What is chronic obstructive pulmonary disease?
Chronic obstructive pulmonary disease (COPD) has been defined by the Global Initiative for Chronic Obstructive Lung Disease as follows: COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. COPD is the internationally preferred term, which includes chronic bronchitis, emphysema, chronic airflow obstruction and chronic airflow limitation, either alone or in combination. Some conditions that can cause airflow obstruction, such as cystic fibrosis and bronchiectasis, are not included in the term COPD. COPD has an insidious onset, usually occurs above the age of 50 years and is predominantly caused by smoking, although it does occur rarely in non-smokers. COPD is the term used internationally to refer collectively to several lung diseases that are progressive, irreversible and potentially life-threatening. COPD is characterised by airflow obstruction that does not change markedly over a period of several months.
Special issues for effective treatment of homeless drug users
Substance misuse is inextricably linked into the homelessness story of many of the individuals who find themselves homeless in the UK. Many patients will not be seeking treatment for their substance misuse but can be reassured that treatment will be forthcoming should their attitude change in the future. Alcohol is an important factor in the addiction picture for many homeless patients. It is a fact of life in the homeless environment, with many homeless people having primary alcohol problems. Even if the patient is not using alcohol at the time of assessment, it is extremely common, if not the norm, for alcohol use to creep in as substitute prescribing is instituted and street drug usage decreases. Homeless people live in a dangerous and threatening environment. Substance misusers who are homeless are prone to chronic illnesses such as epilepsy, asthma or chronic obstructive pulmonary disease or chronic hepatitis C.
The respiratory system
Respiratory diseases often lead to hospital admission, and patients with chronic obstructive pulmonary disease may require repeated admissions for infective exacerbations. Smoking remains the single most important cause of respiratory disease despite greater awareness of the dangers of cigarette smoking and health warnings placed in advertisements and on cigarette packets. The nasal cavities form the first part of the respiratory passage and extend from the anterior nares or nostrils to the nasopharynx. The nares are lined with respiratory epithelium, with some olfactory epithelium. The respiratory tract includes the nose, nasopharynx and larynx, extending down into the alveoli to include the blood supply. A history of childhood asthma, pneumonia or whooping cough is sometimes relevant to the later development of chest symptoms in an adult. Chest injuries and previous pneumonia may explain changes seen on a chest X-ray.
Oxygen therapy in acute exacerbations of chronic obstructive pulmonary disease
Published in Expert Review of Respiratory Medicine, 2015
During the last decade, there have been major advances in knowledge of the effects of oxygen therapy in patients with acute exacerbations of chronic obstructive pulmonary disease. This includes a randomised controlled trial of oxygen therapy in the pre-hospital setting, which showed that high concentration oxygen therapy leads to a 2.4-fold increased risk of mortality compared with titrated oxygen therapy to maintain oxygen saturations (SpO2) within a target range of 88–92%. Professional guidelines now recommend the use of supplementary oxygen in acute exacerbations of chronic obstructive pulmonary disease only if the SpO2 is less than 88%, with titration to achieve an SpO2 of 88–92%, and the delivery of bronchodilators by air-driven nebulisation or metered dose inhaler with a spacer. The aim of this review is to provide an overview of the evidence base that underpins these recommendations. We suggest that their implementation will require important changes to current clinical practice in which there is an entrenched culture of the use of high concentration oxygen therapy.
Defining exacerbations in chronic obstructive pulmonary disease
Published in Expert Review of Respiratory Medicine, 2015
Chronic obstructive pulmonary disease is a very common disease often punctuated by intermittent episodes of exacerbation. These exacerbations affect the natural history of the disease, accelerating a decline in lung function. They affect the individual in many ways and affect the health service caring for these patients. The definition of exacerbation varies and lacks clarity. The definitions used most are either symptom based, for example, breathlessness, sputum production and sputum purulence, or event driven, for example, an event causing a patient to seek healthcare input or change to medications. In this article, we discuss the importance of exacerbations, the clinical definitions, clinical trial definitions, physiological and biomarker evidence of exacerbations and the challenges associated with each of these. Application of a practical definition would aid in our clinical management of patients with chronic obstructive pulmonary disease and facilitate developments in future therapeutic advances through clinical trials.
Inhaler technique and training in people with chronic obstructive pulmonary disease and asthma
Published in Expert Review of Respiratory Medicine, 2012
Asthma and chronic obstructive pulmonary disease are both common conditions with an increasing prevalence worldwide. Inhaled therapy for these conditions has a number of advantages over systemic therapy, including reduced side effects and quicker onset of action. The effective use of inhaled therapy is critically dependent upon the nature of the drug-delivery system and the ability of the patient to use the system correctly. There are a wide number of inhaler devices on the market, each with positive and negative aspects. A crucial part of patient care is to ensure that the choice of inhaler device for the individual is an effective therapy. There are a number of interventions that can help with the choice of inhaler device and also improve the ability of the patient to use inhaled therapy. Inhaler technique training needs to be a cornerstone of the care of patients with asthma or chronic obstructive pulmonary disease to ensure optimal therapy.