chest.

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of at least 21 °C (70 °F) for a minimum of nine hours a day was associated with better health in those with COPD, especially for smokers. The World Health Organization (WHO) recommends indoor temperatures of a slightly higher range between 18 and 24 °C (64 and 75 °F).

2281:). A triple inhaled therapy of LABA/LAMA/ICS improves lung function, reduces symptoms and exacerbations and is seen to be more effective than mono or dual therapies. NICE guidelines recommend the use of ICSs in people with asthmatic features or features suggesting steroid responsiveness. 2487:

infections. The symptoms that worsen are not specific to COPD and differential diagnoses need to be considered. Acute exacerbations are typically treated by increasing the use of short-acting bronchodilators including a combination of a short-acting inhaled beta agonist and short-acting

1922:

Some smokers can achieve long-term smoking cessation through willpower alone. Smoking, however, is highly addictive and many smokers need further support. The chance of quitting is improved with social support, engagement in a smoking cessation program and the use of medications such as

432:

Most cases of COPD can be prevented by reducing exposure to risk factors such as smoking and indoor and outdoor pollutants. While treatment can slow worsening, there is no conclusive evidence that any medications can change the long-term decline in lung function. COPD treatments include

904:

It has since been recognized that COPD is more complex, with a diverse group of disorders of differing risk factors and clinical courses that has resulted in a number of subtypes or phenotypes of COPD being accepted and proposed. The two classic emphysematous and chronic bronchitic

343:. However, this basic dogma has been challenged as varying degrees of co-existing emphysema, chronic bronchitis, and potentially significant vascular diseases have all been acknowledged in those with COPD, giving rise to the classification of other phenotypes or subtypes. 2873:

In 2011, there were approximately 730,000 hospitalizations in the United States for COPD. Globally, COPD in 2019 was the third-leading cause of death. In low-income countries, COPD does not appear in the Top 10 causes of death; in other income groups, it is in the Top 5.

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typically based on the FEV1 expressed as a percentage of the predicted "normal" for the person's age, gender, height and weight. Guidelines published in 2011 by American and European medical societies recommend partly basing treatment recommendations on the FEV1. The

1208:, generally have higher rates of COPD. Urban air pollution significantly effects the developing lung and its maturation, and contributes a potential risk factor for the later development of COPD. The overall effect in relation to smoking is believed to be small. 2213:. When used with inhaled steroids they increase the risk of pneumonia. While steroids and LABAs may work better together, it is unclear if this slight benefit outweighs the increased risks. There is some evidence that combined treatment of LABAs with long-acting 8281: 3137:

augmentation treatment for people who have alpha-1 antitrypsin deficiency is unclear. A later clinical trial of double-dosing has shown some improvements in slowing the breakdown of elastin and the progression of emphysema with further studies being called for.

11658:

Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. (December 2012). "Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010".

2217:(LAMA), an anticholinergic, and LABA +ICS (inhaled corticosteroid) may be similar in benefits in terms of fewer exacerbation's and quality of life measures for moderate to severe COPD, but LAMA+LABA offers better improvements in forced expiratory volume ( 917:

and COPD. Spirometry measures are inadequate for defining phenotypes and chest X-ray, CT and MRI scans have been mostly employed. Most cases of COPD are diagnosed at a late stage and the use of imaging methods would allow earlier detection and treatment.

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van Geffen WH, Tan DJ, Walters JA, Walters EH (2023-12-06). Cochrane Airways Group (ed.). "Inhaled corticosteroids with combination inhaled long-acting beta2-agonists and long-acting muscarinic antagonists for chronic obstructive pulmonary disease".

2347:

are widely used. Theophylline is seen to have a mild bronchodilatory effect in stable COPD. Inspiratory muscle function is seen to be improved but the causal effect is unclear. Theophylline is seen to improve breathlessness when used as an add-on to

7065:

Knox-Brown B, Patel J, Potts J, Ahmed R, Aquart-Stewart A, Cherkaski H, et al. (January 2023). "Small airways obstruction and its risk factors in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study".

1881:. The distinction between asthma and COPD is made on the basis of the symptoms, smoking history and whether airflow limitation is reversible with bronchodilators at spirometry. Chronic bronchitis with normal airflow is not classified as COPD. 11106: 2826:

is related to COPD. The proportion of disability from COPD globally has decreased from 1990 to 2010 due to improved indoor air quality primarily in Asia. The overall number of years lived with disability from COPD, however, has increased.

2577:(LVRS) may be an option. LVRS involves the removal of damaged tissue, which improves lung function by allowing the rest of the lungs to expand. It is considered when the emphysema is in the upper lobes and when there are no comorbidities. 1483:. Hyperinflation from exercise is linked to shortness of breath in COPD, as breathing in is less comfortable when the lungs are already partly filled. Hyperinflation may also worsen during an exacerbation. There may also be a degree of 1479:

air from the previous breath remaining within the lungs when the next breath is started, resulting in an increase in the total volume of air in the lungs at any given time, a process called air trapping which is closely followed by

4007:

Dobler CC, Morrow AS, Beuschel B, Farah MH, Majzoub AM, Wilson ME, et al. (March 2020). "Pharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-analysis".

677:, hospital admissions for COPD exacerbations sharply decreased which may be attributable to reduction of emissions and cleaner air. There has also been a marked decrease in the number of cold and flu infections during this time. 567:, which can improve shortness of breath. Shortness of breath is often responsible for reduced physical activity and low levels of physical activity are associated with worse outcomes. In severe and very severe cases there may be 1983:

and electrical heating is also effective. Using fuels such as kerosene or coal might produce less household particulate matter than traditional biomass such as wood or dung, but whether this is better health wise is unclear.

2012:

When self-management interventions, such as taking corticosteroids and using supplemental oxygen, is combined with action plans, health-related quality of life is improved compared to usual care. In those with COPD who are

4797:

Aleva FE, Voets LW, Simons SO, de Mast Q, van der Ven AJ, Heijdra YF (March 2017). "Prevalence and Localization of Pulmonary Embolism in Unexplained Acute Exacerbations of COPD: A Systematic Review and Meta-analysis".

2965:(1837) to describe lungs that did not collapse when he opened the chest during an autopsy. He noted that they did not collapse as usual because they were full of air and the airways were filled with mucus. In 1842, 1716:

guidelines group people into four categories based on symptoms assessment, degree of airflow limitation and history of exacerbations. Weight loss, muscle loss and fatigue are seen in severe and very severe cases.

562:

and chest tightness associated with breathlessness can be variable over the course of a day or between days and are not always present. Chest tightness often follows exertion. Many people with more advanced COPD

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can bring about the development of COPD, or its exacerbations. Those with COPD are more susceptible to the harmful effects of particulate exposure that can cause acute exacerbations brought about by infections.

871:

that is present for at least three months each year for two years but does not always result in airflow limitation although the risk of developing COPD is great. These older definitions grouped the two types as

557:

which is most characteristic of the condition. Shortness of breath (breathlessness) is often the most distressing symptom responsible for the associated anxiety and level of disability experienced. Symptoms of

2248:

is another anticholinergic alternative. When compared to tiotropium, the LAMAs aclidinium, glycopyrronium, and umeclidinium appear to have a similar level of efficacy; with all four being more effective than

2204:

are often used as maintenance therapy. Some feel the evidence of benefits is limited, while others view the evidence of benefit as established. Long-term use appears safe in COPD with adverse effects include

4195: 2537:

For people with COPD, the ideal indoor humidity levels are 30–50% RH. Maintaining indoor humidity can be difficult in the winter, especially in cold climates where the heating system is constantly running.

11842:

Martinez FJ, Curtis JL, Sciurba F, Mumford J, Giardino ND, Weinmann G, Kazerooni E, Murray S, Criner GJ, Sin DD, Hogg J, Ries AL, Han M, Fishman AP, Make B, Hoffman EA, Mohsenifar Z, Wise R (April 2007).

615:. Chronic bronchitis can occur before the restricted airflow diagnostic of COPD. Some people with COPD attribute the symptoms to the consequences of smoking. In severe COPD, vigorous coughing may lead to 4053:"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015" 2297:

continued treatment and are reversible. One effect is dramatic weight loss and its use is to be avoided in underweight people. It is also advised to be used with caution in those who have depression.

11098: 2221:) and a lower risk of pneumonia. All three together, LABA, LAMA and ICS, have some evidence of benefits. Indacaterol requires an inhaled dose once a day and is as effective as the other long-acting β 4226:

Mayer AF, Karloh M, Dos Santos K, de Araujo CL, Gulart AA (March 2018). "Effects of acute use of pursed-lips breathing during exercise in patients with COPD: a systematic review and meta-analysis".

