Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management

Joyce Akwe; Nadene Fair

doi:doi:10.11648/j.ijcems.20160202.11

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Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management

Joyce Akwe, Nadene Fair

Published in International Journal of Clinical and Experimental Medical Sciences (Volume 2, Issue 2)

Received: 26 February 2016 Accepted: 3 March 2016 Published: 31 March 2016

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Abstract

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease. It is among the fastest growing chronic diseases diagnosed in the world today. COPD is the third most common cause of death in the United States. It is characterized by the development of an inflammatory response of the lungs to noxious substances such as tobacco or air pollution. If the exposure becomes recurrent or persistent, the lungs develop chronic inflammatory response leading to lung parenchymal damage, air trapping and progressive airflow limitation. The Diagnosis of COPD is usually made in the context of symptoms and spirometry evidence of airway obstruction with post bronchodilator spirometry FEV1/FVC < 0.70. Most patients with COPD first seek medical attention when they develop dyspnea. Once the diagnosis of COPD is confirmed, the treatment is geared mainly towards preventing exacerbations and eliminating risk factors and exposures. Several treatment combinations can be used in patients with stable COPD to prevent exacerbations and to improve their quality of life. Patients with COPD exacerbations have to be appropriately diagnosed and promptly treated to prevent complications. Patient’s symptoms, the degree of airflow limitation, risk of exacerbations and the presence of comorbidities have to be assessed. Both pharmacological and non-pharmacological interventions have been used in the management of COPD. Appropriate pharmacologic therapy can reduce COPD symptoms, reduce the frequency and severity of exacerbations, and improve health status and exercise tolerance. None of the existing medications for COPD have been shown conclusively to modify the long-term decline in lung function.

Published in	International Journal of Clinical and Experimental Medical Sciences (Volume 2, Issue 2)
DOI	10.11648/j.ijcems.20160202.11
Page(s)	13-25
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

