Chronic Obstructive Pulmonary Disease

Rita K. Cydulka Sorabh Khandelwal

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Chapter References

Individuals with chronic obstructive pulmonary disease (COPD) frequently develop severe respiratory distress and are among the most frustrating, frightening, and challenging patients to manage. In a fearful state of mixed anxiety, intense physical effort, and disoriented fatigue, such people face a constant battle against asphyxiation. At other times, presentation is prompted by otherwise uncomplicated medical or surgical disease, which becomes more serious or catastrophic as the impact of chronic respiratory disease is unmasked.

The American Thoracic Society (ATS) defines COPD as a disease state characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema. The airflow obstruction is generally progressive, may be accompanied by airway hyperactivity, and may be partially reversible. Chronic bronchitis is defined as the presence of chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of chronic cough have been excluded. Emphysema is defined as abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis. Note that chronic bronchitis is defined in clinical terms and emphysema in terms of anatomic pathology. 1

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