Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation, due to airway and/or alveolar damage caused by exposure to noxious particles or gases. The main risk factor is smoking, but other environmental triggers such as occupational exposures have been identified. COPD can be due to accelerated decline of pulmonary function or abnormal lung development during the early stages of life. COPD assessment involves evaluation of symptoms, exacerbation history, airflow limitation, and comorbidities, which are frequents, and found to worsen outcome and increase mortality. COPD can lead to chronic respiratory failure. Smoking cessation is the best way of changing the natural course of COPD. The main treatments for COPD include pulmonary rehabilitation, and pharmacological therapy such as inhaled bronchodilators and corticosteroids. Both can reduce COPD symptoms and improve exercise tolerance. These treatments should be individualized, and guided by the severity of the disease. In patients with advanced emphysema, bronchoscopic interventional therapy reduces hyperinflation and can improve exercise tolerance and health status. In patients with severe chronic respiratory failure, tong-term oxygen therapy improves survival. In case of severe chronic hypercapnia, long-term non-invasive ventilation may improve hospitalization-free survival. In selected patients with end-stage COPD, lung transplantation improves quality of life and functional capacity. (C) 2019 Published by Elsevier Masson SAS on behalf of Academie Nationale De Medecine.