7121:"The association of spirometric small airways obstruction with respiratory symptoms, cardiometabolic diseases, and quality of life: results from the Burden of Obstructive Lung Disease (BOLD) study" 1975:

In developing countries one key effort is to reduce exposure to smoke from cooking and heating fuels through improved ventilation of homes and better stoves and chimneys. Proper stoves may improve

10825:

Thomas MJ, Simpson J, Riley R, Grant E (June 2010). "The impact of home-based physiotherapy interventions on breathlessness during activities of daily living in severe COPD: a systematic review".

8994:

Cave AC, Hurst MM (May 2011). "The use of long acting β₂-agonists, alone or in combination with inhaled corticosteroids, in chronic obstructive pulmonary disease (COPD): a risk-benefit analysis".

362:

definitions. Emphysema and chronic bronchitis remain the predominant phenotypes of COPD but there is often overlap between them and a number of other phenotypes have also been described. COPD and

4572:"Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease" 3443:"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015" 1085:

that women are more susceptible than men to the harmful effects of tobacco smoke. For the same amount of cigarette smoking, women have a higher risk of COPD than men. In non-smokers, exposure to

3151:

to treat people with COPD when they experience episodes of shortness of breath; treating people remotely may reduce the number of emergency-room visits and improve the person's quality of life.

2984:

in December 1952. This spurred epidemiological research in the United Kingdom, Holland and elsewhere. In 1953, George L. Waldbott, an American allergist, first described a new disease he named

950:

Another recognized phenotype is the frequent exacerbator. The frequent exacerbator has two or more exacerbations a year, has a poor prognosis and is described as a moderately stable phenotype.

1935:. Combining smoking-cessation medication with behavioral therapy is more than twice as likely to be effective in helping people with COPD stop smoking, compared with behavioral therapy alone. 7866: 2980:

Air pollution and the increase in cigarette smoking in Great Britain at the start of the 20th century led to high rates of chronic lung disease, though it received little attention until the

4102:"Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" 1763:

in the blood; this is recommended in those with an FEV1 less than 35% predicted, those with a peripheral oxygen saturation less than 92% and those with symptoms of congestive heart failure.

3070:

and does not interfere with any drug. It improves mucus clearance by allowing it to move more freely. Further studies are to be carried out in the US to determine optimum dosage levels.

2893: 1993:

can reduce the rate of lung function decline and also reduce mortality from smoking-related diseases such as lung cancer and cardiovascular disease. Other recommendations include annual

3189:

Chronic obstructive pulmonary disease may occur in a number of other animals and may be caused by exposure to tobacco smoke. Most cases of the disease, however, are relatively mild. In

521: 1569:

less than 70% in someone with symptoms of COPD defines a person as having the disease. Based on these measurements, spirometry would lead to over-diagnosis of COPD in the elderly. The

2274:

can be effective in treating an acute exacerbation. They appear to have fewer side effects than those given intravenously. Five days of steroids work as well as ten or fourteen days.

1720:

Use of screening questionnaires, such as COPD diagnostic questionnaire (CDQ), alone or in combination with hand-held flow meters is appropriate for screening of COPD in primary care.

1142:. There is evidence of it causing some respiratory problems and its use in combination may have a cumulative toxic effect suggesting it as a risk factor for spontaneous pneumothorax, 1587:

using spirometry in those without symptoms has uncertain effect and is generally not recommended; however, it is recommended for those without symptoms but with a known risk factor.

639:

that lasts for several days. The key symptom is increased breathlessness, other more pronounced symptoms are of excessive mucus, increased cough and wheeze. A commonly found sign is

8616: 3928:

Torres-Duque CA, García-Rodriguez MC, González-García M (August 2016). "Is Chronic Obstructive Pulmonary Disease Caused by Wood Smoke a Different Phenotype or a Different Entity?".

867:

and is just one of the structural abnormalities that can limit airflow. The condition can exist without airflow limitation but commonly it does. Chronic bronchitis is defined as a

12885: 1296:

Genetics play a role in the development of COPD. It is more common among relatives of those with COPD who smoke than unrelated smokers. The most well known genetic risk factor is

2005:

vaccine for individuals above 60 years; giving advice as to healthy eating and encouraging physical exercise. Guidance is also advised as to managing breathlessness and stress.

2321:, reduce the frequency of exacerbations in those who have two or more a year. This practice may be cost effective in some areas of the world. Concerns include the potential for 12227: 9281:"Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease" 2352:. All instances of improvement have been reported using sustained release preparations. Methylxanthines are not recommended for use in exacerbations due to adverse effects. 835:, though if infected they are at risk of hospitalization and developing severe COVID-19. However, there are laboratory and clinical studies showing a possibility of certain 519: 2074:; whether one is better than the others is unclear. There is no clear evidence of improved outcomes for those with less severe cases. The FDA recommends against the use of 1907:

of governments, public health agencies and antismoking organizations can reduce smoking rates by discouraging people from starting and encouraging people to stop smoking.

1325:

The COPDGene study is an ongoing longitudinal study into the epidemiology of COPD, identifying phenotypes and looking for their likely association with susceptible genes.

3098:

had been completed and seventeen were underway. Overall, stem cell therapy has proved to be safe. The trials include the use of stem cells from different sources such as

824:

is common in those with COPD as it is for other lung conditions that affect airflow. Cognitive impairment is associated with the declining ability to cope with the basic

13481: 2480: 1016:

are also recognized as risk factors, as the comorbidity of COPD is reported to be 12 times higher in patients with asthma after adjusting for smoking history. In Europe

632: 469: 2516:

can improve lung function and shorten hospital stays but their use is recommended for only five to seven days; longer courses increase the risk of pneumonia and death.

1388:

COPD develops as a significant and chronic inflammatory response to inhaled irritants which ultimately leads to bronchial and alveolar remodelling in the lung known as

1259:, chemicals and fumes increases the risk of COPD in smokers, nonsmokers and never-smokers. Substances implicated in occupational exposure and listed in the UK, include 947:, has been shown to have benefit in treating the eosinophilic inflammatory type rather than the use of oral corticosteroids, but further studies have been called for. 8763:"Association of Home Noninvasive Positive Pressure Ventilation With Clinical Outcomes in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis" 2413:

and pulmonary hypertension, the levels involved are 56–59 mmHg. Oxygen therapy is to be used for between 15 and 18 hours per day and is said to decrease the risk of

2385: 1911:

in public areas and places of work are important measures to decrease exposure to secondhand smoke and while many places have instituted bans, more are recommended.

2870:

around 4,000. In the United States in 2018, almost 15.7 million people had been diagnosed with COPD and it is estimated that millions more have not been diagnosed.

8915:"Dual combination therapy versus long-acting bronchodilators alone for chronic obstructive pulmonary disease (COPD): a systematic review and network meta-analysis" 7208:

Lo Bello F, Ieni A, Hansbro PM, Ruggeri P, Di Stefano A, Nucera F, et al. (May 2020). "Role of the mucins in pathogenesis of COPD: implications for therapy".

4987:"Pathobiological mechanisms underlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical significance and therapeutic strategies" 1789: 791:

is a risk factor for the development of COPD, and is also a potential comorbidity. Most people with COPD die from comorbidities and not from respiratory problems.

11633: 2363:

support the general use of antioxidants. Erdosteine has been shown to significantly reduce the risk of exacerbations, shorten their duration and hospital stays.

1740:. Characteristic signs of COPD on X-ray include hyperinflation (shown by a flattened diaphragm and an increased retrosternal air space) and lung hyperlucency. A 11704:"Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010" 11005:

Ferreira IM, Brooks D, White J, Goldstein R (December 2012). Ferreira IM (ed.). "Nutritional supplementation for stable chronic obstructive pulmonary disease".

12038: 3158:

against lung disease including COPD. Astaxanthin is a potent antioxidant with anti-inflammatory properties and more trials are said to be needed into its use.

3049: 2266: 1972:

which has resulted in improvements in the lung function of their populations. Individuals are also advised to avoid irritants of indoor and outdoor pollution.

1713: 1708: 1654: 856: 520: 359: 289: 7429:

Cooper CB (October 2006). "The connection between chronic obstructive pulmonary disease symptoms and hyperinflation and its impact on exercise and function".

1565:(FVC), which is the greatest volume of air that can be breathed out in a single large breath. Normally, 75–80% of the FVC comes out in the first second and a 7580: 2376:

Recent studies show that metformin plays a role in reducing systemic inflammation by reducing biomarker levels that are increased during COPD exacerbations.

