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Chronic Obstructive Pulmonary Disease
Classification and external resources
ICD-10 J40. - J44., J47.
ICD-9 490 - 492, 494 - 496
OMIM 606963
DiseasesDB 2672
MedlinePlus 000091
eMedicine med/373 emerg/99
MeSH C08.381.495.389
.Chronic obstructive pulmonary disease (COPD) refers to chronic bronchitis and emphysema, a pair of two commonly co-existing diseases of the lungs in which the airways become narrowed.^ Hodgkin JE. Prognosis in chronic obstructive pulmonary disease.
  • COPD: Management of Acute Exacerbations and Chronic Stable Disease - August 15, 2001 - American Family Physician 10 February 2010 12:51 UTC www.aafp.org [Source type: Academic]

^ This form of COPD is called chronic bronchitis .
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

^ The airways in the lungs become narrowed, and in some people, the airways become clogged with mucus.
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

[1] .This leads to a limitation of the flow of air to and from the lungs causing shortness of breath.^ It stops people from exercising, and it is the major symptom that severely limits the activities of people with COPD. The inability to exercise without developing shortness of breath gets worse as COPD progresses.
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

^ Increased work of breathing from increased airways resistance/expiratory flow limitation .
  • Exercise training in chronic obstructive pulmonary disease 10 February 2010 13:25 UTC www.rehab.research.va.gov [Source type: Academic]

^ Even simple activities may cause very bad shortness of breath.
  • COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health 10 February 2010 13:25 UTC health.yahoo.com [Source type: General]

.In contrast to asthma, the limitation of airflow is poorly reversible and usually gets progressively worse over time.^ In fact, COPD can get progressively worse over time.
  • Chronic Obstructive Pulmonary Disease (COPD) - Symptoms and Treatment 10 February 2010 13:25 UTC www.cleanairplus.com [Source type: General]

^ COPD gradually gets worse over time.
  • COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health 10 February 2010 13:25 UTC health.yahoo.com [Source type: General]

^ COPD gets gradually worse over time.
  • What Is Chronic Obstructive Pulmonary Disease– Support Plus Medical 10 February 2010 13:25 UTC www.supportplusmedical.com [Source type: Academic]
  • Chronic Obstructive Pulmonary Disease Herbal Supplements 10 February 2010 13:25 UTC www.herbsmd.com [Source type: FILTERED WITH BAYES]
  • Alternative Therapies for COPD - Chronic Obstructive Pulmonary Disease 10 February 2010 12:51 UTC healingdeva.com [Source type: Academic]

.COPD is caused by noxious particles or gas, most commonly from tobacco smoking, which triggers an abnormal inflammatory response in the lung.^ Most (but not all) cases of COPD are caused by tobacco smoking.
  • Nosology for Our Day: Its Application to Chronic Obstructive Pulmonary Disease -- Snider 167 (5): 678 -- American Journal of Respiratory and Critical Care Medicine 10 February 2010 13:25 UTC ajrccm.atsjournals.org [Source type: Academic]

^ COPD is almost always caused by smoking.
  • COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health 10 February 2010 13:25 UTC health.yahoo.com [Source type: General]
  • Healthwise Knowledgebase 10 February 2010 13:25 UTC health.med.umich.edu [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:51 UTC www.jhsmiami.org [Source type: FILTERED WITH BAYES]

^ Cigarette smoking causes COPD by inciting a chronic inflammatory response to the pollutants in the smoke.
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

[2][3] .The inflammatory response in the larger airways is known as chronic bronchitis, which is diagnosed clinically when people regularly cough up sputum.^ He will cough frequently and will bring up sputum.
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

^ This compound definition uses the combination of chronic bronchitis defined in clinical terms, emphysema in anatomical terms, and airflow obstruction representing a physiologic state.
  • Nosology for Our Day: Its Application to Chronic Obstructive Pulmonary Disease -- Snider 167 (5): 678 -- American Journal of Respiratory and Critical Care Medicine 10 February 2010 13:25 UTC ajrccm.atsjournals.org [Source type: Academic]

^ These persons have nonremitting airflow obstruction of variable severity, which is associated with airway hyperreactivity, chronic productive cough, and decreased tolerance for exercise.
  • Nosology for Our Day: Its Application to Chronic Obstructive Pulmonary Disease -- Snider 167 (5): 678 -- American Journal of Respiratory and Critical Care Medicine 10 February 2010 13:25 UTC ajrccm.atsjournals.org [Source type: Academic]

.In the alveoli, the inflammatory response causes destruction of the tissues of the lung, a process known as emphysema.^ First, chronic exposure to an irritant, such as cigarette smoke, causes inflammatory cells (such as macrophages and neutrophils) to gather in the airspaces of the lung.
  • Chronic Obstructive Pulmonary Disease - COPD, Emphysema, Chronic Bronchitis - Life Extension Health Concern 10 February 2010 13:25 UTC www.lef.org [Source type: Academic]

^ With regard to the observed histopathological changes, it can be concluded that SO 2 exposure leads to a more diffuse alveolar damage with a more extensive damage with destruction of lung tissue after longer exposure.
  • Respiratory Research | Full text | Models of chronic obstructive pulmonary disease 10 February 2010 13:25 UTC respiratory-research.com [Source type: Academic]

^ The airflow obstruction is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.
  • Nosology for Our Day: Its Application to Chronic Obstructive Pulmonary Disease -- Snider 167 (5): 678 -- American Journal of Respiratory and Critical Care Medicine 10 February 2010 13:25 UTC ajrccm.atsjournals.org [Source type: Academic]

.The natural course of COPD is characterized by occasional sudden worsenings of symptoms called acute exacerbations, most of which are caused by infections or air pollution.^ Signs and symptoms of an acute exacerbation of COPD may include any of the following: .
  • NGC - NGC Summary 10 February 2010 13:25 UTC www.guidelines.gov [Source type: Academic]
  • NGC - NGC Summary 10 February 2010 12:51 UTC www.guideline.gov [Source type: Academic]

^ The sudden decompensation seen in acute exacerbations of COPD can be caused by a variety of factors.
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

^ This is called a COPD exacerbation .
  • Healthwise Knowledgebase 10 February 2010 13:25 UTC health.med.umich.edu [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:51 UTC www.jhsmiami.org [Source type: FILTERED WITH BAYES]

.The diagnosis of COPD requires lung function tests.^ Interpretative strategies for lung function tests.
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

^ A history and physical exam provide important information needed to diagnose, treat, and monitor COPD. Lung function tests measure the amount of air in your lungs and the speed at which air moves in and out of the lungs and airways.
  • Healthwise Knowledgebase 10 February 2010 13:25 UTC health.med.umich.edu [Source type: FILTERED WITH BAYES]

^ A diagnosis of COPD requires a history of chronic progressive symptoms (cough, sputum production, wheeze, or dyspnea).
  • Nosology for Our Day: Its Application to Chronic Obstructive Pulmonary Disease -- Snider 167 (5): 678 -- American Journal of Respiratory and Critical Care Medicine 10 February 2010 13:25 UTC ajrccm.atsjournals.org [Source type: Academic]