COPD Epidemiology, Pathophysiology, Staging and Diagnosis

References

[1]	Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015. Available from: http://www.goldcopd.org/.
[2]	Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise (88 capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004; 350: 1005.
[3]	AS Buist, MA McBurnie, WM Vollmer, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007; 370: 741–750.
[4]	AS Gershon, C Wang, AS Wilton, R Raut, T To. Trends in chronic obstructive pulmonary disease prevalence, incidence, and mortality in Ontario, Canada, 1996 to 2007: a population-based study. Arch Intern Med. 2010; 170: pp. 560–565.
[5]	MJ Hall, CJ DeFrances, SN Williams, A Golosinskiy, A Schwartzman. National Hospital Discharge Survey: 2007 summary. Health Stat Report. 2010; 29: 1–20 24.
[6]	Gershon, Andrea S et al. Lifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study. The Lancet. 201; 378: 991–996.
[7]	Halbert, RJ, Isonaka, S, George, D, and Iqbal, A. Interpreting COPD prevalence estimates: what is the true burden of disease? Chest. 2003; 123: 1684–1692.
[8]	Halbert, RJ, Natoli, JL, Gano, A, Badamgarav, E, Buist, AS, and Mannino, DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006; 28: 523–532.
[9]	Buist, A Sonia et al. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. Lancet. 2007; 370: 741–750
[10]	Hogg JC. Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet. 2004; 364: 709-21.
[11]	Barnes PJ, Shapiro SD, Pauwels RA. Chronic obstructive pulmonary disease: molecular and cellular mechanisms. Eur Respir J. 2003; 22: 672-88.
[12]	Hogg JC, Chu F, Utokaparch S, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004; 350: 2645-53.
[13]	Cosio MG, Saetta M, Agusti A. Immunologic aspects of chronic obstructive pulmonary disease. N Engl J Med. 2009; 360: 2445-54.
[14]	O'Donnell DE, Laveneziana P. Dyspnea and activity limitation in COPD: mechanical factors. COPD. 2007; 4: 225-36.
[15]	Zwar NA, Marks GB, Hermiz O, Middleton S, Comino EJ, Hasan I, et al. Predictors of accuracy of diagnosis of chronic obstructive pulmonary disease in general practice. Med J Aust. 2011; 195(4): 168-71.
[16]	Kessler R, Partridge MR, Miravitlles M, Cazzola, M, Vogelmeier, C, Leynaud, D, Ostinelli, J. Symptom variability in patients with severe COPD: a pan-European crosssectional study. Eur Respir J. 2011; 37: 264-72.
[17]	Espinosa de los Monteros MJ, Pena C, Soto Hurtado EJ, Jareno J, Miravitlles M. Variability of respiratory symptoms in severe COPD. Arch Bronconeumol. 2012; 48: 3-7.
[18]	Burrows B, Niden AH, Barclay WR, Kasik JE. Chronic obstructive lung disease II. Relationships of clinical and physiological findings to the severity of aiways obstruction. Am Rev Respir Dis. 1965; 91: 665-78.
[19]	Stockley RA, O'Brien C, Pye A, Hill SL. Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. Chest. 2000; 117: 1638-45.
[20]	Simon PM, Schwartzstein RM, Weiss JW, Fencl V, Teghtsoonian M, Weinberger SE. Distinguishable types of dyspnea in patients with shortness of breath. Am Rev Respir Dis. 1990; 142: 1009-14.
[21]	Schols AM, Soeters PB, Dingemans AM, Mostert R, Frantzen PJ, Wouters EF. Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. Am Rev Respir Dis. 1993; 147: 1151-6.
[22]	Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005; 26: 948-68.
[23]	Heffner JE, Mularski RA, Calverley PM. COPD performance measures: missing opportunities for improving care. Chest. 2010; 137: 1181-9. doi: 10.1378/chest.09-2306.
[24]	Hospers JJ, Postma DS, Rijcken B, et al. Histamine airway hyper-responsiveness and mortality from chronic obstructive pulmonary disease: a cohort study. Lancet. 2000; 356: 1313-7.
[25]	Diaz PT, King MA, Pacht ER, et al. Increased susceptibility to pulmonary emphysema among HIV-seropositive smokers. Ann Intern Med. 2000; 132: 369-372.
[26]	Wilkinson TM, Patel IS, Wilks M, et al. Airway bacterial load and FEV1 decline in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003; 167: 1090-5.
[27]	Berry MJ, Adair NE, Rejeski WJ. Use of peak oxygen consumption in predicting physical function and quality of life in COPD patients. Chest. 2006; 129: 1516-22.
[28]	Dahl M, Vestbo J, Lange P, et al. C-reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2007; 175: 250-255.
[29]	Drummond MB, Blackford AL, Benditt JO, et al. Continuous oxygen use in nonhypoxemic emphysema patients identifies a high-risk subset of patients: retrospective analysis of the National Emphysema Treatment Trial. Chest. 2008; 134: 497-506.
[30]	De Torres JP, Cote CG, López MV, et al. Sex differences in mortality in patients with COPD. Eur Respir J. 2009; 33: 528-35. doi: 10.1183/09031936.00096108. Epub 2008 Dec 1.
[31]	Kohansal R, Martinez-Camblor P, Agustí A, et al. The natural history of chronic airflow obstruction revisited: an analysis of the Framingham offspring cohort. Am J Respir Crit Care Med. 2009; 180: 3-10.
[32]	Haruna A, Muro S, Nakano Y, et al. CT scan findings of emphysema predict mortality in COPD. Chest. 2010; 138: 635-640.
[33]	Global Strategy for the Diagnosis, Management and Prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2013; www.goldcopd.org. Accessed on September 09, 2015.