1777: 17: 6827:

Reilly JJ, Silverman EK, Shapiro SD (2011). "Chronic Obstructive Pulmonary Disease". In Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J (eds.).

6377:

Chatkin JM, Zabert G, Zabert I, Chatkin G, Jiménez-Ruiz CA, de Granda-Orive JI, et al. (September 2017). "Lung Disease Associated With Marijuana Use".

2040:

is common in those with COPD and can cause increased exacerbations. Supplementation when deficient can give a 50% reduction in the number of exacerbations.

8863:"Long-acting beta2-agonist in addition to tiotropium versus either tiotropium or long-acting beta2-agonist alone for chronic obstructive pulmonary disease" 2977:

of the lungs. However, his spirometer could only measure volume, not airflow. Tiffeneau and Pinelli in 1947 described the principles of measuring airflow.

909:

are fundamentally different conditions with unique underlying mechanisms. Another subtype of COPD, categorized by some as a separate clinical entity, is

12775: 9770:"Inhaled Corticosteroids and the Pneumonia Risk in Patients With Chronic Obstructive Pulmonary Disease: A Meta-analysis of Randomized Controlled Trials" 11169:

Mu Z, Chen PL, Geng FH, Ren L, Gu WC, Ma JY, Peng L, Li QY (2017). "Synergistic effects of temperature and humidity on the symptoms of COPD patients".

2618:

to target individual lobe segments, can be carried out regardless of collateral ventilation and can be repeated with the natural advance of emphysema.

12162: 9232:"Combined corticosteroid and long-acting beta(2)-agonist in one inhaler versus long-acting beta(2)-agonists for chronic obstructive pulmonary disease" 7897: 1825: 1570: 715:

Acute exacerbations in COPD are often unexplained and thought to have many causes other than infections. A study has emphasized the possibility of a

11766: 7870: 12244: 2591:

Minimally invasive bronchoscopic procedures may be carried out to reduce lung volume. These include the use of valves, coils, or thermal ablation.

2358:

may help to reduce exacerbations in some people with chronic bronchitis; noticed by less hospitalization and less days of disability in one month.

683:

is proving an increasing risk in many parts of the world and government agencies have published protective advice on their websites. In the US the

8482:"Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials" 7016:"Assessing Static Lung Hyperinflation by Whole-Body Plethysmography, Helium Dilution, and Impulse Oscillometry System (IOS) in Patients with COPD" 13100: 12890: 8433:"Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease" 1179: 331:

such as walking or dressing becoming difficult. While COPD is incurable, it is preventable and treatable. The two most common types of COPD are

4051:

Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (GBD 2015 Mortality and Causes of Death Collaborators) (October 2016).

12557: 4748:"Impact of Frailty on the Risk of Exacerbations and All-Cause Mortality in Elderly Patients with Stable Chronic Obstructive Pulmonary Disease" 13945: 10592:

McNamara RJ, McKeough ZJ, McKenzie DK, Alison JA (December 2013). "Water-based exercise training for chronic obstructive pulmonary disease".

7725: 1837: 8608: 3066:

inhalation of unfragmented hyaluronan overcame the effects of fragmented HA and reduced inflammation. Inhaled HA only acts locally in the

14188: 2595:

are one-way valves that may be used in those with severe hyperinflation resulting from advanced emphysema; a suitable target lobe and no

1732:

is not useful to establish a diagnosis of COPD but it is of use in either excluding other conditions or including comorbidities such as

794:

Anxiety and depression are often complications of COPD. Other complications include a reduced quality of life and increased disability,

11940: 4414: 2634:

is another imaging method that may be used to evaluate cases for surgical interventions and also to evaluate post-surgery responses. A

1962: 13700: 10778:"Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD)" 2650: 1889:

Most cases of COPD are potentially preventable through decreasing exposure to tobacco smoke and other indoor and outdoor pollutants.

1596: 1338: 5354:

Mekov E, Nuñez A, Sin DD, Ichinose M, Rhee CK, Maselli DJ, Coté A, Suppli Ulrik C, Maltais F, Anzueto A, Miravitlles M (June 2021).

2603:

of the lobe that ensures a reduction in residual volume that improves lung function, the capacity for exercise and quality of life.

12218: 9994:

Mammen MJ, Sethi S (2012). "Macrolide therapy for the prevention of acute exacerbations in chronic obstructive pulmonary disease".

8609:"Fluoroquinolone Antibacterial Drugs: Drug Safety Communication – FDA Advises Restricting Use for Certain Uncomplicated Infections" 7749:"Diagnostic accuracy of screening tools for chronic obstructive pulmonary disease in primary health care: Rapid evidence synthesis" 4173: 3325: 1308:(AAT) also smokes. It is responsible for about 1–5% of cases and the condition is present in about three to four in 10,000 people. 12392: 8844: 8842: 8840: 1801: 1392:. Thus, airway remodelling with narrowing of peripheral airway and emphysema are responsible for the alteration of lung function. 839:

for COPD providing a protective role against COVID-19. Differentiating COVID-19 symptoms from an exacerbation is difficult; mild

13724: 13496: 12419:"Intravenous alpha-1 antitrypsin augmentation therapy for treating patients with alpha-1 antitrypsin deficiency and lung disease" 9132:"Indacaterol, a once-daily beta2-agonist, versus twice-daily beta₂-agonists or placebo for chronic obstructive pulmonary disease" 5516: 5514: 5512: 5510: 5508: 3990: 3988: 3986: 3984: 3982: 3980: 3978: 3421: 1036:

increased susceptibility for the later development of COPD. A genetic association for the variants has been sometimes found with

12868: 12322:"A Prospective Safety and Feasibility Study of the RejuvenAir™ System Metered Cryospray Therapy for Chronic Bronchitis Patients" 9716:"Comparative efficacy of long-acting muscarinic antagonist monotherapies in COPD: a systematic review and network meta-analysis" 8282:"Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary" 7828:"Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary" 3419: 3417: 3415: 3413: 3411: 3409: 3407: 3405: 3403: 3401: 2610:

coils instead of valves is recommended where there is collateral ventilation that would prevent the use of valves. Nitinol is a

1227:. Women are affected more as they have a greater exposure. These fuels are used as the main source of energy in 80% of homes in 11220: 8837: 8212: 4694: 1813: 1558: 1138:

it is often smoked in combination with tobacco or on its own by tobacco smokers. Higher use however has shown a decline in the

5505: 3975: 659:

may be bacterial or in combination sometimes secondary to a viral infection. The most common bacterial infection is caused by

12751: 12718: 12201: 12053: 10436: 10378:"Oxygen for breathlessness in patients with chronic obstructive pulmonary disease who do not qualify for home oxygen therapy" 9527:

Jones P (April 2013). "Aclidinium bromide twice daily for the treatment of chronic obstructive pulmonary disease: a review".

8245: 8188: 8161: 8005: 7907: 7798: 7560: 7370: 6995: 6836: 6701: 6672: 6125: 6098: 6071: 5165: 3398: 3201:. RAO can be quite severe and most often is linked to exposure to common allergens. COPD is also commonly found in old dogs. 3012: 2292:(PDE4 inhibitors) are anti-inflammatories that improve lung function and reduce exacerbations in moderate to severe illness. 2079: 9570:

Cazzola M, Page CP, Matera MG (June 2013). "Aclidinium bromide for the treatment of chronic obstructive pulmonary disease".

4443:"Mechanisms of Virus-Induced Airway Immunity Dysfunction in the Pathogenesis of COPD Disease, Progression, and Exacerbation" 1060:

activity is diminished and an inflammatory response promoted. The damage leads to a susceptibility for infection, including

704:

The number of exacerbations is not seen to relate to any stage of the disease; those with two or more a year are classed as

12270:

Poggi C, Mantovani S, Pecoraro Y, Carillo C, Bassi M, D'Andrilli A, Anile M, Rendina EA, Venuta F, Diso D (November 2018).

3612: 2062:

In those with a severe exacerbation, antibiotics improve outcomes. A number of different antibiotics may be used including

1131:

use, also confer a risk. Water-pipe or hookah smoke appears to be as harmful or even more harmful than smoking cigarettes.

7971: 6191: 1538:, a chronic cough, sputum production, or frequent winter colds and a history of exposure to risk factors for the disease. 1333:

has identified more than 80 genome regions associated with COPD and further studies in these regions has been called for.

14157: 13940: 13695: 13093: 12979: 7386:

O'Donnell DE (April 2006). "Hyperinflation, dyspnea, and exercise intolerance in chronic obstructive pulmonary disease".