.Important management strategies are smoking cessation, vaccinations, rehabilitation, and drug therapy (often using inhalers).^ The 2005 AHRQ report (2) systematically reviewed RCTs that evaluated spirometry as a motivational tool for smoking cessation, independently or in combination with behavioral and pharmacologic therapies.
  • Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force — Ann Intern Med 10 February 2010 13:25 UTC www.annals.org [Source type: Academic]

^ The management of chronic stable COPD always includes smoking cessation and oxygen therapy.
  • COPD: Management of Acute Exacerbations and Chronic Stable Disease - August 15, 2001 - American Family Physician 10 February 2010 12:51 UTC www.aafp.org [Source type: Academic]

^ Grade D - In most cases bronchodilator therapy is best administered using a hand-held inhaler device (including a spacer device if appropriate).
  • NGC - NGC Summary 10 February 2010 13:25 UTC www.guideline.gov [Source type: Academic]

.Some patients go on to requiring long-term oxygen therapy or lung transplantation.^ You require long-term oxygen or corticosteroid therapy.
  • Healthwise Knowledgebase 10 February 2010 13:25 UTC health.med.umich.edu [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:51 UTC www.jhsmiami.org [Source type: FILTERED WITH BAYES]

^ You need long-term oxygen or corticosteroid therapy.
  • COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health 10 February 2010 13:25 UTC health.yahoo.com [Source type: General]

^ Tarpy S. Celli B. Long-term oxygen therapy.
  • Exercise training in chronic obstructive pulmonary disease 10 February 2010 13:25 UTC www.rehab.research.va.gov [Source type: Academic]

[2]
.Worldwide, COPD ranked as the sixth leading cause of death in 1990. It is projected to be the fourth leading cause of death worldwide by 2030 due to an increase in smoking rates and demographic changes in many countries.^ Ten leading causes of death.
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

^ COPD currently is the fourth leading cause of death among Americans.

^ MORTALITY COPD is an important cause of death in many countries and is still increasing because of the expanding epidemic of smoking and the increasingly aging population.
  • Update in Chronic Obstructive Pulmonary Disease 2006 -- Rabe et al. 175 (12): 1222 -- American Journal of Respiratory and Critical Care Medicine 10 February 2010 13:25 UTC ajrccm.atsjournals.org [Source type: Academic]

[4] .COPD is the 4th leading cause of death in the U.S., and the economic burden of COPD in the U.S. in 2007 was $42.6 billion in health care costs and lost productivity.^ Nationally, it is the fourth leading cause of death.
  • COPD Program at UVA Earns Joint Commission Certification 10 February 2010 12:51 UTC hsc.virginia.edu [Source type: Academic]

^ COPD is a leading cause of death, illness, and disability in the United States.
  • Chronic Obstructive Pulmonary Disease 10 February 2010 13:25 UTC www.triwest.com [Source type: General]

^ It is also the sixth leading cause of death worldwide.
  • Chronic Obstructive Pulmonary Disease and Emphysema: eMedicine Emergency Medicine 10 February 2010 13:25 UTC emedicine.medscape.com [Source type: Academic]

[5][6]
.COPD is also known as chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic airflow limitation (CAL) and chronic obstructive respiratory disease (CORD).^ The nature of small-airway obstruction in chronic obstructive pulmonary disease.
  • Update in Chronic Obstructive Pulmonary Disease 2006 -- Rabe et al. 175 (12): 1222 -- American Journal of Respiratory and Critical Care Medicine 10 February 2010 13:25 UTC ajrccm.atsjournals.org [Source type: Academic]

^ Chronic obstructive pulmonary disease with lung cancer and/or cardiovascular disease.
  • Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal 10 February 2010 13:25 UTC pmj.bmj.com [Source type: Academic]

^ Diagnosis and management of chronic obstructive pulmonary disease (COPD).
  • NGC - NGC Summary 10 February 2010 13:25 UTC www.guidelines.gov [Source type: Academic]
  • NGC - NGC Summary 10 February 2010 12:51 UTC www.guideline.gov [Source type: Academic]

Contents

Signs and symptoms

.One of the most common symptoms of COPD is shortness of breath (dyspnea).^ The critical symptom of COPD is dyspnea , difficulty breathing.
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

^ Dyspnea, the feeling of breathlessness, is a common symptom.
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

^ What Causes COPD? Smoking Is the Most Common Cause of COPD Most cases of chronic obstructive pulmonary disease (COPD) develop after repeatedly breathing in fumes and other things that irritate and damage the lungs and airways.
  • Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea 10 February 2010 13:25 UTC www.birdsongmedical.com [Source type: General]

People with COPD commonly describe this as: "My breathing requires effort," "I feel out of breath," or "I can't get enough air in".[7] .People with COPD typically first notice dyspnea during vigorous exercise when the demands on the lungs are greatest.^ People with COPD typically first notice dyspnea during vigorous exercise when the demands on the lungs are greatest.
  • COPD 10 February 2010 12:51 UTC www.godasco.com [Source type: FILTERED WITH BAYES]

^ At first, this shortness of breath occurs only during vigorous exercise.
  • Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education 10 February 2010 13:25 UTC www.nursingceu.com [Source type: Academic]

^ The main difference in COPD is that the key problem there is primarily destruction of the very peripheral parts of the lung, most commonly nowadays in people who smoke.
  • What Is The Difference Between Asthma And COPD (Chronic Obstructive Pulmonary Disease)? - ABC News 10 February 2010 13:25 UTC abcnews.go.com [Source type: News]

.Over the years, dyspnea tends to get gradually worse so that it can occur during milder, everyday activities such as housework.^ Over the years, dyspnea tends to get gradually worse so that it can occur during milder, everyday activities such as housework.
  • COPD 10 February 2010 12:51 UTC www.godasco.com [Source type: FILTERED WITH BAYES]

^ In the advanced stages of COPD, dyspnea can become so bad that it occurs during rest and is constantly present.
  • COPD 10 February 2010 12:51 UTC www.godasco.com [Source type: FILTERED WITH BAYES]

^ In addition to cutting your working years short, it can also sap you of the strength and stamina for leisure activities, such as travel, exercise, and even socializing with friends.
  • Chronic Obstructive Pulmonary Disease Treating Emphysema And Chronic Bronchitis: Smoking Cessation - AOL Health 10 February 2010 13:25 UTC www.aolhealth.com [Source type: General]
  • Chronic Obstructive Pulmonary Disease Treating Emphysema And Chronic Bronchitis: Respiratory Health - AOL Health 10 February 2010 13:25 UTC www.aolhealth.com [Source type: General]

.In the advanced stages of COPD, dyspnea can become so bad that it occurs during rest and is constantly present.^ The shortness of breath can become so bad that it can occur even when the person is resting.
  • MedFriendly.com: Chronic obstructive pulmonary disease 10 February 2010 13:25 UTC www.medfriendly.com [Source type: FILTERED WITH BAYES]

^ But as emphysema progresses, dyspnea can also occur at rest.
  • Chronic Obstructive Pulmonary Disease - COPD Overview 10 February 2010 13:25 UTC www.buzzle.com [Source type: Academic]

