A COPD Primer

415 Pages·2016·12.472 MB·English

by  Ralph J. Panos, William L. Eschenbacher

Ralph J. Panos, William L. Eschenbacher
A COPD Primer

Ralph J. Panos,
William L. Eschenbacher
A COPD Primer
Managing Editor: Magdalena Wierzchowiecka
Language Editor: Dylan Richards
Published by De Gruyter Open Ltd, Warsaw/Berlin
Part of Walter de Gruyter GmbH, Berlin/Munich/Boston
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 license,
which means that the text may be used for non-commercial purposes, provided credit is given to the
author. For details go to http://creativecommons.org/licenses/by-nc-nd/3.0/.
© 2015 Ralph J. Panos and chapters’ contributors
ISBN: 978-3-11-046800-7
e-ISBN: 978-3-11-046811-3
Bibliographic information published by the Deutsche Nationalbibliothek. The Deutsche National-
bibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data are
available in the Internet at http://dnb.dnb.de.
Managing Editor: Magdalena Wierzchowiecka
Language Editor: Dylan Richards
www.degruyteropen.com
Cover illustration: is an original work by Mohammad Ahsan Zafar, MD.
Contents
Preface    xvii
Ralph J. Panos, MD
1 Introduction and Definition of Chronic Obstructive Pulmonary Disease
COPD    1
1.1 Definition of Chronic Obstructive Pulmonary Disease (COPD)    2
1.1.1 Preventable    2
1.1.2 Progressive    2
1.1.3 Treatable    3
1.1.4 Airflow Obstruction That Is Not Reversible [Persistent]    4
1.1.5 Major Point of Confusion: “Reversibility”    4
1.1.6 Inflammation    5
1.1.7 Lung/Pulmonary    6
1.1.8 Exacerbation    6
1.2 Diagnostic Criteria    6
1.3 Staging Disease Severity    7
1.4 COPD Is a Syndrome    8
1.5 Genetic Factors    8
1.6 Clinical Symptoms and Differential Diagnosis    9
1.7 Imaging     10
1.8 Treatment    10
1.9 Conclusion    11
1.10 Summary Points    11
References    11
Ralph J. Panos, MD
2 Epidemiology and Economic Consequences of COPD    14
2.1 Introduction    14
2.2 Epidemiology    15
2.2.1 Risk Factors for COPD Development    15
2.2.1.1 Tobacco Smoke    15
2.2.1.2 Passive or Environmental Tobacco Smoke Exposure    16
2.2.1.3 Non-tobacco Smoke Factors    16
2.2.1.4 Occupational Exposures    16
2.2.1.5 Air Pollution    17
2.2.1.6 Sex    18
2.2.1.7 Infections    18
2.2.2 Prevalence    18
2.2.2.2 United States    19
2.3 Economics    21
2.3.1 Direct Costs    21
2.3.2 Indirect Costs    22
2.3.3 Effect of Treatment    22
2.4 Conclusion    23
2.5 Summary Points    24
References    24
William L. Eschenbacher, MD
3 COPD Recognition and Diagnosis: Approach to the Patient with Respiratory
Symptoms    31
3.1 Introduction    31
3.2 Patient Presenting with Respiratory Symptoms    31
3.2.1 Further Discussion of Dyspnea/Shortness of Breath    33
3.3 Initial Screening Evaluation for a Patient Presenting with Respiratory
Symptoms Including Dyspnea    35
3.3.1 Exclude Causes of Symptoms Other than Lung Disease    36
3.3.2 Respiratory Causes for Symptoms    36
3.3.2.1 Initial Evaluation of Respiratory Processes     36
3.3.2.2 Further Evaluation of Causes of Respiratory Symptoms After Spirometry
Test Results    37
3.4 COPD    38
3.4.1 Definition of COPD    38
3.4.2 Other Diagnostic Tests to Help Confirm the Presence of COPD    40
3.5 Asthma    41
3.6 Interstitial Lung Disease    42
3.7 Summary Points    43