3215: 2853:

such as lung cancer and cardiovascular disease and the number and severity of exacerbations needing hospital admittance.

2586: 2002: 1506:

in the lungs, while emphysema leads to the breakdown of capillaries in the lungs. Both of these conditions may result in

12840: 10865:"The Use of Spinal Manipulative Therapy in the Management of Chronic Obstructive Pulmonary Disease: A Systematic Review" 6545: 4409: 921:

The identification and recognition of different phenotypes can guide appropriate treatment approaches. For example, the

14193: 14183: 13950: 13746: 11625: 2949:

Early descriptions of probable emphysema began in 1679 by T. Bonet of a condition of "voluminous lungs" and in 1769 by

2845:

NICE recommends against the use of BODE for the prognosis assessment in stable COPD; factors such as exacerbations and

2631: 2373:

are not contraindicated for those with COPD and should only be used where there is concomitant cardiovascular disease.

2142: 884:

due to their pink complexion, fast breathing rate and pursed lips. Type B were chronic bronchitic types referred to as

811: 118: 8319: 6010:"The involvement of GM-CSF deficiencies in parallel pathways of pulmonary alveolar proteinosis and the alcoholic lung" 3161:

American COPD patients and their caregivers consider the following COPD-related research areas as the most important:

14147: 13927: 13427: 13122: 13117: 4669: 2162: 12393:"First UK patients get pioneering new treatment for serious lung disease | Royal Brompton & Harefield hospitals" 12059: 2907:

is believed to have first been used in 1965. Previously it has been known by a number of different names, including

1089:(passive smoking) is the cause of 1.2 million deaths from the more than 8 million deaths worldwide each year due to 997: 2720: 2083: 1581:(the maximum speed of expiration), commonly used in asthma diagnosis, is not sufficient for the diagnosis of COPD. 1385:). The relative contributions of these two factors vary between people. Air trapping precedes lung hyperinflation. 1377:

in which chronic, incompletely reversible poor airflow (airflow limitation) and an inability to breathe out fully (

953:

A pulmonary vascular COPD phenotype has been described due to cardiovascular dysfunction. A molecular phenotype of

550: 11361:

Duffy S, Marchetti N, Criner GJ (September 2020). "Surgical Therapies for Chronic Obstructive Pulmonary Disease".

11310:"Surgical and endoscopic interventions that reduce lung volume for emphysema: a systemic review and meta-analysis" 11042:"Bronchodilators delivered by nebuliser versus inhalers for lung attacks of chronic obstructive pulmonary disease" 10776:

Ammous O, Feki W, Lotfi T, Khamis AM, Gosselink R, Rebai A, Kammoun S (2023-01-06). Cochrane Airways Group (ed.).

2830:

There are many variables affecting the long-term outcome in COPD and GOLD recommends the use of a composite test (

2244:, another long-acting agent, reduces hospitalizations associated with COPD and improves quality of life. The LAMA 2094:. Fewer than 20% of exacerbations require hospital admission. In those without acidosis from respiratory failure, 1424:

involvement similar to that in asthma. Part of this cell response is brought on by inflammatory mediators such as

13891: 8966:"Recommendations | Chronic obstructive pulmonary disease in over 16s: diagnosis and management | Guidance | NICE" 5463: 9338:"Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis" 2953:

of lungs which were "turgid particularly from air". In 1721 the first drawings of emphysema were made by Ruysh.

2541:

Keeping the indoor relative humidity above 40% RH significantly reduces the infectivity of aerosolized viruses.

14198: 14162: 13628: 13086: 8075: 6327:

Patel MP, Khangoora VS, Marik PE (October 2019). "A Review of the Pulmonary and Health Impacts of Hookah Use".

3790: 2823: 1768: 1297: 973: 779: 402: 12039:"Pathologic Features of Chronic Obstructive Pulmonary Disease: Diagnostic Criteria and Differential Diagnosis" 11954: 8431:

Lenferink A, Brusse-Keizer M, van der Valk PD, Frith PA, Zwerink M, Monninkhof EM, et al. (August 2017).

7972:"Chronic obstructive pulmonary disease in over 16s: diagnosis and management | Guidance and guidelines | NICE" 4149: 13736: 5153: 2724: 2574: 2568: 2289: 1904: 1573:

criteria additionally require a FEV1 less than 80% of predicted. People with COPD also exhibit a decrease in

1561:(FEV1), which is the greatest volume of air that can be breathed out in the first second of a breath and the 1484: 1326: 906: 340: 233: 11533:

Valipour A (January 2017). "Bronchoscopic Thermal Vapour Ablation: Hot Stuff to Treat Emphysema Patients!".

10275:"Role of metformin in treatment of patients with chronic obstructive pulmonary disease: a systematic review" 7913: 3023:

It is generally accepted that COPD is widely underdiagnosed and many people remain untreated. In the US the

2995:

Modern treatments were developed during the second half of the 20th century. Evidence supporting the use of

1097:, and during the early life of the child is a risk factor for the later development of COPD in their child. 296:

or shortness of breath, cough, sputum production and/or exacerbations) due to abnormalities of the airways (

13935: 13886: 13719: 13657: 4847: 4845: 4843: 4841: 4839: 4837: 3369: 3367: 3194: 3118: 3058: 2460: 2406: 2334: 1924: 1449: 1170: 1165: 9907:"Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease" 4494:"Non-typeable Haemophilus influenzae chronic colonization in chronic obstructive pulmonary disease (COPD)" 3388: 3386: 3384: 3382: 3365: 3363: 3361: 3359: 3357: 3355: 3353: 3351: 3349: 3347: 782:(A1AD) is an important risk factor for COPD. It is advised that everybody with COPD be screened for A1AD. 13896: 11925:"National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2011: Statistical Brief #160" 10625:"Non-invasive ventilation during exercise training for people with chronic obstructive pulmonary disease" 8208: 4934:

Clementi EA, Talusan A, Vaidyanathan S, Veerappan A, Mikhail M, Ostrofsky D, et al. (January 2019).

2500:, with both appearing to be equally effective. Nebulization may be easier for those who are more unwell. 2102: 656: 13066: 12734:

Churg A, Wright JL (2007). "Animal models of cigarette smoke-induced chronic obstructive lung disease".

12468:"The Biological Effects of Double-Dose Alpha-1 Antitrypsin Augmentation Therapy. A Pilot Clinical Trial" 11408:"1 Recommendations | Endobronchial valve insertion to reduce lung volume in emphysema | Guidance | NICE" 9181:"The safety of long-acting β2-agonists in the treatment of stable chronic obstructive pulmonary disease" 4834: 4570:

Halpin DM, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, Agusti AA, Vogelmeier CF (January 2021).

4542: 4392: 4390: 4388: 4386: 4384: 4382: 4380: 4378: 4376: 4374: 3257: 1408:, appears to be the precursor for the development of emphysema. The inflammatory cells involved include 1357:

shown in upper diagram. Lungs damaged by COPD in lower diagram with an inset showing a cross-section of

14082: 12800:

Miller MS, Tilley LP, Smith FW (January 1989). "Cardiopulmonary disease in the geriatric dog and cat".

9031:"Inhaled corticosteroids versus long-acting beta(2)-agonists for chronic obstructive pulmonary disease" 3379: 3344: 3117:

is being trialed and has been used as part of a clinical trial (2021) in a hospital in the UK. The new

2896: 2448: 2402: 1874: 1155: 1017: 825: 422: 366:

may coexist and converge in some individuals. COPD is associated with low-grade systemic inflammation.

328: 192: 12659:"Developing a patient-driven chronic obstructive pulmonary disease (COPD) research agenda in the U.S." 11065: 8384:"Action plans with brief patient education for exacerbations in chronic obstructive pulmonary disease" 6498:"Effect of cannabis smoking on lung function and respiratory symptoms: a structured literature review" 2467:

this can lead to improvements in COPD symptoms. Supplemental nutrition may be useful in those who are

13955: 13580: 13554: 13279: 13180: 11309: 11291: 11289: 8671: 7721: 6927: 4371: 3114: 2966: 2943: 2277:

The use of corticosteroids is associated with a decrease in the number of lymphoid follicles (in the

1764: 843:

may delay its recognition and where they include loss of taste or smell COVID-19 is to be suspected.

