Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow obstruction that is not fully reversible. The airflow obstruction is usually progressive and associated with an inflammatory response of the lungs to noxious particles and gases, often from smoking. COPD is the third leading cause of death in the United States, with both its prevalence and mortality continuing to increase. It has also become one of the leading causes of death and disability worldwide. COPD is estimated to affect more than 5% of the total population in the United States; approximately 5 million adults have emphysema and another 10 million have chronic bronchitis. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of COPD. Figures show spirometry test results in a normal patient and a patient with severe COPD, stages of COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the pathogenesis of emphysema from smoking, pathologic lesions in small airways in a patient with COPD, the acinar structure of normal lungs compared with that of lungs in patients with centriacinar (centrilo