Magazine article Drug Topics

Out of Breath

Magazine article Drug Topics

Out of Breath

Article excerpt

New global, evidence-based guidelines offer suggestions on how to treat COPD

International health officials have released plans to battle a growing killer: chronic obstructive pulmonary disease (COPD). The disease affects twice as many Americans as diabetes and is the fourth-leading cause of death, with an estimated 16 million people diagnosed with it. Surprisingly, as many as 16 million more people remain undiagnosed.

The need to increase awareness of COPD and improve its recognition and treatment has led to the release of the first international guidelines to manage the condition. The new guidelines were developed by an international team of scientists from the Global Initiative for Chronic Obstructive Lung Disease (GOLD), created by the World Health Organization, and the U.S. National Heart, Lung & Blood Institute.

COPD is an umbrella term used to describe airflow limitation that is largely irreversible and is associated mainly with emphysema and chronic bronchitis. The reduced airflow is often progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Chronic cough and sputum production frequently precede the development of airflow obstruction in those "at risk" and may lead to respiratory or heart failure in individuals with severe disease. Cigarette smoking is the principal risk factor for COPD, accounting for 80% to 90% of all cases. Other risk factors include heredity, secondhand smoke, exposure to air pollution at work and in the environment, and a history of childhood respiratory infections.

Although there is currently no cure for COPD, the guidelines establish goals for effective diagnosis and management of the disease. "One of the biggest pieces to emerge from the guidelines is the need to identify patients who may be at risk," Stanley Fiel, M.D., said of the initiative. He is vice-chair of medicine at MCPHahnemann University in Philadelphia.

Patients who are short of breath or have a cough with sputum often are diagnosed as having a cold or bronchitis and are treated with antibiotics when, in fact, especially if they are smokers, "there is a good chance that they have COPD," he said.

The guidelines institute goals for the management of COPD, which include assessing and monitoring the disease, reducing risk factors, and managing stable COPD exacerbations. …

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