References    43
William L. Eschenbacher, MD
4 Pulmonary Function Testing: Spirometry: Presence and Severity of Airflow
Limitation/Obstruction    45
4.1 Introduction    45
4.2 Reasons for Spirometry Testing    46
4.3 Spirometry Screening for COPD    47
4.4 Limitations of Spirometry     47
4.5 Three Phases of a Spirometry Test    48
4.6 Displaying the Results of Spirometry Testing    49
4.7 Acceptability and Repeatability Criteria of Spirometry Testing    51
4.8 Measurements from Spirometry Testing    52
4.9 Patterns of Spirometry Impairment or Limitation    52
4.9.1 Airflow Obstruction Pattern     52
4.9.2 Restrictive Lung Defect Pattern    54
4.9.3 Mixed Impairment with Both Airflow Obstruction and Lung
Restriction    54
4.10 Interpretation of Spirometry Results    54
4.10.1 Reference Equations    54
4.10.2 Racial Differences in Reference Equations    58
4.10.3 The Lower Limit of the Normal (LLN) Range    59
4.10.4 What is Considered to Be Abnormal?    60
4.10.5 Determine Predicted Values and % of Predicted Values    60
4.10.6 Interpretation of Spirometry Test Results for Impairment Patterns    60
4.10.7 Airflow Obstruction     60
4.10.7.1 Possible Restrictive Lung Defect     61
4.10.7.2 Mixed Impairment Pattern     62
4.10.7.3 Controversy for Determination of Airflow Limitation/Obstruction    62
4.10.7.4 Bronchodilator Response    63
4.11 Summary Points    64
References    64
William L. Eschenbacher, MD
5 Radiology: Use of Lung Imaging to Help in the Identification of Patients
with COPD    66
5.1 Introduction    66
5.2 Chest Radiographs    66
5.3 Computed Tomography (CT) Scans    67
5.3.1 CT Scans and Emphysema    67
5.3.2 CT Scans and Air-trapping    68
5.3.3 CT Evaluation of Airway Changes in COPD    69
5.3.4 CT Scans for COPD Phenotypes    70
5.3.5 Lack of Correlation Between CT Findings and Spirometric Results for
COPD    70
5.3.6 CT Scans for Smoking-related Interstitial Lung Diseases    71
5.3.7 Use of Low Dose CT Scans for Surveillance for Lung Cancer    72
5.4 Other Advanced Imaging Techniques in COPD    72
5.4.1 PET Scans    72
5.4.2 MRI Scans    73
5.5 Summary Points    73
References    74
Michael T. Borchers, PhD, Gregory Motz, PhD
6 Pathogenesis of COPD    76
6.1 Introduction    76
6.2 Chronic Bronchitis     77
6.3 Emphysema    77
6.4 Smooth Muscle    77
6.5 Fibrosis    78
6.6 Pathogenesis of COPD    78
6.6.1 Genetics: Gene-association Studies    78
6.6.2 Epigenetics    79
6.6.3 Protease: Antiprotease Imbalance    79
6.6.4 Oxidative Stress    80
6.7 Airway Inflammation in COPD    82
6.7.1 Epithelium    83
6.7.2 Neutrophils    83
6.7.3 Macrophages    84
6.7.4 Eosinophils     84
6.7.5 Mast Cells    85
6.7.6 γδ T Cells    85
6.7.7 Natural Killer (NK) Cells    86
6.7.8 Natural Killer T (NKT) Cells    86
6.7.9 T Cells    87
6.7.10 B Cells     88
6.7.11 Dendritic Cells     89
6.8 Cytokines and Chemokines in COPD    89
6.9 COPD as an Autoimmune Disease    90
6.10 Systemic Inflammation    91
6.10.1 Cardiovascular Disease    91
6.10.2 Nutritional Abnormalities    92
6.10.3 Skeletal Muscle Dysfunction    92
6.10.4 Osteoporosis    93
6.10.5 Neurological Disorders    93
6.11 COPD Exacerbations    93
6.12 Summary Points    94
References    94
Shari Altum, Ph.D., Katherine Butler, Psy.D., Rachel Juran, Psy.D.
