Nihon rinsho. Japanese journal of clinical medicine
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According to the guideline presented by Global Initiative for Chronic Obstructive Lung Disease(GOLD), the diagnosis of chronic obstructive pulmonary disease (COPD) has been simplified. COPD is diagnosed when FEV1(forced expiratory volume in one second)/FVC(forced vital capacity) is less than 70% (except Stage 0), and also the severity of disease is classified by FEV1. In this article, spirometry, a screening test for COPD, is explained at first, and then further examination to understand the pathophysiology of COPD is discussed. For management and following-up of COPD, both lung function test and arterial blood gas analysis are important.
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Clinical stages of chronic obstructive pulmonary disease(COPD) have been described in the guideline by American Thoracic Society(ATS), European Respiratory Society(ERS), and Japanese Respiratory Society. Recently, the clinical stage in GOLD(Global Initiative Obstructive Lung Disease) was also published in the guideline as an international standard. Although severity or clinical stages of COPD in ATS, ERS, and JRS guidelines is determined by only % predicted FEV1.0/FVC(%FEV1.0), GOLD guideline added clinical symptoms to %FEV1.0 for determining clinical stages of COPD. ⋯ Prognosis of COPD patients shows a clear decline in proportion to that of %FEV1.0. However, pulmonary circulation disorder also affects the prognosis of COPD. Pulmonary hypertension is often found in severe COPD.
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COPD(Chronic Obstructive Pulmonary Disease) is a cause of chronic respiratory failure which leads to pulmonary hypertension and cor pulmonale. Not only chronic hypoxia but also low QOL(quality of life) due to dyspnea are shown to affect survival of COPD patients. ⋯ The induction of HOT needs a consideration of risk of narcosis and evaluations of oxygen desaturation during exercise and sleep as well as hypoxia at rest. Higher QOL of HOT patients might require an alteration of prescription guidelines of HOT.
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Standard for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) was published from Japanese Respiratory Society in 1999. In this guideline the definition, epidemiology, risk factors, pathology, methods of diagnosis, methods of therapy and care were fully described. Especially, in this guideline, we used the thin slice CT for the diagnosis and classification of disease severity. After the publication, this guidelines were distributed to all of the JRS members(about 10,000 doctors).
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The identification of risk factors is an important step toward developing strategies for prevention and treatment of any disease. The risks of COPD are related to environmental exposures in combination with the genetic makeup of the individual. ⋯ Air pollution, occupational dusts and chemicals can also cause COPD when the exposures are sufficiently intense or prolonged. This is a summary of environmental risk factors for COPD.