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Upon completion of the chapter, the reader will be able to:

  1. Describe the pathophysiology of chronic obstructive pulmonary disease (COPD).

  2. Identify signs and symptoms of COPD.

  3. List the treatment goals for a patient with COPD.

  4. Design an appropriate COPD treatment regimen based on patient-specific data.

  5. Develop a monitoring plan to assess effectiveness and adverse effects of pharmacotherapy for COPD.

  6. Formulate an appropriate education plan for a patient with COPD.




  • Image not available. Inflammation plays a key role in the pathophysiology of chronic obstructive pulmonary disease (COPD), but it differs from that seen in asthma; therefore, the use of and response to anti-inflammatory medications are different.

  • Image not available. An integrated approach of health maintenance (e.g., smoking cessation), drug therapy, and supplemental therapy (e.g., oxygen and pulmonary rehabilitation) should be used in a stepwise manner. Symptom severity and risk of COPD exacerbations can be used to guide therapy decisions.

  • Image not available. Smoking cessation slows the rate of decline in pulmonary function in patients with COPD.

  • Image not available. Bronchodilators are the mainstay of treatment for symptomatic COPD. They reduce symptoms and improve exercise tolerance and quality of life.

  • Image not available. Inhaled corticosteroids are recommended for patients with severe and very severe COPD and frequent exacerbations that are not adequately controlled by long-acting bronchodilators.

  • Image not available. Antibiotics should be used in patients with COPD exacerbations who: (a) have all three cardinal symptoms (increased dyspnea, increased sputum volume, and increased purulence); (b) have increased sputum purulence and one other cardinal symptom; or (c) experience a severe exacerbation requiring mechanical ventilation.




Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation that is not fully reversible. It is caused by exposure to noxious particles or gases, most commonly cigarette smoke. It is a major cause of morbidity and mortality and a leading cause of disability in the United States.


Previous definitions of COPD included chronic bronchitis and emphysema. Chronic bronchitis is defined clinically as a chronic productive cough for at least 3 months in each of two consecutive years in a patient in whom other causes have been excluded.1 Chronic bronchitis can exist in patients with normal spirometry and may precede the development of COPD. Emphysema is defined pathologically as destruction of alveoli.1 The major risk factor for both conditions is cigarette smoking, and many patients share characteristics of each condition. Therefore, guidelines have moved away from using these subsets and instead focus on chronic airflow limitation.


The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is an expert panel of health professionals who have developed a consensus document with recommendations for the diagnosis and care of patients with COPD.1 The online document is updated annually and is commonly referred to as the GOLD guidelines. Major revisions were released in January 2012. The American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and ...

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