Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Mechanisms and Classifications of Chronic Obstructive Pulmonary Disease: A Literature Review

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Mechanisms and Classifications of Chronic Obstructive Pulmonary Disease: A Literature Review

Article excerpt


In 2003, the Australian and New Zealand guidelines for the management of Chronic Obstructive Pulmonary Disease (COPD) defined the condition as a chronic and progressive illness that may cause serious co-morbidities and exacerbations that induce major care burdens on the healthcare system. COPD results in airway narrowing, loss of elastic recoil and altered respiratory architecture. The clinical features of COPD include dyspnea, cough, sputum production, chest tightness and in the later stages pulmonary hypertension, cor pulmonale and hypercapnia (McKenzie, Frith, Burdon, &Town 2003). There can be a clinical overlap between bronchitis, asthma and emphysema (ATS 1995b). It is not uncommon for people with obstructive lung disease to share the traits of more than one of these conditions (Soriano et al. 2003). The dominant clinical feature is usually indicative of the underlying condition (Leidy 1995). Expiratory airflow limitation is reported as the primary index of COPD pathology (Polkey 2002). The American Thoracic Society (ATS) and the British Thoracic Society (BTS) had reported that a bronchodilator reversibility in the order of 12-15% percent from baseline in respiratory function testing should be considered more consistent with asthma than emphysema (ATS 1991 ; BTS 1997).

In 1990 the worldwide prevalence of COPD placed the condition as twelfth ranked, with respect to the global burden of disease. It has been projected that COPD will increase to fifth ranking by the year 2020 (Murray & Lopez 2002). The global prevalence of COPD cases had been estimated as 11.6/1000 men and 8.77/1000 women (WHO 2006). COPD is a significant health concern for many Australians with, nearly 10% of our adult population over the age of forty-five years affected (Clinical Evaluation and Health Service Evaluation Unit 1999; Crockett, Cranston & Moss 2002). In 2002, COPD was ranked as the third most common burden of disease in Australia behind heart disease and stroke (AIHW 2002). COPD remains an underestimated condition. The slow onset and insidious nature of the condition translates to an illness that is often not diagnosed until it becomes clinically apparent (Reid et al. 2003).

The mechanisms involved in the development of COPD are variable. Reports in the literature include smoking status as a descriptor, with less reportage of exposure to other aetiological factors. This arguably contributes to the continuation of a public perception that COPD is a self-inflicted condition. A review of the literature that has reported the classification of the severity of COPD revealed inconsistent parameters of disease severity between international bodies. The lack of consensus between the various guidelines in grading COPD impairment must influence the reported incidence of disease severity and/or, the effects of interventions (Jenkins 2003). The purpose of this paper is to describe the mechanisms and classification systems of COPD used by nurses and other health disciplines.


A search of Medline and CINAHL databases using the following search terms was conducted; COPD, obstructive lung conditions, disease staging, disease severity, pathophysiology, quality of life and dyspnea. This review was not a systematic review and papers published between 1985 until 2006 were reviewed based on the physiological reports, research findings, and chosen for their relevance to synthesizing the mechanisms, classifications and systematic effects of COPD.


COPD is a systemic, permanent and progressive condition and there are a number of mechanisms involved in its development. Smoking is the cardinal risk factor in the development of COPD and continuation the most significant determinant for disease progression (Mannino 2002; McKenzie et al. 2003). Smoking is defined as the daily smoking of tobacco products, including packet cigarettes, roll your own cigarettes, pipes and cigars (AIHW 2002). …

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