Chronic Obstructive Pulmonary Disease

COPD is a term used to describe a spectrum of disorders characterized by reduced maximal expiratory flow and slow forced emptying of the lungs (Table 1). It is associated with symptoms of obstructive lung diseases, such as cough, mucus production, breathlessness, airflow limitation, and wheezing. COPD can be present with or without substantial physical impairment or symptoms. The World Health Organisation states that it is the fourth leading cause of global mortality. In the United Kingdom, it is estimated that 18% of males and 14% of females aged 40-68 years may have developed features of COPD. Severe exacerbations remain the largest single cause of emergency admissions for respiratory disease, with a mean hospital stay of 10 days.

Table 1 Consequences of disease-related malnutrition in COPD

Reduced lung function and dyspnea Reduced maximal O2 consumption Decreased peripheral muscle function Decreased exercise performance Decreased quality of life Increased need for hospitalization

Increased postoperative complications during lung volume reduction surgery Increased mortality

Adapted from Stratton et al. (2002).

The prevalence of COPD is greatest in socioeco-nomically deprived people. It is probably underdiag-nosed partly because many people do not consult their general practitioners or do not reveal all their symptoms. In general, the major cause of COPD is smoking. Other causes include ^-antitrypsin deficiency, cystic fibrosis, air pollution, occupational exposure, and bronchietasis.

Chronic bronchitis and emphysema are two of the major diseases grouped under COPD. Patients with COPD have features of both conditions, although one may be more prominent than the other.

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