^ In more advanced stages, people may experience rapid changes in the ability to breathe, shortness of breath at rest, fatigue, depression , memory problems, confusion, and frequent waking during sleep.
  • Chronic Obstructive Pulmonary Disease 10 February 2010 13:25 UTC www.puritan.com [Source type: Academic]
  •   
    Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.henrysmarkets.com/app/henrys/hn.php?org=henrysmarkets&p=hn&ContentID=1196001">www.henrysmarkets.com</a> [Source type: Academic]</li><li> <em><c_title> Chronic Obstructive Pulmonary Disease </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.publix.com/wellness/notes/Display.do?id=Concern&childId=COPD">www.publix.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__79" class="citable__local-anchor">.</a><span class='citationPopup' rel="79">Other symptoms of COPD are a persistent cough, <a href="/Sputum" title="Sputum">sputum</a> or mucus production, <a href="/Wheezing" title="Wheezing" class="mw-redirect">wheezing</a>, chest tightness, and tiredness.</span><span class="citable__li" citable_id="79"><a href="#citable__79"><strong>^</strong></a> <c_txt>The signs and symptoms of COPD are different for each person, but common symptoms are cough, coughing up mucus, shortness of breath, wheezing, and chest tightness.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="79"><a href="#citable__79"><strong>^</strong></a> <c_txt>Chronic mucus (sputum) production when you cough.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="79"><a href="#citable__79"><strong>^</strong></a> <c_txt>Common signs are cough, sputum production, shortness of breath, wheezing, and chest tightness.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_7" class="reference"><a href="#cite_note-7"><span>[</span>8<span>]</span></a></sup><sup id="wikipedia_cite_ref_autogenerated1_8_0" class="reference"><a href="#cite_note-autogenerated1-8"><span>[</span>9<span>]</span></a></sup></div> <div style="margin: 1.12em 0; display:block"><a name="citable__272" class="citable__local-anchor">.</a><span class='citationPopup' rel="272">People with advanced (very severe) COPD sometimes develop <a href="/Respiratory_failure" title="Respiratory failure">respiratory failure</a>.</span><span class="citable__li" citable_id="272"><a href="#citable__272"><strong>^</strong></a> <c_txt>In very severe COPD, complications like respiratory failure or signs of heart failure may develop.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="272"><a href="#citable__272"><strong>^</strong></a> <c_txt>Very severe COPD (stage 4) .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="272"><a href="#citable__272"><strong>^</strong></a> <c_txt>In very severe COPD, you have some of the symptoms of stages 1 through 3, plus you may have: .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__4" class="citable__local-anchor">.</a><span class='citationPopup' rel="4">When this happens, <a href="/Cyanosis" title="Cyanosis">cyanosis</a>, a bluish discoloration of the lips caused by a lack of oxygen in the blood, can occur.</span><span class="citable__li" citable_id="4"><a href="#citable__4"><strong>^</strong></a> <c_txt>When this happens, the amount of oxygen in your blood may drop.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="4"><a href="#citable__4"><strong>^</strong></a> <c_txt>While looking for the cause of an episode of decompensation, an adequate level of blood oxygen and an appropriate blood pH need to be maintained in the patient.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__49" class="citable__local-anchor">.</a><span class='citationPopup' rel="49">An excess of carbon dioxide in the blood can cause headaches, drowsiness or twitching (<a href="/Asterixis" title="Asterixis">asterixis</a>).</span><span class="citable__li" citable_id="49"><a href="#citable__49"><strong>^</strong></a> <c_txt>Arterial blood gases test measures the amount of oxygen, carbon dioxide, and acid in the blood.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="49"><a href="#citable__49"><strong>^</strong></a> <c_txt>Confusion (because of too little oxygen and too much carbon dioxide in the blood).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="49"><a href="#citable__49"><strong>^</strong></a> <c_txt>Now the hypoxemia is accompanied by hypercapnia (excess blood carbon dioxide) and the patient develops chronic respiratory acidosis, an ominous sign (Sharma, 2006; Swadron & Mandavia, 2006).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__55" class="citable__local-anchor">.</a><span class='citationPopup' rel="55">A complication of advanced COPD is <a href="/Cor_pulmonale" title="Cor pulmonale">cor pulmonale</a>, a strain on the heart due to the extra work required by the heart to pump blood through the affected lungs.</span><span class="citable__li" citable_id="55"><a href="#citable__55"><strong>^</strong></a> <c_txt>Heart failure affecting the right side of the heart ( cor pulmonale ).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="55"><a href="#citable__55"><strong>^</strong></a> <c_txt>Disclaimer: The following information is provided for the public by the Department of Health and Human Services, National Institutes of Health and The National Heart, Lung, and Blood Institute and was last updated in January, 2006.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="55"><a href="#citable__55"><strong>^</strong></a> <c_txt>Pulmonary hypertension can cause right-sided heart failure (cor pulmonale), and this will lead to jugular venous distension and edema of the legs and ankles.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_9" class="reference"><a href="#cite_note-9"><span>[</span>10<span>]</span></a></sup> <a name="citable__168" class="citable__local-anchor">.</a><span class='citationPopup' rel="168">Symptoms of cor pulmonale are <a href="/Peripheral_edema" title="Peripheral edema">peripheral edema</a>, seen as swelling of the ankles, and dyspnea.</span><span class="citable__li" citable_id="168"><a href="#citable__168"><strong>^</strong></a> <c_txt>Symptoms of cor pulmonale are peripheral edema, seen as swelling of the ankles, and dyspnea.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.godasco.com/NewPages/Info_Librarys/info_library/COPD.asp">www.godasco.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="168"><a href="#citable__168"><strong>^</strong></a> <c_txt>If the heart cannot manage the additional work, right heart failure also known as Cor pulmonale results and leads to swelling of the feet and ankles.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) Symptoms, Causes, and Treatments by MedicineNet.com</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/page4.htm">www.medicinenet.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="168"><a href="#citable__168"><strong>^</strong></a> <c_txt>There is the possibility that the person's heart may not be able to hand the additional work; if this is the case then right heart failure, also known as, 'Cor Pulmonale,' can result and lead to swelling of the person's feet and ankles.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) - Causes Symptoms and Treatment</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.disabled-world.com/health/respiratory/chronic-obstructive-pulmonary-disease.php">www.disabled-world.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__177" class="citable__local-anchor">.</a><span class='citationPopup' rel="177">There are a few <a href="/Medical_sign" title="Medical sign">signs</a> of COPD that a healthcare worker may detect although they can be seen in other diseases.</span><span class="citable__li" citable_id="177"><a href="#citable__177"><strong>^</strong></a> <c_txt>A patient with mild COPD may have few signs of the disease, especially when sitting quietly.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="177"><a href="#citable__177"><strong>^</strong></a> <c_txt>Although the results of several of these studies show an aggregation of COPD in families, there is no clear Mendelian pattern of inheritance.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genetic Risk Factors for Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://tobaccodocuments.org/pm/2063633573-3584.html">tobaccodocuments.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="177"><a href="#citable__177"><strong>^</strong></a> <c_txt>COPD is an insidious disease, and it develops over many years before it compromises people enough that they go to a doctor.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__165" class="citable__local-anchor">.</a><span class='citationPopup' rel="165">Some people have COPD and have none of these signs.</span><span class="citable__li" citable_id="165"><a href="#citable__165"><strong>^</strong></a> <c_txt>These inhalers work for some people.