763: 110: 11407: 4329:"Chronic Obstructive Pulmonary Disease: Epidemiology, Biomarkers, and Paving the Way to Lung Cancer" 3965: 3963: 3961: 3959: 1304:(genetic subtype) with a specific treatment. This risk is particularly high if someone deficient in 13731: 13559: 13544: 13537: 13442: 13403: 13350: 13328: 13286: 13214: 12990: 3094:

has the potential to restore lung function and thereby improve quality of life. In June 2021 eight

2611: 2599:

are required for this procedure. The placement of one or more valves in the lobe induces a partial

2426: 2189: 2170: 2134: 2114: 1878: 1858: 1704: 1557:, a medication to open up the airways. Two main components are measured to make the diagnosis, the 1553:

measures the amount of airflow obstruction present and is generally carried out after the use of a

1374: 1319: 611:

and when it persists for more than three months each year for at least two years, it is defined as

442: 292:

2024 defined COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms (

285: 225: 196: 180: 13710: 11286: 9667:"Umeclidinium bromide versus placebo for people with chronic obstructive pulmonary disease (COPD)" 8761:

Wilson ME, Dobler CC, Morrow AS, Beuschel B, Alsawas M, Benkhadra R, et al. (February 2020).

8480:

Jolliffe DA, Greenberg L, Hooper RL, Mathyssen C, Rafiq R, de Jongh RT, et al. (April 2019).

6061: 3718: 3716: 3714: 3712: 3710: 3708: 3706: 3704: 3440: 2153:

causing them to relax and allow improved airflow. They reduce shortness of breath, tend to reduce

1577:

due to decreased surface area in the alveoli, as well as damage to the capillary bed. Testing the

1005: 13859: 13501: 13417: 13292: 10521: 10132:"Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease" 9819:

Chinet T, Dumoulin J, Honore I, Braun JM, Couderc LJ, Febvre M, et al. (December 2016). "".

8965: 4254: 3956: 3702: 3700: 3698: 3696: 3694: 3692: 3690: 3688: 3686: 3684: 2513: 2091: 1507: 1381:) exist. The poor airflow is the result of small airways disease and emphysema (the breakdown of 1334: 1220: 1159: 836: 410: 114: 101: 61: 11744: 7827: 7717: 5918:"Effects of different routes of endotoxin injury on barrier function in alcoholic lung syndrome" 5237:

Ramírez-Venegas A, Torres-Duque CA, Guzmán-Bouilloud NE, González-García M, Sansores RH (2019).

5081: 4908: 3812: 3508: 3506: 807: 655:. The common cold is usually associated with the winter months but can occur at any time. Other 13985: 13838: 13799: 13714: 13667: 13366: 13209: 8666: 3504: 3502: 3500: 3498: 3496: 3494: 3492: 3490: 3488: 3486: 2887: 2639: 2596: 2501: 2154: 1966: 1854: 1049: 893: 803: 747: 680: 661: 587:

The most often first symptom of COPD is a chronic cough, which may or may not be productive of

171: 13041: 12708: 12191: 10914:"Effectiveness of manual therapy in COPD: A systematic review of randomised controlled trials" 10426: 8280:

Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. (February 2013).

8235: 8178: 8151: 7171:

obstruction predicts future chronic airflow obstruction: a multinational longitudinal study".

7014:

D'Ascanio M, Viccaro F, Calabrò N, Guerrieri G, Salvucci C, Pizzirusso D, et al. (2020).

6689: 6662: 6412:

Underner M, Urban T, Perriot J, Peiffer G, Harika-Germaneau G, Jaafari N (December 2018). "".

3681: 13247: 13219: 12657:

Gruß I, McCreary GM, Ivlev I, Houlihan ME, Yawn BP, Pasquale C, et al. (December 2021).

11234:

Noti JD, Blachere FM, McMillen CM, Lindsley WG, Kashon ML, Slaughter DR, Beezhold DH (2013).

9080:"Effect of long-acting beta-agonists on the frequency of COPD exacerbations: a meta-analysis" 8913:

Oba Y, Keeney E, Ghatehorde N, Dias S, et al. (Cochrane Airways Group) (December 2018).

7550: 7360: 6088: 3091: 2556: 2550: 2322: 2306: 2214: 1994: 1783:

Chest X-ray demonstrating severe COPD, displaying small heart size in comparison to the lungs

1405: 1393: 1113: 1053: 993: 461: 7516: 6115: 3483: 3287: 1795:

A lateral chest X-ray of a person with emphysema, displaying barrel chest and flat diaphragm

1064:, more so when combined with smoking; smoking induces the upregulation of the expression of 701:. This same advice is offered in Canada and Australia to the effects of their forest fires. 13864: 13816: 13804: 13618: 13576: 13175: 11247: 11178: 9856:"Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease" 7320:"Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology" 6278:"Early life insults as determinants of chronic obstructive pulmonary disease in adult life" 6250: 5815: 4936:"Metabolic Syndrome and Air Pollution: A Narrative Review of Their Cardiopulmonary Effects" 3062: 3028: 2981: 2627: 2489: 2435: 2245: 2037: 1998: 1945: 1898: 1741: 1584: 1578: 1057: 821: 608: 564: 465: 446: 406: 246: 13476: 11702:

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. (December 2012).

10329:"Oxygen therapy in COPD and interstitial lung disease: navigating the knowns and unknowns" 8573:

Mackay AJ, Hurst JR (July 2012). "COPD exacerbations: causes, prevention, and treatment".

7266:"The pathology of small airways disease in COPD: historical aspects and future directions" 6928:"COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside" 6877:

Maselli DJ, Bhatt SP, Anzueto A, Bowler RP, DeMeo DL, Diaz AA, et al. (August 2019).

5704: 5236: 5039:"Pulmonary heart disease: The heart-lung interaction and its impact on patient phenotypes" 2992:. This was the first association between tobacco smoking and chronic respiratory disease. 2849:

need to be considered. Other factors that contribute to a poor outcome include older age,

2078:

when other options are available due to higher risks of serious side effects. In treating

985: 8: 14132: 14099: 13845: 13794: 13422: 13242: 13109: 12956: 6192:"Female Smokers Are at Greater Risk of Airflow Obstruction Than Male Smokers. UK Biobank" 6143:"Host, Gender, and Early-Life Factors as Risks for Chronic Obstructive Pulmonary Disease" 3134: 2592: 2398: 2033: 1433: 1305: 944: 910: 892:

and swollen ankles. These differences were suggested to be due to the presence or not of

554: 324: 90: 11924: 11251: 11182: 10982: 10957: 10649: 10624: 9882: 9855: 9313: 9280: 7147: 7120: 5819: 4720: 4181: 3875: 2430:

significantly reduce future hospital admissions, mortality and improve quality of life.

52: 13990: 13855: 13811: 13643: 13564: 13491: 13361: 12684: 12658: 12634: 12609: 12585: 12492: 12467: 12443: 12418: 12369: 12344: 12298: 12271: 12011: 11984: 11871: 11844: 11819: 11792: 11728: 11703: 11684: 11607: 11558: 11510: 11483: 11459: 11434: 11386: 11340: 11270: 11235: 11202: 11074: 11041: 10889: 10864: 10802: 10777: 10753: 10728: 10701: 10676: 10567: 10549: 10402: 10377: 10353: 10328: 10301: 10274: 10232: 10205: 10156: 10131: 10066: 10041: 10019: 9931: 9906: 9796: 9769: 9742: 9715: 9691: 9666: 9642: 9617: 9595: 9552: 9463: 9438: 9414: 9389: 9362: 9337: 9256: 9231: 9207: 9180: 9156: 9131: 9109: 9055: 9030: 8939: 8914: 8890: 8787: 8762: 8738: 8713: 8689: 8654: 8550: 8525: 8457: 8432: 8408: 8383: 8127: 8102: 8052: 8025: 7775: 7748: 7692: 7625: 7600: 7528: 7411: 7292: 7265: 7243: 7101: 7042: 7015: 6968: 6955: 6903: 6878: 6795: 6770: 6746: 6721: 6522: 6497: 6437: 6352: 6304: 6277: 6232: 6167: 6142: 6034: 6009: 5990: 5942: 5917: 5890: 5865: 5838: 5803: 5779: 5754: 5713: 5688: 5661: 5634: 5610: 5585: 5561: 5534: 5494: 5436: 5409: 5382: 5355: 5212: 5126: 5101: 5065: 5038: 5011: 4986: 4962: 4935: 4892: 4865: 4823: 4774: 4747: 4650: 4596: 4571: 4523: 4469: 4442: 4355: 4328: 4301: 4274: 4126: 4101: 4077: 4052: 4033: 3848: 3766: 3739: 3665: 3638: 3586: 3559: 3467: 3442: 3126: 2456: 1976: 1756: 1733: 1471: 1366: 1264: 1236: 1224: 1000:, non-silica dust (e.g., dust from gypsum, cement, limestone, marble and dolomite) and 860: 783: 755: 716: 636: 620: 612: 492: 378: 347: 336: 85: 12813: 12096: 11719: 11672: 11328: 10537: 8680: 8524:

Vollenweider DJ, Frei A, Steurer-Stey CA, Garcia-Aymerich J, Puhan MA (October 2018).

