The Science Journal of the American Association for Respiratory Care

Special Articles

May 2002 / Volume 47 / Number 5 / Page 586

Chronic Obstructive Pulmonary Disease: On an Exponential Curve of Progress

John E Heffner MD

Introduction
Societal Impact of Chronic Obstructive Pulmonary
Disease
Response to the Epidemic of Chronic Obstructive Pulmonary Disease
Definition
Epidemiology
Pathogenesis
Natural History
Etiologic Factors
Diagnosis
Patient Monitoring
Pharmacologic Therapy of Stable Disease
Advances in Surgical Therapy
Nocturnal Noninvasive Ventilation
Rehabilitation
Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Noninvasive Positive-Pressure Ventilation for Acute Exacerbations
Future Directions
The last 50 years have witnessed major progress in our understanding of the underlying nature of chronic obstructive pulmonary disease (COPD) and approaches to care. During the last 10 years, however, there has been an explosive expansion of knowledge related to this disorder. Large-scale epidemiologic studies show that COPD is the fourth leading cause of death in the United States and will be the fifth leading health burden worldwide by the year 2020. We have also learned that COPD is an inflammatory disorder of small airways, which presents new opportunities for therapy involving interfering with the early components of the inflammatory cascade. Unfortunately, most clinicians fail to perform spirometric screening of at-risk individuals, so most patients first present with COPD during a sudden exacerbation of the disease. Worldwide interest is emerging in promoting earlier diagnosis and finding new pharmacologic interventions to halt the progression of airway and parenchymal damage. In this review, evidence is presented that we are on the upward limb of an exponential curve of progress in managing COPD, which will produce major advances in our ability to recognize and treat this disorder in its earliest stages.
Key words: chronic obstructive pulmonary disease, COPD.
[Respir Care 2002;47(5):586–607]

Introduction

To know chronic obstructive pulmonary disease (COPD) is to know pulmonary--and a large chunk of critical care--medicine. Those of us who were trained in pulmonary critical care during the 1970s gained much of our respiratory education through caring for COPD patients. We learned ventilator management and the importance of intrinsic positive end-expiratory pressure, principles of respiratory care, bronchodilator and corticosteroid pharmacotherapy, management of drug toxicity (thanks to the use of aminophylline), the importance of measuring health-related quality of life in monitoring disease, and the need for physicians to become skilled in palliative and end-of-life care.

So I appreciate the opportunity at this stage of my career to pause and reflect on the progress we have made in our understanding of COPD. As I look back at the 30 years of my experience with this condition I conclude that we are on an exponential curve of improving our knowledge of COPD. In this paper I will highlight that progress by touching on those aspects of our understanding of COPD that have undergone the greatest change and those that offer the most promise for providing further insight into the disease.

The entire text of this article is available in the printed version of the May 2002 RESPIRATORY CARE.

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