A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases (2011) / Chapter Skim
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3 Chronic Lung Disease
3 Chronic Lung Disease
Pages 33-50
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From page 33... ...
DEFINITION Chronic obstructive pulmonary disease is an umbrella term for several conditions, including chronic bron chitis and emphysema as well as a subset of patients with asthma, that impede the flow of air in the bronchi and trachea. COPD has been defined as "a disease state characterized by airflow limitation that is not fully reversible.
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Obstructive disorders, asthma, and COPD are the most common chronic respiratory diseases. The restrictive disorders are heterogeneous, including diffuse parenchymal lung diseases (e.g., idiopathic pulmonary fibrosis)
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. Compared to tobacco control, evidence is limited on effectiveness of controlling exposures to other risk factors for COPD, including maternal smoking and nutrition, early childhood exposure to tobacco smoke and infections, outdoor and indoor air pollution, occupational exposures, and other behavioral factors.
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Results are inconclusive on the use of spirometry as a tool to enhance smoking cessation, and they are not available on the use of pharmacological treatments among asymptomatic persons with chronic airflow obstruction. A major limitation of spirometry screening is the low TABLE 3-1 Questions and Conclusions on Screening for Chronic Obstructive Pulmonary Disorder (COPD)
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is the hallmark for diagnosing COPD, clinicians infrequently use spirometry and most often diagnose chronic lung diseases based solely on respiratory symptoms and current or past cigarette smoking (Han et al., 2007; Joo et al., 2008a)
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Reduce risk factors Smoking cessation is a critical component in the management of patients with COPD. Cessation is associated with reduced rate of decline in lung function, improved symptoms, and lower mortality (Anthonisen et al., 2005a; HHS, 2004)
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The available evidence strongly suggests that disruption of this cycle of physical inactivity and deconditioning is necessary to substantially improve functional performance and health status for patients with COPD. Pulmonary rehabilitation programs have been designed to address this problem and are cost-effective (American Thoracic Society, 1999; Griffiths et al., 2001; Lacasse et al., 2006)
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A number of methods to prevent or limit exacerbations have been examined, including pharmacological measures, self-management education, pulmonary rehabilitation, and control of exposures that cause exacerbations. To examine the comparative effectiveness of four categories of inhaled medications for preventing exacerbations, Puhan and colleagues (2009a)
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. Results from a large, multicenter randomized trial of care coordination programs among more than 18,000 Medicare beneficiaries -- which included patients treated for such common chronic conditions as coronary artery disease (60.5 percent)
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used Medicare claims data for more than 90,000 patients with COPD, congestive heart failure, and cancer to examine patterns of care at the hospital level, including length of stay, intensive care unit (ICU) days, and physician visits.
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are needed for other chronic lung diseases, including asthma. In fact, collection of these data on asthma, for example, could lead to improved understanding of the relationship between asthma and COPD.
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2007. Systematic review of the chronic care model in chronic obstructive pulmonary disease prevention and management.
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2007. Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: A population-based cohort study.
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2007. Geographic variation in chronic obstructive pulmonary disease exacerbation rates.
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2005. A cohort study showed that health insurance databases were accurate to distinguish chronic obstructive pulmonary disease from asthma and classify disease severity.
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2009b. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease.
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2010. Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease.
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2005. Pulmonary rehabilitation in chronic obstructive pulmonary disease.
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