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Clinical Management of Chronic Obstructive Pulmonary Disease


Since the publication of the first edition, chronic obstructive pulmonary disease (COPD), as a public health issue, has increased in line with the predictions of the World Health Organization and by the year 2020, will become one of the main killers of human life.

With several important large scaled trials becoming available and our knowledge of COPD's determinants rapidly growing, it was essential to update Clinical Management of Chronic Obstructive Pulmonary Disease with a ...

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Since the publication of the first edition, chronic obstructive pulmonary disease (COPD), as a public health issue, has increased in line with the predictions of the World Health Organization and by the year 2020, will become one of the main killers of human life.

With several important large scaled trials becoming available and our knowledge of COPD's determinants rapidly growing, it was essential to update Clinical Management of Chronic Obstructive Pulmonary Disease with a second edition that will enable physicians to stay informed, aid in the clinical diagnosis, and the proper treatment of COPD

Within this text expert analysis will examine:

  • new treatments and combative strategies developed from recent and current clinical trails
  • the pathological and physiological mechanisms of chronic obstructive pulmonary disease
  • current and up to date information from developing worlds faced with the COPD epidemic
  • the burden COPD has and will have in the future for patients, treatments and society
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Editorial Reviews

Doody's Review Service
Reviewer: Joel C Seidman, MD (William Beaumont Hospitals)
Description: This is the second edition of a book, significantly revised from its first edition published in 2002, which broadly addresses all aspects of chronic obstructive pulmonary disease (COPD). Both editions were inspired by the Global Initiative for Obstructive Lung Disease (GOLD) guidelines published in 2001.
Purpose: The book is an attempt to adopt the observations of authorities from diverse experience, providing a comprehensive review of the current state of the art respecting COPD.
Audience: The audience is large and varied, but would include primary care internists, pulmonologists, and intensivists. Nurses, respiratory therapists, and rehabilitators would undoubtedly find the reference informative. It would also provide a real-life reference for basic science researchers in putting a face on applications carried out in the laboratory. There are nearly 50 contributors of international renown, although primarily from the United States, Canada, and Western Europe.
Features: This is one of the most comprehensive and up-to-date treatises that I have surveyed covering basic molecular biology and genetics underlying the disease for the clinician, epidemiology, early diagnosis, clinical presentation, and management from mildly afflicted to those requiring assisted ventilation and end-of-life palliation. The book focuses exceptionally upon the speculated growing role for pharmacotherapeutics, originally relegated to symptom palliation; that is, it makes inferences upon disease modification and impact upon mortality. In the latter respect, it offers evidence-based medicinal reviews and practice guidelines, constituents often lacking in similar undertakings. Particular emphasis is placed on objective measures of monitoring disease progress, an exercise becoming more important as survival potentially increases and upon hearing about management that might be rendered from multidisciplinary perspectives; experiences, in reality, not always afforded patients and/or their caregivers firsthand. This edition augments substantially the presentation of the last edition. Illustrations and graphics are limited, but sufficient to carry out the ends of each chapter. The bibliographies at each chapter end are extensive and relevant.
Assessment: This book achieves its likely intended goals well. For an average practitioner, it comes across as very accessible. I would personally consider it a very practical resource and would be intent upon adding it to my personal library.
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Product Details

  • ISBN-13: 9780849375873
  • Publisher: Taylor & Francis
  • Publication date: 11/16/2007
  • Series: Lung Biology in Health and Disease Series , #222
  • Edition description: REV
  • Edition number: 2
  • Pages: 608
  • Product dimensions: 6.00 (w) x 9.10 (h) x 1.30 (d)

Table of Contents

Introduction   Claude Lenfant     v
Foreword   Thomas Similowski     vii
Foreword   John F. Murray     ix
Preface     xv
Contributors     xix
Understanding COPD and Its Impact
The Burden of COPD?   Wen Qi Gan   Don D. Sin     1
Introduction     1
Definition and Clinical Features of COPD     1
The Prevalence of COPD     3
Functional Impairment and Office Visits for COPD     6
Emergency Room Visits and Hospitalizations     6
Mortality     7
Economic Burden     7
Natural History     9
The Relevance of Stage 0 Disease     10
Risk Factors     11
Summary     16
Conclusions     17
Acknowledgments     17
References     17
Smoking Cessation   Stephen I. Rennard   Lisa M. Hepp     23
Introduction     23
Cigarette Smoking     23
Smoking Cessation: Behavioral Intervention     26
Smoking Cessation: Pharmacotherapy     27
Special Considerations for the COPD Patient     34
HarmReduction     35
Conclusion     36
References     36
The Relationship of Tobacco Smoking to COPD: Histopathogenesis   James C. Hogg     43
Introduction     43
The Inflammatory Immune Response     44
The Adaptive Immune Response     45
Tissue Remodeling     48
Chronic Bronchitis     51
Chronic Airflow Limitation     53
Small Airway Obstruction     54
Emphysema     56
The CLE and Panacinar Forms of Emphysema     57
Other Forms of Emphysema     58
Pulmonary Hypertension     58
Summary     61
References     61
COPD as a Systemic Disease   Alvar Agusti     67
Introduction     67
Systemic Inflammation     67
Nutritional Abnormalities and Weight Loss     69
Skeletal Muscle Dysfunction     69
Cardiovascular Effects     70
Nervous System Effects     71
Osteoskeletal Effects     71
Conclusions     71
References     72
Assessing COPD
Early Diagnosis of COPD: Usefulness, Tools, and Actors   Dennis E. Doherty    Ketan Buch     77
Introduction     77
Burden of COPD and the Need for Early Diagnosis     78
Currently Available Tools for Prevention and Early Diagnosis of COPD     79
Actors Awaiting Prime Time     85
Summary     85
References     86
Assessment of Symptoms and Quality of Life in the COPD Patient   Carme Santiveri   Paul W. Jones     89
Introduction     89
Why Make Measurements of Symptoms and Quality of Life?     89
Symptoms and Health Status     90
Instruments for Symptoms     95
Instruments for Health Status     98
Factors that Are Related to Health Status in COPD     102
Bronchodilators     107
Specific Issues about Symptoms and Health Status Assessment     110
References     112
Measuring Ventilatory and Respiratory Impairment in COPD   Rik Gosselink   Thierry Troosters   Marc Decramer     119
Introduction     119
Exercise Testing     120
Maximal Incremental Exercise Testing     120
How to Interpret the Maximal Exercise Test     121
Exercise Endurance Tests     124
Respiratory Muscle Testing     126
Acknowledgments     128
References     128
Imaging of Lung Morphology and Function in COPD   Philippe Grenier   Catherine Beigelman-Aubry   Anne-Laure Brun   Pierre-Yves Brillet     133
Introduction     133
Chest Radiography     133
Computed Tomography     138
Nuclear Medicine     153
MR Imaging     154
References     156
Assessing the Systemic Consequences of COPD   Jan Tkac   S. F. Paul Man   Don D. Sin     165
Introduction     165
Extrapulmonary Disorders Associated with COPD     165
The Impact of Systemic Consequences of COPD on Mortality     180
Conclusion     181
Acknowledgments     182
References     182
The Pulmonary Vasculature of COPD   Joan Albert Barbera     189
Introduction     189
Epidemiology     189
Pathology     191
Pathophysiology and Natural History of Pulmonary Hypertension     192
Pathobiology     195
Evaluation and Diagnosis of Pulmonary Hypertension in COPD      197
Treatment     200
References     205
How the COPD Patient Should Be Assessed for Comorbidities   Joan B. Soriano   Jaume Sauleda     211
Introduction     211
Gold and ATS/ERS Guidelines     212
Comorbidities in General: Definitions     213
Mechanisms on Tobacco and Other Risk Factors     214
Brief on Systemic Inflammation     215
Measurements of Comorbidities in COPD     215
Comorbidities as Specific Causes of Death in COPD Patients     218
Comorbidities by Severity of COPD     219
Comorbidities in Women with COPD     219
Review of Organ-Specific Comorbidities     220
Assessment of Comorbidities in Primary Care     226
Assessment of Comorbidities in Respiratory Medicine     227
Treatment Considerations in COPD     228
Concluding Remarks     231
References     232
Goals of COPD Treatments and Measurement of Their Efficacy: From Clinical Trials to Real-World Practice   Veronique Pepin   Francois Maltais   Yves Lacasse     239
Introduction     239
Outcomes in Epidemiological and Clinical Studies     239
Outcomes in Clinical and Physiological Studies     244
Conclusion     257
References     257
Pharmacological Treatments of COPD
Choosing the Right Bronchodilator   Donald A. Mahler     263
Introduction     263
Goals of Treatment     264
Long-Acting [beta subscript 2]-Agonists     264
Long-Acting Muscarinic Antagonist     266
Effect of Long-Acting Bronchodilators on Goals of Treatment     266
Comparison of Long-Acting [beta subscript 2]-Agonists and Tiotropium     273
Combining Long-Acting [beta subscript 2]-Agonists and Tiotropium as Maintenance Therapy     274
Theophylline     274
Summary     275
References     276
When Should We Use Glucocorticoids in COPD?   Peter M. A. Calverley     281
Introduction     281
Pharmacology and Mechanisms Action     281
Corticosteroids as an Aid to Diagnosis     284
Corticosteroids in Exacerbations of COPD     285
Corticosteroids in Stable Disease     286
Combination Therapy     290
Side Effects     292
Conclusion     293
References     294
Treating and Preventing Infections   Sanjay Sethi      297
Introduction     297
Definition and Severity of Exacerbations     298
Pathogenesis of Exacerbations     299
Microbial Pathogens in COPD     299
Pathogenesis of Infectious Exacerbations     302
Treatment of Exacerbations     303
Antibiotics in the Treatment of Exacerbations     304
Risk Stratification of Patients     308
Risk-Stratification Approach to Antibiotic Therapy in Exacerbation     310
Antiviral Therapy for Exacerbations     312
Prevention of Exacerbations     312
Chronic Infection in COPD     314
Community-Acquired Pneumonia in Patients with COPD     317
Conclusions     318
References     318
Phosphodiesterase 4 Inhibitors, Mucolytics, and Emerging Pharmacotherapies for COPD   Mark A. Giembycz     323
Introduction     323
PDE4 Inhibitors     323
Mucolytics     339
Other New Chemical Entities for COPD     341
Concluding Remarks     341
Acknowledgments     342
References     342
Managing Exacerbations: An Overview   J. J. Soler-Cataluna   Roberto Rodriguez-Roisin      347
Introduction     347
Pathophysiology     348
Prevention of Exacerbations     349
Prevention of Infective Exacerbations     350
Anti-inflammatory Treatment     351
Long-Acting Inhaled Bronchodilators     352
Combination Therapy (LABAs Plus ICs)     354
Triple Combination Therapy (Tiotropium Plus LABA Plus ICs)     354
Mucolytics and Antioxidants     356
Nonpharmacological Treatment     356
Management of Exacerbations     357
Treatment of Exacerbations     359
HaH and Supported Discharge Services     364
References     364
Nonpharmacological Approaches in COPD
Exercise Training in COPD   Thierry Troosters   Rik Gosselink   Chris Burtin   Marc Decramer     371
Introduction     371
Exercise Limitation in Lung Disease     372
Exercise Tolerance and Health-Related Quality of Life After Exercise Training     374
The Exercise Training Intervention     374
Pulmonary Rehabilitation: More Than Exercise Training     380
References     380
New Components of Pulmonary Rehabilitation in COPD   Emiel F. M. Wouters   Martijn A. Spruit     385
Introduction     385
New Modalities of Pulmonary Rehabilitation     385
Supplements During Exercise Training     390
Conclusions     392
References     392
Long-Term Oxygen Therapy for the Patient with COPD   Emmanuel Weitzenblum   Matthieu Canuet   Ari Chaouat   Romain Kessler     397
Introduction     397
Beneficial Effects of LTOT in Hypoxemic COPD     397
Indications of LTOT in COPD     404
Home Oxygen Therapy     408
References     413
Noninvasive Ventilation in COPD   M. W. Elliott     419
Introduction     419
Noninvasive Positive Pressure Ventilation in Exacerbations of COPD     419
The Role of NPPV After IMV     422
Longer Term Effects of NPPV in Exacerbations of COPD     423
When Should NPPV be Discontinued?     424
Where Should NPPV be Performed?     425
Long-Term Domiciliary NPPV for Stable COPD     426
Practical Problems Specific to Patients with COPD     429
Conclusion     430
References     430
Surgical Therapy for COPD   Fernando J. Martinez    Andrew C. Chang   Kevin M. Chan   435
Introduction     435
History of Surgical Therapy for Emphysema     435
Surgical Techniques     436
What Are the Results of Surgery?     437
Which Patients Should and Which Should Not Be Considered for Surgery?     450
Conclusions     462
References     463
Perioperative Medical Management for Patients with COPD: The Anesthesiologist's View   Marc Licker   Francois Clergue     475
Introduction     475
Risk Factors for Postoperative Mortality and Cardiopulmonary Morbidity     479
Respiratory Consequences of Anesthesia and Surgery     487
Principles of Perioperative Anesthetic Care in COPD Patients     493
Conclusions     503
References     504
Providing Palliative and End-of-Life Care for Patients with COPD   David H. Au   J. Randall Curtis     515
Introduction     515
What Is Quality Palliative and End-of-Life Care?     516
Do Patients with COPD Receive Less Palliative Care at the End of Life?     517
Relationship Between the Trajectory Toward Death and End-of-Life Care     518
Why Don't Physicians Discuss End-of-Life Care with Patients with Severe COPD?     519
Frequency and Timing of End-of-Life Discussions     521
What Common Symptoms and Conditions Do Patients with COPD Experience at the End of Life?     522
Palliative Treatments for Dyspnea and Other Symptoms     522
Does Patient Health Status Influence the Desire for Life-Sustaining Treatment?     525
Decision Making in the Setting of Depression     525
The Role of Advance Directives     526
Summary     526
Acknowledgments     527
References     527
A Global Strategy for a Global Disease   Christine Jenkins     531
Introduction     531
The First Global COPD Initiative and Guideline: Gold     531
Subsequent Global Initiatives for COPD     533
Bold Project     534
WHO Framework Convention on Tobacco Control     534
Translation into Practice     535
Is One Global COPD Guideline Enough?     536
Are There Deficiencies in Current International COPD Guidelines?     537
A Methodology for Appraising Clinical Practice Guidelines     539
Should Guidelines Have a Standardized Format or Structure?     539
What Are the Barriers to Effective Guideline Implementation?      540
Evaluation of Implementation Strategies     542
Advocacy     543
Summary     543
References     544
Caring for the Patient with COPD: A Practical Summary of Guidelines for Clinicians   Nicolas Roche   Gerard Huchon   Stephen I. Rennard   Roberto Rodriguez-Roisin     547
Introduction     547
Conclusion     561
References     562
Index     565
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