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease | COPD Symptom | COPD Treatment</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.sleepdisordersguide.com/chronic-obstructive-pulmonary-disease.html">www.sleepdisordersguide.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="165"><a href="#citable__165"><strong>^</strong></a> <c_txt>Some people with COPD may also have asthma.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.rxfacts.org/patients/COPD.php">www.rxfacts.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="165"><a href="#citable__165"><strong>^</strong></a> <c_txt>Some people with COPD may have asthma too.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.peacehealth.org/kbase/topic/special/hw32559/sec5.htm">www.peacehealth.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> Common signs are:</div> <ul> <li><a href="/Tachypnea" title="Tachypnea">tachypnea</a>, a rapid breathing rate</li> <li>wheezing sounds or crackles in the lungs heard through a <a href="/Stethoscope" title="Stethoscope">stethoscope</a></li> <li>breathing out taking a longer time than breathing in</li> <li>enlargement of the chest, particularly the front-to-back distance (<a href="/Hyperinflation" title="Hyperinflation">hyperinflation</a>)</li> <li>active use of muscles in the neck to help with breathing</li> <li>breathing through pursed lips</li> <li>increased anteroposterior to lateral ratio of the chest (i.e. <a href="/Barrel_chest" title="Barrel chest">barrel chest</a>).</li> </ul> <h2><span class="mw-headline" id="wikipedia_Cause">Cause</span></h2> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Smoking">Smoking</span></h3> <div style="margin: 1.12em 0; display:block"><a name="citable__98" class="citable__local-anchor">.</a><span class='citationPopup' rel="98">The primary risk factor for COPD is chronic tobacco smoking.</span><span class="citable__li" citable_id="98"><a href="#citable__98"><strong>^</strong></a> <c_txt>COPD cases are caused by tobacco smoke.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Summit Medical Group - Chronic Obstructive Pulmonary Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.summitmedicalgroup.com/library/adult_health/chronic_obstructive_pulmonary_disease/">www.summitmedicalgroup.com</a> [Source type: General]</li><li> <em><c_title>Adult Health Advisor 2009.1: Chronic Obstructive Pulmonary Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.med.umich.edu/1libr/aha/aha_copd_crs.htm">www.med.umich.edu</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="98"><a href="#citable__98"><strong>^</strong></a> <c_txt>Genetic risk factors for chronic obstructive pulmonary disease (COPD).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Vitamin D Research | Chronic Obstructive Pulmonary Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.vitamindcouncil.org/science/research/vitamin-d-and-chronic-obstructive-pulmonary-disease.shtml">www.vitamindcouncil.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="98"><a href="#citable__98"><strong>^</strong></a> <c_txt>The risk factors for COPD include: .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD: are you at risk?</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.woio.com/global/story.asp?s=11592882">www.woio.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__219" class="citable__local-anchor">.</a><span class='citationPopup' rel="219">In the <a href="/United_States" title="United States">United States</a>, 80 to 90% of cases of COPD are due to smoking.</span><span class="citable__li" citable_id="219"><a href="#citable__219"><strong>^</strong></a> <c_txt>In 2004 a comparison of the two major heart/lung diseases in the United States revealed 24 million cases of COPD (estimated, half still undiagnosed) and 79.4 million cases of cardiovascular disease (NHLBI, 2007).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="219"><a href="#citable__219"><strong>^</strong></a> <c_txt>In the United States, higher rates of COPD are found among white people, blue-collar workers, and people with less formal education.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="219"><a href="#citable__219"><strong>^</strong></a> <c_txt>Mostow SR; O'Brien RF Am J Med (United States) Nov 29 1985, 79 (5B) p78-80 .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>EMPHYSEMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE Page 3</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.lef.org/protocols/abstracts/abstr-046b.html">www.lef.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_medcauses_10_0" class="reference"><a href="#cite_note-medcauses-10"><span>[</span>11<span>]</span></a></sup> <a name="citable__65" class="citable__local-anchor">.</a><span class='citationPopup' rel="65"><sup id="wikipedia_cite_ref_11" class="reference"><a href="#cite_note-11"><span>[</span>12<span>]</span></a></sup> Exposure to cigarette smoke is measured in <a href="/Pack-years" title="Pack-years" class="mw-redirect">pack-years</a><sup id="wikipedia_cite_ref_12" class="reference"><a href="#cite_note-12"><span>[</span>13<span>]</span></a></sup>, the average number of packages of cigarettes smoked daily multiplied by the number of years of smoking.</span><span class="citable__li" citable_id="65"><a href="#citable__65"><strong>^</strong></a> <c_txt>A person's smoking intensity is measured in pack-years .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="65"><a href="#citable__65"><strong>^</strong></a> <c_txt>Based on inhalative exposure to noxious stimuli such as cigarette smoke, the administration of tissue-degrading enzymes or gene-targeting techniques, a number of experimental approaches to mimic acute and chronic features of COPD have been established in the past years.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Respiratory Research | Full text | Models of chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://respiratory-research.com/content/5/1/18">respiratory-research.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="65"><a href="#citable__65"><strong>^</strong></a> <c_txt>Protection by N-acetylcysteine of the histopathological and cytogenetical damage produced by exposure of rats to cigarette smoke.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>EMPHYSEMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE Page 3</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.lef.org/protocols/abstracts/abstr-046b.html">www.lef.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__67" class="citable__local-anchor">.</a><span class='citationPopup' rel="67">The likelihood of developing COPD increases with age and cumulative smoke exposure, and almost all life-long smokers will develop COPD, provided that smoking-related, extrapulmonary diseases (cardiovascular, diabetes, cancer) do not claim their lives beforehand.</span><span class="citable__li" citable_id="67"><a href="#citable__67"><strong>^</strong></a> <c_txt>COPD is a life-long disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="67"><a href="#citable__67"><strong>^</strong></a> <c_txt>However, not all smokers develop COPD, and not all patients with COPD are smokers or have smoked in the past.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="67"><a href="#citable__67"><strong>^</strong></a> <c_txt>COPD is almost always caused by smoking.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_13" class="reference"><a href="#cite_note-13"><span>[</span>14<span>]</span></a></sup></div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Occupational_exposures">Occupational exposures</span></h3> <div style="margin: 1.12em 0; display:block"><a name="citable__85" class="citable__local-anchor">.</a><span class='citationPopup' rel="85">Intense and prolonged exposure to workplace dusts found in <a href="/Coal_mining" title="Coal mining">coal mining</a>, <a href="/Gold_mining" title="Gold mining">gold mining</a>, and the cotton textile industry and chemicals such as <a href="/Cadmium" title="Cadmium">cadmium</a>, <a href="/Isocyanates" title="Isocyanates" class="mw-redirect">isocyanates</a>, and fumes from <a href="/Welding" title="Welding">welding</a> have been implicated in the development of airflow obstruction, even in nonsmokers.</span><span class="citable__li" citable_id="85"><a href="#citable__85"><strong>^</strong></a> <c_txt>Long-term exposure to lung irritants such as industrial dust and chemical fumes.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="85"><a href="#citable__85"><strong>^</strong></a> <c_txt>Miners, firefighters, metal workers, grain handlers, cotton workers, paper mill workers, agricultural workers, construction workers who handle cement, and others employed in occupations associated with prolonged exposure to dusts, fumes, or gases develop significant airflow obstruction, coughing, phlegm, dyspnea, wheezing, and reduced lung function.