Chronic obstructive pulmonary disease (BPCO)
Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with an enhanced inflammatory response in the airways and the lungs to noxious particles or gases
COPD is caused by the inhalation of harmful substances (especially cigarette smoke) that determine chronic inflammation through a variety of mechanisms. The main clinical manifestations of COPD include chronic cough and sputum production and/or dyspnea (i.e. shortness of breath), occurring initially only on exertion and later even at rest. Therefore, a clinical diagnosis of COPD should be considered in any patient older than 40 years who has the above symptoms and/or a history of exposure to risk factors for the disease, especially cigarette smoke (including ex-smokers).
The clinical course of COPD is complicated by periods of worsening of symptoms, known as exacerbations (or flare-ups), which have a negative impact on lung function, disease progression, and prognosis; they often require treatment with antibiotics and/or oral steroids, and are also frequent cause of hospitalization and greater health care expenditures. A chronic inflammation of both central and peripheral airways, involving several types of inflammatory cells and inflammatory mediators, is an almost constant finding in patients with COPD. Inflammation is associated with lung damage and structural remodeling, and contribute to airflow limitation typical of COPD; the presence of reactive inflammatory and tissue repair processes in response to noxious stimuli (mostly cigarette smoke) is an almost invariable finding in the airways of patients.
Several comorbidities are associated with COPD: the most frequent are cardiovascular and cerebrovascular diseases, lung cancer, diabetes, osteoporosis, anxiety and depression. Comorbidities add considerably to the challenges of managing patients with COPD, and in particular have a significant impact on quality of life, health care resource utilization, frequency of hospitalization and, obviously, mortality.
The goals of treatment of COPD include slowing the progression of the disease, reducing exacerbations, and improving the quality of life of patients. Several guidelines recommend a multidisciplinary approach to the patient with COPD, which includes primarily inhalation therapy and non-pharmacological measures (e.g. pulmonary rehabilitation)..