7079: 4117: 4068: 3458: 1534:

The diagnosis of COPD should be considered in anyone over the age of 35 to 40 who has

1480: 14112: 13356: 13185: 13146: 13078: 13001: 12817: 12757: 12747: 12714: 12689: 12639: 12590: 12538: 12497: 12448: 12374: 12303: 12197: 12144: 12127:

Fishman AP (May 2005). "One hundred years of chronic obstructive pulmonary disease".

12049: 12016: 11932: 11876: 11824: 11733: 11688: 11676: 11599: 11594: 11577: 11550: 11515: 11464: 11390: 11378: 11332: 11275: 11194: 11151: 11079: 11022: 10987: 10935: 10894: 10842: 10807: 10758: 10706: 10654: 10605: 10553: 10541: 10478: 10432: 10407: 10358: 10306: 10237: 10161: 10112: 10071: 10011: 9976: 9936: 9887: 9836: 9801: 9747: 9696: 9647: 9587: 9544: 9509: 9468: 9419: 9367: 9318: 9300: 9261: 9212: 9161: 9101: 9096: 9079: 9060: 9011: 9007: 8944: 8895: 8819: 8792: 8743: 8694: 8590: 8555: 8503: 8462: 8413: 8301: 8241: 8184: 8157: 8132: 8057: 8001: 7950: 7903: 7847: 7780: 7671: 7630: 7556: 7555:(5th ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 69. 7520: 7446: 7403: 7366: 7341: 7297: 7247: 7235: 7152: 7105: 7093: 7047: 6991: 6972: 6960: 6908: 6832: 6800: 6751: 6697: 6668: 6643: 6593: 6527: 6478: 6429: 6394: 6356: 6344: 6309: 6224: 6172: 6121: 6094: 6067: 6039: 5994: 5982: 5947: 5895: 5843: 5784: 5718: 5666: 5615: 5566: 5498: 5486: 5441: 5387: 5336: 5301: 5260: 5204: 5161: 5131: 5070: 5016: 5002: 4967: 4897: 4815: 4779: 4654: 4642: 4601: 4527: 4515: 4474: 4360: 4306: 4243: 4131: 4082: 4037: 4025: 3945: 3840: 3832: 3771: 3670: 3591: 3472: 3141: 3121:

which takes about an hour to carry out, places electrodes to destroy branches of the

3087: 2950: 2484: 2452: 2158:

used with a long-acting beta-2 agonist is more effective than either one on its own.

1915: 1437: 1250: 1143: 1086: 674: 512: 434: 394: 206: 159: 73: 12973: 12969: 12965: 12961: 12466:

Campos MA, Geraghty P, Holt G, Mendes E, Newby PR, Ma S, et al. (August 2019).

11611: 11562: 11344: 11206: 10376:

Ekström M, Ahmadi Z, Bornefalk-Hermansson A, Abernethy A, Currow D (November 2016).

10091:"Preventing COPD exacerbations with macrolides: a review and budget impact analysis" 10023: 9854:

Walters JA, Tan DJ, White CJ, Gibson PG, Wood-Baker R, Walters EH (September 2014).

9599: 9113: 8851:, pp. 48–52, Chapter 3: Evidence supporting prevention and maintenance therapy. 8204: 8183:(4th ed.). Wolters Kluwer/Lippincott Williams & Wilkins. pp. 521–522. 7532: 7415: 6570:

Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM (September 2006).

6441: 6340: 5523:, pp. 54–58, Chapter 3: Evidence supporting prevention and maintenance therapy. 4099: 3997:, pp. 60–65, Chapter 3: Evidence supporting prevention and maintenance therapy. 3903: 3852: 3428:, pp. 40–46, Chapter 3: Evidence supporting prevention and maintenance therapy. 2727:

lost to chronic obstructive pulmonary disease per 100,000 inhabitants in 2004:

14055: 14048: 13912: 13833: 13672: 13608: 13457: 12809: 12739: 12679: 12669: 12629: 12621: 12580: 12576: 12572: 12528: 12487: 12479: 12438: 12434: 12430: 12364: 12356: 12293: 12283: 12136: 12092: 12006: 11996: 11866: 11856: 11814: 11804: 11723: 11715: 11668: 11589: 11542: 11505: 11495: 11454: 11446: 11370: 11324: 11265: 11255: 11186: 11141: 11069: 11061: 11057: 11053: 11018: 11014: 10977: 10973: 10969: 10925: 10884: 10876: 10834: 10797: 10793: 10789: 10748: 10744: 10740: 10696: 10692: 10688: 10644: 10640: 10636: 10601: 10597: 10533: 10468: 10397: 10393: 10389: 10348: 10340: 10296: 10286: 10227: 10217: 10151: 10147: 10143: 10102: 10061: 10057: 10053: 10003: 9972: 9968: 9964: 9926: 9922: 9918: 9877: 9872: 9867: 9828: 9791: 9781: 9737: 9727: 9686: 9682: 9678: 9637: 9633: 9629: 9579: 9556: 9536: 9499: 9458: 9454: 9450: 9409: 9405: 9401: 9357: 9349: 9308: 9296: 9292: 9251: 9247: 9243: 9202: 9192: 9151: 9147: 9143: 9091: 9050: 9046: 9042: 9003: 8934: 8930: 8926: 8885: 8881: 8877: 8862: 8782: 8774: 8733: 8729: 8725: 8684: 8676: 8582: 8545: 8541: 8537: 8493: 8452: 8448: 8444: 8403: 8399: 8395: 8293: 8122: 8118: 8114: 8047: 8037: 7940: 7839: 7770: 7760: 7661: 7620: 7612: 7512: 7438: 7395: 7331: 7287: 7277: 7225: 7217: 7188: 7180: 7142: 7132: 7083: 7075: 7037: 7027: 6950: 6942: 6898: 6890: 6790: 6782: 6741: 6733: 6635: 6626:

Pirozzi C, Scholand MB (July 2012). "Smoking cessation and environmental hygiene".

6583: 6517: 6509: 6468: 6421: 6386: 6336: 6299: 6289: 6236: 6214: 6206: 6162: 6154: 6029: 6021: 5974: 5937: 5929: 5885: 5877: 5833: 5823: 5774: 5766: 5736: 5708: 5700: 5656: 5646: 5605: 5597: 5556: 5546: 5478: 5431: 5421: 5377: 5367: 5328: 5291: 5250: 5216: 5194: 5121: 5113: 5060: 5050: 5006: 4998: 4957: 4947: 4887: 4877: 4827: 4807: 4769: 4759: 4632: 4591: 4583: 4505: 4464: 4454: 4350: 4340: 4296: 4286: 4235: 4121: 4113: 4072: 4064: 4017: 3937: 3824: 3761: 3751: 3660: 3650: 3581: 3571: 3462: 3454: 3441:

GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (October 2016).

3210: 2846: 2525: 2138: 2075: 1503: 1429: 1417: 1260: 1032: 868: 767: 709: 604: 106: 65: 13052: 12321: 10042:"Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD)" 9504: 9487: 8498: 8481: 7221: 6025: 5933: 5881: 4866:"Treatment of lung disease in alpha-1 antitrypsin deficiency: a systematic review" 4510: 4493: 1211:

Poorly ventilated fires used for cooking and heating, are often fueled by coal or

46:

Chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD)

14077: 14029: 13917: 13868: 13789: 13705: 13513: 12995: 12880: 12360: 12111: 11260: 11236:"High humidity leads to loss of infectious influenza virus from simulated coughs" 10930: 10913: 10838: 9583: 9488:"Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications" 9439:"Tiotropium versus ipratropium bromide for chronic obstructive pulmonary disease" 7442: 7336: 7319: 6588: 6571: 6425: 6390: 5410:"Impact and prevention of severe exacerbations of COPD: a review of the evidence" 5296: 5279: 5199: 5117: 4239: 3941: 2835: 2340: 2106: 2044: 1467: 1382: 1081: 958: 864: 751: 666: 648: 370: 355: 214: 144: 11450: 10344: 10222: 8811: 7899:

Policy Recommendations for Smoking Cessation and Treatment of Tobacco Dependence

7867:"Spirometry in practice – a practical guide to using spirometry in primary care" 7765: 7184: 6894: 5482: 4811: 2954: 2822:

COPD is progressive and can lead to premature death. It is estimated that 3% of

2141:; either in long-acting or short-acting forms. Beta2–adrenergic agonists target 2133:

basis; their use on a regular basis is not recommended. The two major types are

1703:

A number of methods can be used to assess the affects and severity of COPD. The

14015: 13677: 13588: 13508: 13318: 13313: 13055: 12674: 12625: 12483: 12140: 11546: 10179: 10107: 10090: 8586: 8297: 7843: 7616: 7137: 6946: 6737: 6639: 6210: 4587: 4291: 3220: 3148: 3099: 3095: 3067: 3000: 2974: 2390: 2366: 2271: 2262: 2126: 2052: 2048: 1866: 1737: 1566: 1562: 1554: 1288:

effects of dust exposure and cigarette smoke exposure appear to be cumulative.