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="85"><a href="#citable__85"><strong>^</strong></a> <c_txt>Further animal models focus on the exposure to ultrafine particles, silica and coal dust [ 138 , 139 ].</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Respiratory Research | Full text | Models of chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://respiratory-research.com/content/5/1/18">respiratory-research.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_PMID16690673_14_0" class="reference"><a href="#cite_note-PMID16690673-14"><span>[</span>15<span>]</span></a></sup> <a name="citable__312" class="citable__local-anchor">.</a><span class='citationPopup' rel="312">Workers who smoke and are exposed to these particles and gases are even more likely to develop COPD. Intense <a href="/Silica" title="Silica" class="mw-redirect">silica</a> dust exposure causes <a href="/Silicosis" title="Silicosis">silicosis</a>, a restrictive lung disease distinct from COPD; however, less intense silica dust exposures have been linked to a COPD-like condition.</span><span class="citable__li" citable_id="312"><a href="#citable__312"><strong>^</strong></a> <c_txt>The longer and more intensely people smoke, the more likely they are to develop COPD. .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="312"><a href="#citable__312"><strong>^</strong></a> <c_txt>However, not all smokers develop COPD, and not all patients with COPD are smokers or have smoked in the past.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="312"><a href="#citable__312"><strong>^</strong></a> <c_txt>Both of these diseases are caused by smoking.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_15" class="reference"><a href="#cite_note-15"><span>[</span>16<span>]</span></a></sup> <a name="citable__227" class="citable__local-anchor">.</a><span class='citationPopup' rel="227">The effect of occupational pollutants on the lungs appears to be substantially less important than the effect of cigarette smoking.</span><span class="citable__li" citable_id="227"><a href="#citable__227"><strong>^</strong></a> <c_txt>The negative effects of cigarette smoking on lung function are still greater than occupational exposure.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) - Causes Symptoms and Treatment</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.disabled-world.com/health/respiratory/chronic-obstructive-pulmonary-disease.php">www.disabled-world.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="227"><a href="#citable__227"><strong>^</strong></a> <c_txt>Effect of cigarette smoking and respiratory symptoms.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Developing COPD: a 25 year follow up study of the general population -- Løkke et al. 61 (11): 935 -- Thorax </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://thorax.bmj.com/content/61/11/935.full">thorax.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="227"><a href="#citable__227"><strong>^</strong></a> <c_txt>Workers who smoke and are exposed to these particles and gases are even more likely to develop COPD. The effect of occupational pollutants on the lungs appears to be substantially less important than the effect of cigarette smoking.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic Obstructive Pulmonary Disease (COPD) - IFAonline </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.ifaonline.co.uk/cover/feature/1562030/chronic-obstructive-pulmonary-disease-copd">www.ifaonline.co.uk</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_Harrisons_16_0" class="reference"><a href="#cite_note-Harrisons-16"><span>[</span>17<span>]</span></a></sup></div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Air_pollution">Air pollution</span></h3> <div style="margin: 1.12em 0; display:block"><a name="citable__126" class="citable__local-anchor">.</a><span class='citationPopup' rel="126">Studies in many countries have found that people who live in large cities have a higher rate of COPD compared to people who live in rural areas.</span><span class="citable__li" citable_id="126"><a href="#citable__126"><strong>^</strong></a> <c_txt>COPD is an insidious disease, and it develops over many years before it compromises people enough that they go to a doctor.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="126"><a href="#citable__126"><strong>^</strong></a> <c_txt>A review of studies has found that the inactivated flu shot may reduce the risk of a sudden increase in shortness of breath ( COPD exacerbation) .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="126"><a href="#citable__126"><strong>^</strong></a> <c_txt>In the United States, higher rates of COPD are found among white people, blue-collar workers, and people with less formal education.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_17" class="reference"><a href="#cite_note-17"><span>[</span>18<span>]</span></a></sup> <a name="citable__260" class="citable__local-anchor">.</a><span class='citationPopup' rel="260">Urban <a href="/Air_pollution" title="Air pollution">air pollution</a> may be a contributing factor for COPD as it is thought to slow the normal growth of the lungs although the long-term research needed to confirm the link has not been done.</span><span class="citable__li" citable_id="260"><a href="#citable__260"><strong>^</strong></a> <c_txt>The airway obstruction of COPD slows the movement of air in the lungs.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="260"><a href="#citable__260"><strong>^</strong></a> <c_txt>The goals of long-term COPD treatments are: .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="260"><a href="#citable__260"><strong>^</strong></a> <c_txt>Air pollution may make COPD worse.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__158" class="citable__local-anchor">.</a><span class='citationPopup' rel="158">In many <a href="/Developing_countries" title="Developing countries" class="mw-redirect">developing countries</a> indoor air pollution from cooking fire smoke (often using <a href="/Biomass_fuel" title="Biomass fuel" class="mw-redirect">biomass fuels</a> such as wood and animal dung) is a common cause of COPD, especially in women.</span><span class="citable__li" citable_id="158"><a href="#citable__158"><strong>^</strong></a> <c_txt>Smoke-free indoor air laws .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="158"><a href="#citable__158"><strong>^</strong></a> <c_txt>COPD is almost always caused by smoking.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="158"><a href="#citable__158"><strong>^</strong></a> <c_txt>Indoor air pollution.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_18" class="reference"><a href="#cite_note-18"><span>[</span>19<span>]</span></a></sup></div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Genetics">Genetics</span></h3> <div style="margin: 1.12em 0; display:block"><a name="citable__254" class="citable__local-anchor">.</a><span class='citationPopup' rel="254">Some factor in addition to heavy smoke exposure is required for a person to develop COPD. This factor is probably a <a href="/Gene" title="Gene">genetic</a> susceptibility.</span><span class="citable__li" citable_id="254"><a href="#citable__254"><strong>^</strong></a> <c_txt>Systemic inflammation in COPD: is genetic susceptibility a key factor?</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="254"><a href="#citable__254"><strong>^</strong></a> <c_txt>A lung transplant may be done for some people with very severe COPD. A transplant involves removing the lung of a person with COPD and replacing it with a healthy lung from a donor.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="254"><a href="#citable__254"><strong>^</strong></a> <c_txt>Treatment response differences between sub-phenotypes of COPD, which coexist in some study populations, could be a key factor.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genome Medicine | Full text | Chronic obstructive pulmonary disease: towards pharmacogenetics</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://genomemedicine.com/content/1/11/112">genomemedicine.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__214" class="citable__local-anchor">.</a><span class='citationPopup' rel="214">COPD is more common among relatives of COPD patients who smoke than unrelated smokers.</span><span class="citable__li" citable_id="214"><a href="#citable__214"><strong>^</strong></a> <c_txt>Patients who smoke should stop smoking.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD: Management of Acute Exacerbations and Chronic Stable Disease - August 15, 2001 - American Family Physician</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.aafp.org/afp/20010815/603.html">www.aafp.