[34]	Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: Global Initiative for Chronic Obstructive Lung Disease (GOLD). Revised 2015. www.goldcopd.org. Accessed on September 04, 2014.
[35]	Lange P, Marott JL, Vestbo J, et al. Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification: a study of the general population. Am J Respir Crit Care Med. 2012; 186(10): 975-81. doi: 10.1164/rccm.201207-1299OC. Epub 2012 Sep 20.
[36]	Jones PW, Tabberer M, Chen WH. Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT™) scores. BMC Pulm Med. 2011; 11: 42. doi: 10.1186/1471-2466-11-42.
[37]	Fletcher CM, Elmes PC, Fairbairn MB, et al. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. British Medical Journal. 1959; 2: 257-66.
[38]	Van der Molen T, Willemse BW, Schokker S, et al. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health Qual Life Outcomes. 2003; 1: 13.
[39]	Kelly JL, Bamsey O, Smith C, et al. Health status assessment in routine clinical practice: the chronic obstructive pulmonary disease assessment test score in outpatients. Respiration. 2012; 84: 193-9. doi: 10.1159/000336549. Epub 2012 Mar 22.
[40]	COPD Assessment Test (CAT). http://www.catestonline.org Accessed on September 20, 2012.
[41]	Gupta N, Pinto LM, Morogan A, Bourbeau J. The COPD assessment test: a systematic review. Eur Respir J. 2014; 44(4): 873-84. doi: 10.1183/09031936.00025214.
[42]	Anthonisen NR, Connett JE, Kiley JP, et al Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA. 1994; 272: 1497-1505.
[43]	Gross NJ. Ipratropium bromide. New England Journal of Medicine. 1988; 319: 486-494.
[44]	Gross NJ. Tiotropium bromide. Chest. 2004; 126(6): 1946-53.
[45]	Carter NJ. Inhaled glycopyrronium bromide: a review of its use in patietns with moderate to severe COPD. Drugs. 2013; 73: 741-53. doi: 10.1007/s40265-013-0058-7.
[46]	Anthonisen NR, Connet JE, Enright PL, et al Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med. 2002, 166: 333-339.
[47]	Tashkin DP, Cooper CB. The role of long acting bronchodilators in the management of stable COPD. Chest 2004; 125(1): 249-59.
[48]	Alvarado-Gonzalez A, Arce I. Tiotropium Bromide in Chronic Obstructive Pulmonary Disease and Bronchial Asthma. Journal of Clinical Medicine Research. 2015; 7(11): 831-839. doi: 10.14740/jocmr2305w.
[49]	Sin DD et al. Contemporary management of COPD: clinical applications. JAMA. 2003; 290-2313.
[50]	Qaseem A. et al. Diagnosis and managememnt of stable COPD. A clinical practice guideline update from the American College of Physicians, American college of chest Physicians, American thoracic society and European Respiratory Society. Ann Inten Med. 2011; 156-179.
[51]	Gary TF. Recommendations for management of COPD. Chest. 2000; 117: 23S-28S.
[52]	Murciano D, Auclair MH, Pariente R. A randomized controlled trial of theophylline in patient with severe COPD. NEJM. 1989; 320(23): 1521-5.
[53]	Tarpy SP, Celli BR. Long Term Oxygen Therapy. NEJM. 1995; 333: 710-714.
[54]	R Rodríguez‐Roisin. COPD exacerbations·5: Management. Thorax. 2006 Jun; 61(6): 535–544.
[55]	Callahan CM. Oral corticosteroid therapy for patients with stable COPD. A meta-analyss. Ann inten Med. 1991; 114: 216-223. doi: 10.7326/0003-4819-114-3-216.
[56]	Niewoehner D E, Erbland M L, Deupree R H. et al Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med. 1999; 340: 1941–1947.
[57]	Sayiner A et al Systemic glucocorticoids in severe exacerbations of COPD. Chest. 2001; 119: 726.
[58]	Maltais F, Ostinelli J, Bourbeau J. et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med. 2002; 165: 698–703.
[59]	Alsaeedi A, Sin D D, McAlister F A. The effects of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review of randomized placebo‐controlled trials. Am J Med. 2002; 113: 59–65.
[60]	Celli BR, Thomas NE, Anderson JA et al Effect of pharmacotherapy on the rate of decline of lung function in COPD: Results from the tORCH study. Am J Respiratory Critical Care Med 2008. 178: 332-338.
[61]	Task Group on Mucoactive Drugs. Recommendations for guidelines on clinical trials of mucoactive drugs in chronic bronchitis and chronic obstructive pulmonary disease. Chest. 1994; 106: 1532–1537.
[62]	Niewoehner DE. Outpatient Management of Severe COPD NEJM. 2010; Apr 15; 362(15): 1407-16.
[63]	James K. Stoller. Acute Exacerbations of Chronic Obstructive Pulmonary Disease. N Engl J Med. 2002; 346: 988-994.
[64]	Niewoehner DE et al. Risk indexes for exacerbations and hospitalizations due to COPD. Chest. 2007; 131(1): 20-8.
[65]	COPD Assessment Test (CAT). http://www.catestonline.org (Accessed on September 20, 2012).
[66]	Gupta N, Pinto LM, Morogan A, Bourbeau J. The COPD assessment test: a systematic review. Eur Respir J. 2014; 44(4): 873-84.
[67]	Lange P, Marott JL, Vestbo J, et al. Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification: a study of the general population. Am J Respir Crit Care Med 2012; 186: 975–981.
[68]	Kohansal R, Martinez-Camblor P, Agustí A, et al. The natural history of chronic airflow obstruction revisited: an analysis of the Framingham offspring cohort. Am J Respir Crit Care Med. 2009; 180: 3-10.
[69]	National Emphysema Treatment trial research group: Patients at high risk of death after Lung Volume reduction surgery. N Engl J Med 2001; 345:1075-83.