962: 922: 457: 453: 449: 253: 249: 229: 184: 13006: 11861: 11374: 11190: 9832: 9786: 9540: 8334: 8042: 7399: 7282: 6158: 5978: 5182: 3876:"Chronic obstructive pulmonary disease (COPD) - Aetiology | BMJ Best Practice" 3828: 3576: 1707:

or the COPD assessment test (CAT) are simple questionnaires that may be used.

965:

has been described with a difficulty noted of determining the best treatment.

14177: 14107: 13821: 13532: 12875: 12842:

Global Strategy for Prevention, Diagnosis and Management of COPD: 2021 Report

11894: 9304: 7945: 7928: 7693:"Chronic obstructive pulmonary disease (COPD) - Criteria | BMJ Best Practice" 7193: 6879:"Clinical Epidemiology of COPD: Insights From 10 Years of the COPDGene Study" 6771:"Alpha-1 antitrypsin deficiency: a commonly overlooked cause of lung disease" 5551: 5055: 4459: 4419: 3836: 2883: 2850: 2493: 2414: 2410: 2146: 1980: 1745: 1216: 1200: 1090: 1045: 989: 795: 743: 731: 727: 418: 382: 351: 301: 148: 12946: 12942: 12938: 12288: 12001: 11793:"Epidemiology of chronic obstructive pulmonary disease: a literature review" 11500: 11484:"Lung volume reduction with endobronchial coils for patients with emphysema" 11308:

van Geffen WH, Slebos DJ, Herth FJ, Kemp SV, Weder W, Shah PL (April 2019).

11146: 11129: 10473: 10456: 10291: 10255: 9279:

Fukuda N, Horita N, Kaneko A, Goto A, Kaneko T, Ota E, Kew KM (2023-06-05).

8778: 7666: 7649: 7088: 6513: 5828: 5319:

Postma DS, Rabe KF (24 September 2015). "The Asthma–COPD Overlap Syndrome".

3655: 2001:

to help reduce the risk of exacerbations; CDC and GOLD 2024 also recommends

787:

morbidity and mortality and this rate is amplified when comorbid with COPD.

14044: 13997: 13382: 13334: 13203: 12761: 12693: 12643: 12594: 12542: 12501: 12452: 12378: 12307: 12148: 12020: 11936: 11880: 11828: 11737: 11680: 11603: 11554: 11519: 11468: 11382: 11336: 11279: 11198: 11155: 11083: 11026: 10991: 10939: 10898: 10846: 10811: 10762: 10710: 10658: 10609: 10545: 10482: 10411: 10362: 10310: 10241: 10165: 10116: 10075: 10015: 9980: 9940: 9891: 9840: 9805: 9751: 9700: 9651: 9591: 9548: 9513: 9472: 9423: 9371: 9322: 9265: 9216: 9165: 9105: 9064: 9015: 8948: 8899: 8823: 8796: 8747: 8698: 8594: 8559: 8523: 8507: 8466: 8417: 8305: 8136: 8061: 7954: 7851: 7784: 7675: 7634: 7524: 7450: 7407: 7345: 7301: 7239: 7156: 7097: 7051: 6964: 6912: 6804: 6755: 6647: 6597: 6531: 6482: 6473: 6456: 6433: 6398: 6348: 6313: 6228: 6219: 6176: 6043: 5986: 5951: 5899: 5847: 5788: 5722: 5670: 5619: 5570: 5490: 5445: 5391: 5340: 5305: 5264: 5135: 5074: 5020: 4971: 4901: 4819: 4783: 4646: 4605: 4519: 4478: 4364: 4310: 4247: 4135: 4086: 4029: 3949: 3927: 3844: 3775: 3756: 3674: 3595: 3476: 3004: 2468: 2370: 2344: 2326: 2318: 2225:

agonist drugs that require twice-daily dosing for people with stable COPD.

2071: 2047:

are used in the management of stable COPD and exacerbations. These include

2013: 1870: 1498: 1378: 1192: 1187: 1120: 1013: 788: 759: 670: 640: 616: 188: 12848:. Global Initiative for Chronic Obstructive Lung Disease. 25 November 2020 12821: 12245:"NIH study shows hyaluronan is effective in treating chronic lung disease" 10880: 10375: 9029:

Spencer S, Karner C, Cates CJ, Evans DJ (December 2011). Spencer S (ed.).

6457:"A Systematic Review of the Respiratory Effects of Inhalational Marijuana" 5601: 5535:"Imbalance Between Injury and Defense in the COPD Emphysematous Phenotype" 5332: 5280:"Chronic obstructive pulmonary disease and phenotypes: a state-of-the-art" 5278:

Corlateanu A, Mendez Y, Wang Y, Garnica RJ, Botnaru V, Siafakas N (2020).

5255: 5238: 5208: 4952: 2654:

Chronic obstructive pulmonary disease deaths per million persons in 2012:

14142: 14089: 14072: 14067: 14020: 13975: 13826: 13774: 13741: 13613: 13342: 13274: 13237: 13192: 13127: 13036: 10496: 9336:

Zheng Y, Zhu J, Liu Y, Lai W, Lin C, Qiu K, et al. (November 2018).

8358: 8103:"Smoking cessation for people with chronic obstructive pulmonary disease" 7585: 7032: 6294: 5804:"Human airway branch variation and chronic obstructive pulmonary disease" 5426: 5372: 4882: 4273:

O'Donnell DE, Milne KM, James MD, de Torres JP, Neder JA (January 2020).

3525: 3155: 3122: 3103: 3074: 2899:, who made one of the earliest recorded descriptions of emphysema in 1769 2600: 2505: 2293: 2229: 2210: 2201: 2185: 2130: 2117:

may be used to support breathing and also reduce daytime breathlessness.

2067: 2063: 2056: 2008: 1932: 1908: 1760: 1729: 1494: 1436:

in tobacco smoke and released by inflammatory cells and breakdown of the

1205: 940: 925: 775: 652: 576: 473: 438: 374: 210: 78: 12515:

Nambiar S, Bong How S, Gummer J, Trengove R, Moodley Y (February 2020).

11809: 9732: 9197: 8526:"Antibiotics for exacerbations of chronic obstructive pulmonary disease" 8237:

Chest medicine : essentials of pulmonary and critical care medicine

7230: 6786: 6008:

Slovinsky WS, Romero F, Sales D, Shaghaghi H, Summer R (November 2019).

5651: 5102:"Chronic obstructive pulmonary disease and COVID-19: interrelationships" 4764: 4621:"Covid lockdown: England sees fewer cases of colds, flu, and bronchitis" 4345: 2892: 2630:

might be considered. A CT scan may be useful in surgery considerations.

1759:

is used to determine the need for oxygen supplementation and assess for

288:

characterized by long-term respiratory symptoms and airflow limitation.

14062: 13662: 13648: 13623: 13598: 13593: 13527: 13398: 13374: 13323: 13197: 13162: 13137: 13061: 12556:

McLean S, Nurmatov U, Liu JL, Pagliari C, Car J, Sheikh A (July 2011).

12533: 12516: 12083:

Woolcock A (1984). "The Search for Words to Describe the Bad Blowers".

12044:. In Fishman A, Elias J, Fishman J, Grippi M, Senior R, Pack A (eds.). 10958:"Airway clearance techniques for chronic obstructive pulmonary disease" 10007: 8430: 7929:"Smoking cessation treatment for COPD smokers: the role of counselling" 5770: 4275:"Dyspnea in COPD: New Mechanistic Insights and Management Implications" 3107: 3054: 3008: 2970: 2831: 2635: 2359: 2349: 2310: 2241: 2233: 2197: 2193: 2181: 2166: 2150: 1949: 1831:

Axial CT image of the lung of a person with end-stage bullous emphysema

1550: 1539: 1527: 1459: 1425: 1421: 1413: 1409: 1358: 1175: 1069: 1028: 936: 932: 723: 696: 644: 536: 426: 297: 241: 164: 12921: 12743: 9353: 9230:

Nannini LJ, Lasserson TJ, Poole P (September 2012). Nannini LJ (ed.).