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="214"><a href="#citable__214"><strong>^</strong></a> <c_txt>The most common cause of COPD is smoking.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>British Lung Foundation | Conditions and diseases | COPD</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.lunguk.org/copd.asp">www.lunguk.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="214"><a href="#citable__214"><strong>^</strong></a> <c_txt>However, not all smokers develop COPD, and not all patients with COPD are smokers or have smoked in the past.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_19" class="reference"><a href="#cite_note-19"><span>[</span>20<span>]</span></a></sup> <a name="citable__183" class="citable__local-anchor">.</a><span class='citationPopup' rel="183">The genetic differences that make some peoples' lungs susceptible to the effects of tobacco smoke are mostly unknown.</span><span class="citable__li" citable_id="183"><a href="#citable__183"><strong>^</strong></a> <c_txt>Some evidence for this theory comes from studies on the effect of tobacco smoke on lung cells.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>What Is Chronic Obstructive Pulmonary Disease– Support Plus Medical</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.supportplusmedical.com/copd.php">www.supportplusmedical.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="183"><a href="#citable__183"><strong>^</strong></a> <c_txt>The genetic differences that make some peoples' lungs susceptible to the effects of tobacco smoke are mostly unknown.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic Obstructive Pulmonary Disease (COPD) - IFAonline </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.ifaonline.co.uk/cover/feature/1562030/chronic-obstructive-pulmonary-disease-copd">www.ifaonline.co.uk</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="183"><a href="#citable__183"><strong>^</strong></a> <c_txt>The primary causes of COPD are tobacco smoke and air pollution, which damage and irritate lung tissue, resulting in a narrowing of the airways.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Galapagos and Roche initiate strategic alliance in COPD | TradingMarkets.com </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.tradingmarkets.com/news/stock-alert/glpay_galapagos-and-roche-initiate-strategic-alliance-in-copd-693078.html">www.tradingmarkets.com</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Galapagos and Roche initiate strategic alliance in COPD - FOXBusiness.com</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.foxbusiness.com/story/markets/industries/health-care/galapagos-roche-initiate-strategic-alliance-copd/">www.foxbusiness.com</a> [Source type: News]</li></ul></c_src></small></div><br></span> <a name="citable__154" class="citable__local-anchor">.</a><span class='citationPopup' rel="154"><a href="/Alpha_1-antitrypsin_deficiency" title="Alpha 1-antitrypsin deficiency">Alpha 1-antitrypsin deficiency</a> is a genetic condition that is responsible for about 2% of cases of COPD. In this condition, the body does not make enough of a protein, <a href="/Alpha_1-antitrypsin" title="Alpha 1-antitrypsin">alpha 1-antitrypsin</a>.</span><span class="citable__li" citable_id="154"><a href="#citable__154"><strong>^</strong></a> <c_txt>Eriksson S: Studies in alpha 1 antitrypsin deficiency.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genome Medicine | Full text | Chronic obstructive pulmonary disease: towards pharmacogenetics</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://genomemedicine.com/content/1/11/112">genomemedicine.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="154"><a href="#citable__154"><strong>^</strong></a> <c_txt>People with antitrypsin deficiency have low levels of alpha 1 antitrypsin; the imbalance of proteins leads to the destruction of the lungs and COPD. If people with this condition smoke, the disease progresses more rapidly.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="154"><a href="#citable__154"><strong>^</strong></a> <c_txt>Inherited factors ( genes ), including alpha1-antitrypsin deficiency , a rare condition in which your body may not be able to make a protein (alpha1-antitrypsin) that helps protect the lungs from damage.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__121" class="citable__local-anchor">.</a><span class='citationPopup' rel="121">Alpha 1-antitrypsin protects the lungs from damage caused by <a href="/Protease" title="Protease">protease</a> <a href="/Enzymes" title="Enzymes" class="mw-redirect">enzymes</a>, such as <a href="/Elastase" title="Elastase">elastase</a> and <a href="/Trypsin" title="Trypsin">trypsin</a>, that can be released as a result of an inflammatory response to tobacco smoke.</span><span class="citable__li" citable_id="121"><a href="#citable__121"><strong>^</strong></a> <c_txt>An inflammatory reaction in the lung such as is caused by COPD produces elastase .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="121"><a href="#citable__121"><strong>^</strong></a> <c_txt>It is caused by damage to the lungs over many years, usually from smoking.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="121"><a href="#citable__121"><strong>^</strong></a> <c_txt>The inflammatory response is a stereotyped cascade of events; in COPD, it begins with the activation of local macrophages in the lung tissue; in fact, the gradual and progressive accumulation of macrophages throughout the lungs is a characteristic feature of COPD. These macrophages secrete proteases—destructive enzymes such as elastase.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_20" class="reference"><a href="#cite_note-20"><span>[</span>21<span>]</span></a></sup></div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Other_risk_factors">Other risk factors</span></h3> <div style="margin: 1.12em 0; display:block"><a name="citable__84" class="citable__local-anchor">.</a><span class='citationPopup' rel="84">A tendency to sudden airway constriction in response to inhaled irritants, bronchial hyperresponsiveness, is a characteristic of asthma.</span><span class="citable__li" citable_id="84"><a href="#citable__84"><strong>^</strong></a> <c_txt>They are typically indicated for the relief of bronchospasm, which are contractions of the smooth muscle in the walls of the bronchi and bronchioles that cause the airways to constrict or narrow.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Current COPD Treatments</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.aarc.org/klein/treatments.asp">www.aarc.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="84"><a href="#citable__84"><strong>^</strong></a> <c_txt>Inhaled anticholinergics ease breathing in patients with COPD by preventing the airways from constricting.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Leading COPD drug won't harm heart: FDA - WSFA 12 News Montgomery, AL |</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.wsfa.com/Global/story.asp?S=11828051">www.wsfa.com</a> [Source type: News]</li><li> <em><c_title>Leading COPD drug may raise chances of heart trouble - WSFA 12 News Montgomery, AL |</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.wsfa.com/Global/story.asp?S=11785994">www.wsfa.com</a> [Source type: News]</li><li> <em><c_title> Leading COPD Drug May Raise Chances of Heart Trouble </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.dentalplans.com/articles/46488/leading-copd-drug-may-raise-chances-of-heart-trouble.html">www.dentalplans.com</a> [Source type: Academic]</li><li> <em><c_title>Leading COPD Drug Won't Harm Heart: FDA</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.palmbeachpost.com/health/leading-copd-drug-won-t-harm-heart-fda-179311.html">www.palmbeachpost.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="84"><a href="#citable__84"><strong>^</strong></a> <c_txt>Because of differences in lung size and mechanics, women's airways are more hyperresponsive to exogenous irritants than are men's airways.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Diagnosis of Chronic Obstructive Pulmonary Disease - July 1, 2008 - American Family Physician</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.aafp.org/afp/20080701/87.html">www.aafp.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__88" class="citable__local-anchor">.</a><span class='citationPopup' rel="88">Many people with COPD also have this tendency.</span><span class="citable__li" citable_id="88"><a href="#citable__88"><strong>^</strong></a> <c_txt>Many people with COPD have both.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.cnn.com/HEALTH/library/copd/DS00916.html">www.cnn.com</a> [Source type: General]</li><li> <em><c_title>OhioHealth</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.ohiohealth.com/blank.cfm?print=yes&id=6&action=detail&ref=3770">www.ohiohealth.