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Joyce Akwe, Nadene Fair. (2016). Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management. International Journal of Clinical and Experimental Medical Sciences, 2(2), 13-25. https://doi.org/10.11648/j.ijcems.20160202.11

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ACS Style

Joyce Akwe; Nadene Fair. Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management. Int. J. Clin. Exp. Med. Sci. 2016, 2(2), 13-25. doi: 10.11648/j.ijcems.20160202.11

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AMA Style

Joyce Akwe, Nadene Fair. Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management. Int J Clin Exp Med Sci. 2016;2(2):13-25. doi: 10.11648/j.ijcems.20160202.11

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@article{10.11648/j.ijcems.20160202.11,
  author = {Joyce Akwe and Nadene Fair},
  title = {Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {2},
  number = {2},
  pages = {13-25},
  doi = {10.11648/j.ijcems.20160202.11},
  url = {https://doi.org/10.11648/j.ijcems.20160202.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20160202.11},
  abstract = {Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease. It is among the fastest growing chronic diseases diagnosed in the world today. COPD is the third most common cause of death in the United States. It is characterized by the development of an inflammatory response of the lungs to noxious substances such as tobacco or air pollution. If the exposure becomes recurrent or persistent, the lungs develop chronic inflammatory response leading to lung parenchymal damage, air trapping and progressive airflow limitation. The Diagnosis of COPD is usually made in the context of symptoms and spirometry evidence of airway obstruction with post bronchodilator spirometry FEV1/FVC < 0.70. Most patients with COPD first seek medical attention when they develop dyspnea. Once the diagnosis of COPD is confirmed, the treatment is geared mainly towards preventing exacerbations and eliminating risk factors and exposures. Several treatment combinations can be used in patients with stable COPD to prevent exacerbations and to improve their quality of life. Patients with COPD exacerbations have to be appropriately diagnosed and promptly treated to prevent complications. Patient’s symptoms, the degree of airflow limitation, risk of exacerbations and the presence of comorbidities have to be assessed. Both pharmacological and non-pharmacological interventions have been used in the management of COPD. Appropriate pharmacologic therapy can reduce COPD symptoms, reduce the frequency and severity of exacerbations, and improve health status and exercise tolerance. None of the existing medications for COPD have been shown conclusively to modify the long-term decline in lung function.},
 year = {2016}
}