5586:"Impact of human immunodeficiency virus on pulmonary vascular disease" 4637: 4620: 1116:

that clears the bronchi of mucus, cellular debris and unwanted fluid.

14137: 13769: 13638: 13633: 13603: 13154: 13047: 13012: 9618:"Aclidinium bromide for stable chronic obstructive pulmonary disease" 9390:"Tiotropium versus placebo for chronic obstructive pulmonary disease" 4864:

Edgar RG, Patel M, Bayliss S, Crossley D, Sapey E, Turner AM (2017).

4100:

GBD 2013 Mortality and Causes of Death Collaborators (January 2015).

4021: 3080: 2573:

For severe emphysema that has proved unresponsive to other therapies

2497: 2394: 2355: 2314: 2095: 2021: 2017: 1928: 1755:

is not routinely used except for the exclusion of bronchiectasis. An

1490: 1463: 1134: 1094: 1024: 852: 851:

Many definitions of COPD in the past included chronic bronchitis and

799: 688: 332: 309: 12900: 11128:

Osman LM, Ayres JG, Garden C, Reglitz K, Lyon J, Douglas JG (2008).

8101:

van Eerd EA, van der Meer RM, van Schayck OC, Kotz D (August 2016).

7013: 6852: 4933: 2409:

of less than 88%). When taking into account complications including

1455: 1416:, two types of white blood cells. Those who smoke additionally have 831:

It is unclear if those with COPD are at greater risk of contracting

575:. People with COPD often have increased breathlessness and frequent 14152: 14037: 13437: 13170: 11040:

Van Geffen WH, Douma WR, Slebos DJ, Kerstjens HA (29 August 2016).

10912:

Simonelli C, Vitacca M, Vignoni M, Ambrosino N, Paneroni M (2019).

10863:

Wearing J, Beaumont S, Forbes D, Brown B, Engel R (February 2016).

8100: 6690:"Relationship between cigarette smoking and occupational exposures" 2963:

A Treatise on the Diseases of the Chest and of Mediate Auscultation

2939: 2330: 2110: 2029: 1445: 1441: 1301: 1108:, the major component of alveoli. Smoke also impairs the action of 1101: 1061: 969: 889: 840: 832: 815: 746:) due in part to shared risk factors. Common comorbidities include 720: 692: 572: 559: 488: 398: 305: 152: 8382:

Howcroft M, Walters EH, Wood-Baker R, Walters JA (December 2016).

1522: 13390: 13266: 13017: 11929:

Healthcare Cost and Utilization Project (HCUP) Statistical Briefs

9768:

Chen H, Sun J, Huang Q, Liu Y, Yuan M, Ma C, et al. (2021).

5347: 2996: 2839: 2607: 2440: 2253:. Further research is needed comparing aclidinium to tiotropium. 2250: 1752: 1535: 1284: 1268: 1212: 1105: 1020:

is rated as the second most important risk factor after smoking.

1001: 719:

as sometimes being responsible in these cases. Signs can include

568: 414: 312:) that cause persistent, often progressive, airflow obstruction. 293: 12984: 12738:. Contributions to Microbiology. Vol. 14. pp. 113–25. 10911: 8479: 8381: 8320:"Chronic obstructive pulmonary disease (COPD) - Treatment - NHS" 8240:(5th ed.). Lippincott Williams & Wilkins. p. 172. 7601:"The importance of the assessment of pulmonary function in COPD" 7169: 4272: 3031:

to be an annual focus on increasing awareness of the condition.

2188:. They provide some relief of symptoms for four to six hours. A 984:

The cause of the development of COPD is the exposure to harmful

13487: 13300: 13229: 12933: 12894: 10327:

Khor YH, Renzoni EA, Visca D, McDonald CF, Goh NS (July 2019).

9130:

Geake JB, Dabscheck EJ, Wood-Baker R, Cates CJ (January 2015).

4441:

Guo-Parke H, Linden D, Weldon S, Kidney JC, Taggart CC (2020).

2842:(breathlessness) and exercise and not just spirometry results. 2237: 2218: 2206: 1862: 1272: 1128: 1109: 1009: 914: 771: 596: 592: 363: 176: 12802:

The Veterinary Clinics of North America. Small Animal Practice

11989:

International Journal of Chronic Obstructive Pulmonary Disease

11797:

International Journal of Chronic Obstructive Pulmonary Disease

11435:"Endobronchial Valves for the Treatment of Advanced Emphysema" 11039: 10622: 10591: 9720:

International Journal of Chronic Obstructive Pulmonary Disease

9185:

International Journal of Chronic Obstructive Pulmonary Disease

6282:

International Journal of Chronic Obstructive Pulmonary Disease

5866:"Alcohol use disorder: A pre-existing condition for COVID-19?" 5802:

Smith BM, Traboulsi H, Austin JM, et al. (January 2018).

5407: 5360:

International Journal of Chronic Obstructive Pulmonary Disease

5239:"SMALLa AIRWAY DISEASE IN COPD ASSOCIATED TO BIOMASS EXPOSURE" 4854:, pp. 26–33, Chapter 2: Diagnosis and initial assessment. 4225: 3788: 3395:, pp. 33–35, Chapter 2: Diagnosis and initial assessment. 3376:, pp. 20–27, Chapter 2: Diagnosis and initial assessment. 3288:"Chronic obstructive pulmonary disease (COPD) — Complications" 1807:

Lung bulla as seen on chest X-ray in a person with severe COPD

1767:

recommends that all those diagnosed with COPD be screened for

863:) whose walls break down resulting in permanent damage to the 13308: 12776:"Recurrent Airway Obstruction in Horses - Respiratory System" 12514: 12345:"Stem cell therapy for chronic obstructive pulmonary disease" 12269: 10501:

Global Initiative for Chronic Obstructive Lung Disease - GOLD

9129: 8363:

Global Initiative for Chronic Obstructive Lung Disease - GOLD

7586:

Clinical guideline 101: Chronic Obstructive Pulmonary Disease

6664:

Mosby's Pharmacy Technician – E-Book: Principles and Practice

6007: 5464:"Airway inflammation in COPD: progress to precision medicine" 4984: 3530:

Global Initiative for Chronic Obstructive Lung Disease - GOLD

3190: 2488:

anticholinergic. These medications can be given either via a

2087: 1401: 1397: 1362: 1280: 1276: 1232: 1228: 1038: 588: 390: 320: 316: 94: 11841: 11233: 11004: 10956:

Osadnik CR, McDonald CF, Jones AP, Holland AE (March 2012).

10675:

McKeough ZJ, Velloso M, Lima VP, Alison JA (November 2016).

9713: 6572:"Global burden of COPD: systematic review and meta-analysis" 6090:

Clinical management of chronic obstructive pulmonary disease

5755:"Human lung development: recent progress and new challenges" 3558:

Myc LA, Shim YM, Laubach VE, Dimastromatteo J (April 2019).

3557: 3084:

is being trialed and was due to complete in September 2021.

2434:

exercises alone does not appear to improve quality of life.

1843:

Very severe emphysema with lung cancer on the left (CT scan)

1349: 931:

Two inflammatory phenotypes show a phenotype stability: the

665:. Other risks include exposure to tobacco smoke (active and 315:

The main symptoms of COPD include shortness of breath and a

13257: 10955: 10454: 10040:

Herath SC, Normansell R, Maisey S, Poole P (October 2018).

10039: 9953: 8652: 7826:

Vestbo J, Hurd SS, Agustí AG, et al. (February 2013).

7501: 7119:

Knox-Brown B, Patel J, Potts J, et al. (23 May 2023).

6569: 6411: 5277: 5183:"Anatomy and physiology of collateral respiratory pathways" 4440: 4399:, pp. 104–109, Chapter 5: Management of exacerbations. 3740:"Airway Epithelium Dysfunction in Cystic Fibrosis and COPD" 2938:

were formally defined as components of COPD in 1959 at the

2278: 2025: 1574: 1354: 1315: 1256: 1139: 1124: 1065: 954: 742:

COPD often occurs along with a number of other conditions (

386: 12558:"Telehealthcare for chronic obstructive pulmonary disease" 12472: