The American journal of medicine
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Forced expiratory volume in 1 second (FEV1) declines normally with aging by approximately 30 mL/yr, but in susceptible smokers, the decline is greater (about 60 mL/yr), resulting in the development of chronic obstructive pulmonary disease (COPD). Smoking cessation usually restores the normal or near-normal rate of FEV1 decline, whereas intermittent quitting provides less benefit. Thus, smoking cessation is a critical component for the prevention of COPD progression. ⋯ Genetic components of the decline in FEV1 are being actively explored, but none has been extensively validated other than alpha1-antitrypsin deficiency. To date, only smoking cessation has been definitively shown to be effective in reducing the rate of FEV1 decline, but other therapeutic strategies are under active research. Consequently, FEV1 and its change over time are important outcomes in COPD and valuable measures for the assessment of disease progression.
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Review
Clinical course of chronic obstructive pulmonary disease: review of therapeutic interventions.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease in which patients experience a progressive decline in lung function. Based on clinical evidence, the management of COPD should focus on (1) earlier diagnosis; (2) risk reduction through smoking cessation, decreased exposure to inhaled irritants, and immunization against respiratory pathogens; (3) symptom reduction with pharmacotherapy and pulmonary rehabilitation; (4) decreasing complications by reducing exacerbations and improving pulmonary function; and (5) improving health-related quality of life (HRQOL). ⋯ However, recent evidence from a post hoc analysis of randomized controlled trials of tiotropium suggests that initiation of long-acting bronchodilator therapy at earlier stages of disease may also provide improvements in lung function and HRQOL. The results of ongoing long-term studies may soon provide evidence that in addition to relieving symptoms and improving patient HRQOL, specific pharmacologic therapies may also alter the clinical course of COPD.
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Chronic obstructive pulmonary disease (COPD) remains a leading cause of disability and death in the United States. The identification and amelioration of systemic manifestations of COPD may improve long-term outcomes, including survival. ⋯ The evidence in support of the impact of various COPD treatment modalities on systemic manifestations of COPD is also reviewed. Finally, the usefulness of measuring body mass index, degree of airflow obstruction, dyspnea, and exercise capacity in combination (the BODE index), as a measure of disease severity and mortality risk in COPD, is examined and found to be a simple-to-use tool for predicting COPD-related hospitalization and mortality.
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We evaluated the impact of guideline-concordant empiric antibiotic therapy on time to clinical stability, time to switch therapy, length of hospital stay, and mortality among patients with community-acquired pneumonia. ⋯ Among hospitalized community-acquired patients, guideline-concordant antibiotic therapy is associated with improved in-hospital survival and shorter time to clinical stability, time to switch therapy, and length of hospital stay.