7 Smoking Cessation    104
7.1 Introduction    104
7.2 Smoking Risks    105
7.3 Factors Associated with Cessation    105
7.4 Screening Recommendations    106
7.5 Using Physiological Data When Addressing Smoking    110
7.6 How to Present Spirometry Results to Promote Smoking
Cessation    110
7.7 Readiness for Change    111
7.7.1 Precontemplation    112
7.7.2 Contemplation    113
7.7.3 Preparation    114
7.7.4 Action    114
7.7.5 Maintenance    115
7.8 The 5 A’s Model     116
7.8.1 Step 1: ASK    116
7.8.2 Step 2: ADVISE    117
7.8.3 Step 3: ASSESS    117
7.8.4 Step 4: ASSIST    117
7.8.5 Step 5: ARRANGE    117
7.9 Motivational Interviewing    121
7.9.1 Clinical Effectiveness of Motivational Interviewing for Treating Tobacco
Use Disorder    123
7.9.2 Developing Competency in the Use of Motivational Interviewing    123
7.10 Interventions    123
7.10.1 Nicotine Replacement Therapies and Medications    125
7.11 Other Nicotine Sources    125
7.12 Conclusion    128
7.13 Summary Points    128
References    129
Shari Altum, Ph.D., Rachel Juran, Psy.D., Katherine Butler, Psy.D.
8 Fostering Patient Self-Management of COPD    131
8.1 Introduction    131
8.2 Clinician Skills    131
8.3 Stages of Change    133
8.4 Patient Self-Management Skills     134
8.5 Self-Management Tasks    135
8.5.1 Medication Adherence    136
8.5.2 Exacerbation Action Plans    139
8.5.3 Coping with Breathlessness    140
8.5.4 Exercise    141
8.5.5 Nutrition    142
8.6 Self-Management Programs    142
8.6.1 Pulmonary Rehabilitation    143
8.6.2 Living Well with COPD    144
8.6.3 Chronic Disease Self-Management Program    145
8.7 Shared Decision-Making    146
8.8 End-of-Life Discussions     149
8.9 Integrated Care Teams    150
8.10 Conclusion    150
8.11 Summary Points    153
References    154
Muhammad Ahsan Zafar, MD
9 Natural History, Phenotypes, and Gender Differences in COPD    159
9.1 Natural History of COPD    159
9.2 Factors Influencing Lung Function in COPD    160
9.2.1 Lung Growth and Early Life Events    161
9.2.2 Cigarette Smoking    162
9.2.3 Genetic Susceptibility    163
9.2.4 Advancing Age    163
9.2.5 Emphysema    163
9.2.6 Bronchodilator Responsiveness    164
9.2.7 Early Disease    164
9.2.8 Biomarkers    165
9.3 Role of COPD Exacerbations and Progression of Disease    165
9.3.1 Lung Function Decline    165
9.3.2 Quality of Life    166
9.3.3 Mortality    166
9.3.4 Factors Associated with COPD Exacerbations    166
9.4 COPD Phenotypes    168
9.4.1 Different Phenotypes of COPD    168
9.4.2 Genetic: Alpha 1-antitrypsin Deficiency    168
9.4.2.1 Therapeutic Implications    171
9.4.3 Anatomic: Emphysema-Hyperinflation Phenotype    171
9.4.3.1 Therapeutic Implications    171
9.4.4 Physiologic: Bronchodilator Responsive/COPD-Asthma Overlap
Syndrome    172
9.4.4.1 Therapeutic Implications    172
9.4.5 Clinical Frequent Exacerbator    173
9.4.5.1 Therapeutic Implications    173
9.4.6 Clinical: Chronic Bronchitis/Mucous Producer    176
9.4.6.1 Therapeutic Implications    176
9.5 Gender Differences in COPD     176
9.5.1 Reasons for Gender Differences in COPD    177
9.5.1.1 Change in Tobacco Consumption Trend    177
9.5.1.2 Tobacco Susceptibility    177
9.5.1.3 Biologic Differences    177
9.5.2 Epidemiology    178
9.5.3 Clinical Features and Phenotypic Differences    178
9.5.4 Comorbidities    179
9.5.5 Treatment Disparities    179