Chronic obstructive pulmonary disease

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines chronic obstructive pulmonary disease (COPD) as a “heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration, exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.”

How prevalent is COPD?

COPD is the third highest cause of death globally and affects around 12% of the general population.

What are the risk factors for COPD?

Risk factors for COPD include:

• Smoking
• Ambient air pollution, including nitrogen dioxide
• A low body mass index (BMI)
• Indoor biomass burning
• Childhood asthma
• Occupational dust exposure
• Diet
• Genetic abnormalities, such as α1 antitrypsin deficiency

How is COPD diagnosed?

Spirometry is necessary to diagnose COPD by determining the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC). A post-bronchodilator FEV1/FVC of <0.7 indicates the presence of persistent airflow obstruction and confirms a diagnosis of COPD. Further investigation is undertaken to assess symptoms, disease severity, and risk of exacerbations (ECOPD), which is defined as “an event characterized by dyspnea and/or cough and sputum that worsen over <14 days.”

How can COPD be managed without pharmacological therapy?

Non-pharmacological approaches include:

• Avoiding active and passive smoking
• Limiting exposure to air pollution
• Maintaining a physical activity routine
• Pulmonary rehabilitation programs

What pharmacological therapies are available for COPD?

Currently available pharmacological therapies aim to improve airflow with bronchodilators (β2-adrenoceptor agonists or muscarinic receptor antagonists), suppress inflammation with corticosteroids or phosphodiesterase 4 (PDE4) inhibitors, or reduce exacerbations with antibiotics. Numerous therapies, including biologics that target cytokines known to be involved in type 2 inflammation, are under clinical investigation for reducing exacerbations or mortality in COPD.

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