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TY - JOUR
T1 - Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management
AU - Joyce Akwe
AU - Nadene Fair
Y1 - 2016/03/31
PY - 2016
N1 - https://doi.org/10.11648/j.ijcems.20160202.11
DO - 10.11648/j.ijcems.20160202.11
T2 - International Journal of Clinical and Experimental Medical Sciences
JF - International Journal of Clinical and Experimental Medical Sciences
JO - International Journal of Clinical and Experimental Medical Sciences
SP - 13
EP - 25
PB - Science Publishing Group
SN - 2469-8032
UR - https://doi.org/10.11648/j.ijcems.20160202.11
AB - Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease. It is among the fastest growing chronic diseases diagnosed in the world today. COPD is the third most common cause of death in the United States. It is characterized by the development of an inflammatory response of the lungs to noxious substances such as tobacco or air pollution. If the exposure becomes recurrent or persistent, the lungs develop chronic inflammatory response leading to lung parenchymal damage, air trapping and progressive airflow limitation. The Diagnosis of COPD is usually made in the context of symptoms and spirometry evidence of airway obstruction with post bronchodilator spirometry FEV1/FVC < 0.70. Most patients with COPD first seek medical attention when they develop dyspnea. Once the diagnosis of COPD is confirmed, the treatment is geared mainly towards preventing exacerbations and eliminating risk factors and exposures. Several treatment combinations can be used in patients with stable COPD to prevent exacerbations and to improve their quality of life. Patients with COPD exacerbations have to be appropriately diagnosed and promptly treated to prevent complications. Patient’s symptoms, the degree of airflow limitation, risk of exacerbations and the presence of comorbidities have to be assessed. Both pharmacological and non-pharmacological interventions have been used in the management of COPD. Appropriate pharmacologic therapy can reduce COPD symptoms, reduce the frequency and severity of exacerbations, and improve health status and exercise tolerance. None of the existing medications for COPD have been shown conclusively to modify the long-term decline in lung function.
VL - 2
IS - 2
ER -

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Joyce Akwe

Atlanta Veterans Affair Medical Center, Emory University School of Medicine, Department of Hospital Medicine, Atlanta, GA, USA
Nadene Fair

Atlanta Veterans Affair Medical Center, Emory University School of Medicine, Department of Hospital Medicine, Atlanta, GA, USA

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Joyce Akwe, Nadene Fair. (2016). Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management. International Journal of Clinical and Experimental Medical Sciences, 2(2), 13-25. https://doi.org/10.11648/j.ijcems.20160202.11

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ACS Style

Joyce Akwe; Nadene Fair. Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management. Int. J. Clin. Exp. Med. Sci. 2016, 2(2), 13-25. doi: 10.11648/j.ijcems.20160202.11

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AMA Style

Joyce Akwe, Nadene Fair. Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management. Int J Clin Exp Med Sci. 2016;2(2):13-25. doi: 10.11648/j.ijcems.20160202.11

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@article{10.11648/j.ijcems.20160202.11,
  author = {Joyce Akwe and Nadene Fair},
  title = {Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {2},
  number = {2},
  pages = {13-25},
  doi = {10.11648/j.ijcems.20160202.11},
  url = {https://doi.org/10.11648/j.ijcems.20160202.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20160202.11},
  abstract = {Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease. It is among the fastest growing chronic diseases diagnosed in the world today. COPD is the third most common cause of death in the United States. It is characterized by the development of an inflammatory response of the lungs to noxious substances such as tobacco or air pollution. If the exposure becomes recurrent or persistent, the lungs develop chronic inflammatory response leading to lung parenchymal damage, air trapping and progressive airflow limitation. The Diagnosis of COPD is usually made in the context of symptoms and spirometry evidence of airway obstruction with post bronchodilator spirometry FEV1/FVC < 0.70. Most patients with COPD first seek medical attention when they develop dyspnea. Once the diagnosis of COPD is confirmed, the treatment is geared mainly towards preventing exacerbations and eliminating risk factors and exposures. Several treatment combinations can be used in patients with stable COPD to prevent exacerbations and to improve their quality of life. Patients with COPD exacerbations have to be appropriately diagnosed and promptly treated to prevent complications. Patient’s symptoms, the degree of airflow limitation, risk of exacerbations and the presence of comorbidities have to be assessed. Both pharmacological and non-pharmacological interventions have been used in the management of COPD. Appropriate pharmacologic therapy can reduce COPD symptoms, reduce the frequency and severity of exacerbations, and improve health status and exercise tolerance. None of the existing medications for COPD have been shown conclusively to modify the long-term decline in lung function.},
 year = {2016}
}

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