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="88"><a href="#citable__88"><strong>^</strong></a> <c_txt>How many people have COPD in Canada?</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>What is COPD? : Canadian Lung Association</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.lung.ca/diseases-maladies/copd-mpoc/what-quoi/index_e.php">www.lung.ca</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="88"><a href="#citable__88"><strong>^</strong></a> <c_txt>Anyone who smokes or who smoked in the past can get COPD. People with Alpha-1 antitrypsin deficiency, exposure to second-hand smoke or pollution, or many childhood chest infections, can also get it.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>What is COPD? : Canadian Lung Association</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.lung.ca/diseases-maladies/copd-mpoc/what-quoi/index_e.php">www.lung.ca</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__289" class="citable__local-anchor">.</a><span class='citationPopup' rel="289">In COPD, the presence of bronchial hyperresponsiveness predicts a worse course of the disease.</span><span class="citable__li" citable_id="289"><a href="#citable__289"><strong>^</strong></a> <c_txt>But whatever the cause of your COPD, giving up cigarettes can help slow down how quickly the disease gets worse.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic obstructive pulmonary disease | Life and style | BMJ Group </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guardian.co.uk/lifeandstyle/besttreatments/chronic-obstructive-pulmonary-disease">www.guardian.co.uk</a> [Source type: News]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="289"><a href="#citable__289"><strong>^</strong></a> <c_txt>Not smoking prevents most COPD. In people who smoke, finding and treating small airway disease and taking part in stop-smoking programs may prevent the disease from getting worse.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Health Library</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.floridahospital.com/Home/HealthLibrary.aspx?SubUrl=/Health%20Illustrated%20Encyclopedia/1/000091.htm">www.floridahospital.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="289"><a href="#citable__289"><strong>^</strong></a> <c_txt>Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD: Management of Acute Exacerbations and Chronic Stable Disease - August 15, 2001 - American Family Physician</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.aafp.org/afp/20010815/603.html">www.aafp.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_Harrisons_16_1" class="reference"><a href="#cite_note-Harrisons-16"><span>[</span>17<span>]</span></a></sup> It is not known if bronchial hyperresponsiveness is a cause or a consequence of COPD. Other risk factors such as repeated lung <a href="/Infection" title="Infection">infection</a> and possibly a diet high in cured meats may be related to the development of COPD.</div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_COPD_as_an_autoimmune_disease">COPD as an autoimmune disease</span></h3> <div class="rellink relarticle mainarticle">Main article: <a href="/Autoimmunity" title="Autoimmunity">Autoimmunity</a></div> <div style="margin: 1.12em 0; display:block"><a name="citable__166" class="citable__local-anchor">.</a><span class='citationPopup' rel="166">There is mounting evidence that there may be an autoimmune component to COPD.<sup id="wikipedia_cite_ref_PMID14514931_21_0" class="reference"><a href="#cite_note-PMID14514931-21"><span>[</span>22<span>]</span></a></sup> Many individuals with COPD who have stopped smoking have active inflammation in the lungs.</span><span class="citable__li" citable_id="166"><a href="#citable__166"><strong>^</strong></a> <c_txt>A lung transplant may be done for some people with very severe COPD. A transplant involves removing the lung of a person with COPD and replacing it with a healthy lung from a donor.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="166"><a href="#citable__166"><strong>^</strong></a> <c_txt>Therefore smoking, acute exacerbations of COPD, and asthma are associated with a marked oxidant/antioxidant imbalance in the blood, associated with evidence of increased oxidative stress.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>EMPHYSEMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE Page 3</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.lef.org/protocols/abstracts/abstr-046b.html">www.lef.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="166"><a href="#citable__166"><strong>^</strong></a> <c_txt>Many of the newer treatments for COPD have been directed at individual components of inflammation, given its importance in pathogenesis.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genome Medicine | Full text | Chronic obstructive pulmonary disease: towards pharmacogenetics</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://genomemedicine.com/content/1/11/112">genomemedicine.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__82" class="citable__local-anchor">.</a><span class='citationPopup' rel="82"><sup id="wikipedia_cite_ref_Rutgers00_22_0" class="reference"><a href="#cite_note-Rutgers00-22"><span>[</span>23<span>]</span></a></sup> The disease may continue to get worse for many years after stopping smoking due to this ongoing inflammation.</span><span class="citable__li" citable_id="82"><a href="#citable__82"><strong>^</strong></a> <c_txt>You may think that nothing can help you quit, but today there are several treatments shown to be very good at helping people stop smoking.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="82"><a href="#citable__82"><strong>^</strong></a> <c_txt>Long-term (chronic) mucus production and inflammation over many years may lead to permanent lung damage and may make it more likely that you will get lung infections.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="82"><a href="#citable__82"><strong>^</strong></a> <c_txt>If your disease gets worse, you may want to think about palliative care .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_Rutgers00_22_1" class="reference"><a href="#cite_note-Rutgers00-22"><span>[</span>23<span>]</span></a></sup> This sustained inflammation is thought to be mediated by autoantibodies and autoreactive T cells.<sup id="wikipedia_cite_ref_23" class="reference"><a href="#cite_note-23"><span>[</span>24<span>]</span></a></sup><sup id="wikipedia_cite_ref_24" class="reference"><a href="#cite_note-24"><span>[</span>25<span>]</span></a></sup><sup id="wikipedia_cite_ref_Rutgers00_22_2" class="reference"><a href="#cite_note-Rutgers00-22"><span>[</span>23<span>]</span></a></sup></div> <h2><span class="mw-headline" id="wikipedia_Disease_process">Disease process</span></h2> <div class="thumb tright"> <div class="thumbinner" style="width:222px;"><img alt="" src="http://images-mediawiki-sites.thefullwiki.org/09/1/7/3/9881413047040020.jpg" width="220" height="186" class="thumbimage" /> <div class="thumbcaption"> <div class="magnify"><img src="http://images-mediawiki-sites.thefullwiki.org/09/7/4/4/3695493113783710.png" width="15" height="11" alt="" /></div> Enlarged view of lung tissue showing the difference between healthy lung and COPD</div> </div> </div> <div style="margin: 1.12em 0; display:block">It is not fully understood how tobacco smoke and other inhaled particles damage the lungs to cause COPD. The most important processes causing lung damage are:</div> <ul> <li><a href="/Oxidative_stress" title="Oxidative stress">Oxidative stress</a> produced by the high concentrations of <a href="/Free_radicals" title="Free radicals" class="mw-redirect">free radicals</a> in tobacco smoke.</li> <li><a href="/Cytokine" title="Cytokine">Cytokine</a> release due to <a href="/Inflammation" title="Inflammation">inflammation</a> as the body responds to irritant particles such as tobacco smoke in the airway.</li> <li>Tobacco smoke and free radicals impair the activity of antiprotease enzymes such as <a href="/Alpha_1-antitrypsin" title="Alpha 1-antitrypsin">alpha 1-antitrypsin</a>, allowing <a href="/Protease" title="Protease">protease</a> enzymes to damage the lung.</li> </ul> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Pathology">Pathology</span></h3> <h4><span class="mw-headline" id="wikipedia_Chronic_bronchitis">Chronic bronchitis</span></h4> <div class="rellink relarticle mainarticle">Main article: <a href="/Chronic_bronchitis" title="Chronic bronchitis">chronic bronchitis</a></div> <div style="margin: 1.12em 0; display:block"><a name="citable__244" class="citable__local-anchor">.</a><span class='citationPopup' rel="244">Lung damage and inflammation in the large airways results in chronic bronchitis.</span><span class="citable__li" citable_id="244"><a href="#citable__244"><strong>^</strong></a> <c_txt>Chronic bronchitis is a condition in which the airways in the lungs become inflamed.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Bronchitis (Chronic Obstructive Pulmonary Disease, COPD, Emphysema) | ThirdAge Articles</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.thirdage.com/encyclopedia/chronic-bronchitis-chronic-obstructive-pulmonary-disease-copd-emphysema">www.thirdage.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="244"><a href="#citable__244"><strong>^</strong></a> <c_txt>Chronic bronchitis is a condition that results ...</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>OhioHealth</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.ohiohealth.com/blank.cfm?print=yes&id=6&action=detail&ref=3770">www.ohiohealth.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="244"><a href="#citable__244"><strong>^</strong></a> <c_txt>Chronic bronchitis : bronchitis means 'inflammation of the bronchi'.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>British Lung Foundation | Conditions and diseases | COPD</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.lunguk.org/copd.asp">www.lunguk.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__83" class="citable__local-anchor">.</a><span class='citationPopup' rel="83">Chronic bronchitis is defined in clinical terms as a cough with <a href="/Sputum" title="Sputum">sputum</a> production on most days for 3 months of a year, for 2 consecutive years.</span><span class="citable__li" citable_id="83"><a href="#citable__83"><strong>^</strong></a> <c_txt>Chronic mucus (sputum) production when you cough.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="83"><a href="#citable__83"><strong>^</strong></a> <c_txt>Chronic bronchitis is defined as “productive cough that is present for a period of three months in each of two consecutive years in the absence of another identifiable cause of excessive sputum production.” .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/chronic-obstructive-pulmonary-disease/">www.clevelandclinicmeded.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="83"><a href="#citable__83"><strong>^</strong></a> <c_txt>Signs may include a chronic cough and sputum production.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_ohcm_25_0" class="reference"><a href="#cite_note-ohcm-25"><span>[</span>26<span>]</span></a></sup> <a name="citable__5" class="citable__local-anchor">.</a><span class='citationPopup' rel="5">In the airways of the lung, the hallmark of chronic bronchitis is an increased number (<a href="/Hyperplasia" title="Hyperplasia">hyperplasia</a>) and increased size (<a href="/Hypertrophy" title="Hypertrophy">hypertrophy</a>) of the <a href="/Goblet_cells" title="Goblet cells" class="mw-redirect">goblet cells</a> and <a href="/Mucous_glands" title="Mucous glands" class="mw-redirect">mucous glands</a> of the airway.</span><span class="citable__li" citable_id="5"><a href="#citable__5"><strong>^</strong></a> <c_txt>All chronic bronchitis is characterized by an increase in the number and size of the mucus glands in the airways of the lung.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="5"><a href="#citable__5"><strong>^</strong></a> <c_txt>The pathologic hallmark of chronic bronchitis is an increase in goblet cell size and number that leads to excessive mucus secretion.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/chronic-obstructive-pulmonary-disease/">www.clevelandclinicmeded.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="5"><a href="#citable__5"><strong>^</strong></a> <c_txt>In chronic bronchitis, the airways have become inflamed and thickened, and there is an increase in the number and size of mucus-producing cells.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__184" class="citable__local-anchor">.</a><span class='citationPopup' rel="184">As a result, there is more mucus than usual in the airways, contributing to narrowing of the airways and causing a cough with sputum.</span><span class="citable__li" citable_id="184"><a href="#citable__184"><strong>^</strong></a> <c_txt>You may cough up more mucus than usual, or mucus that is a different color than usual.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic Obstructive Pulmonary Disease | Causes, Symptoms, Treatment | PDRHealth</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.pdrhealth.com/disease/disease-mono.aspx?contentFileName=ND7192G.xml&contentName=Chronic+Obstructive+Pulmonary+Disease&contentId=375&TypeId=2">www.pdrhealth.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="184"><a href="#citable__184"><strong>^</strong></a> <c_txt>The damaged airways make a lot more mucus than normal.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD therapy vitamins herbs supplements : by Ray Sahelian, M.D., natural treatment chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.raysahelian.com/copd.html">www.raysahelian.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="184"><a href="#citable__184"><strong>^</strong></a> <c_txt>Cells in the airways make more mucus (sputum) than usual, which tends to clog the airways.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease - Medpedia</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://wiki.medpedia.com/Chronic_Obstructive_Pulmonary_Disease">wiki.medpedia.com</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li><li> <em><c_title>Understanding COPD – Chronic Obstructive Pulmonary Disease | Womens Health Base</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.womenshealthbase.com/copd/all/1/">www.womenshealthbase.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__118" class="citable__local-anchor">.</a><span class='citationPopup' rel="118"><a href="/Microscope" title="Microscope">Microscopically</a> there is <a href="/Infiltration_(medical)" title="Infiltration (medical)">infiltration</a> of the airway walls with <a href="/Inflammation" title="Inflammation">inflammatory</a> cells.</span><span class="citable__li" citable_id="118"><a href="#citable__118"><strong>^</strong></a> <c_txt>The airway walls bulge with invading inflammatory cells.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="118"><a href="#citable__118"><strong>^</strong></a> <c_txt>The secretory cells coat the inner walls of the airways with mucus.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="118"><a href="#citable__118"><strong>^</strong></a> <c_txt>In humans, airway infiltration by increasing numbers of inflammatory cells is seen as COPD progresses [ 6 ] , and airway inflammatory cytokine levels correlate with disease progression [ 29 ] .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genome Medicine | Full text | Chronic obstructive pulmonary disease: towards pharmacogenetics</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://genomemedicine.com/content/1/11/112">genomemedicine.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__127" class="citable__local-anchor">.</a><span class='citationPopup' rel="127">Inflammation is followed by scarring and remodeling that thickens the walls and also results in narrowing of the airways.</span><span class="citable__li" citable_id="127"><a href="#citable__127"><strong>^</strong></a> <c_txt>The airways become inflamed, leading to scarring and thickening of the walls (chronic obstructive bronchitis) and results in chronic narrowing of the airways.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD): Causes, Symptoms & Prevention | Gilbert Guide</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.gilbertguide.com/articles/chronic-obstructive-pulmonary-disease-copd-causes-symptoms-prevention/">www.gilbertguide.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="127"><a href="#citable__127"><strong>^</strong></a> <c_txt>Inflammation is followed by scarring and remodelling that thickens the walls resulting in narrowing of the small airway.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> COPD Clinical Trials </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.clinicalconnection.com/Clinical_Trials/Condition/copd.aspx">www.clinicalconnection.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="127"><a href="#citable__127"><strong>^</strong></a> <c_txt>The airways in the lungs can become scarred and narrowed.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic obstructive pulmonary disease (COPD) treatments</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.uptodate.com/patients/content/topic.do?topicKey=lung_dis/4567">www.uptodate.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__42" class="citable__local-anchor">.</a><span class='citationPopup' rel="42">As chronic bronchitis progresses, there is <a href="/Squamous_metaplasia" title="Squamous metaplasia">squamous metaplasia</a> (an abnormal change in the tissue lining the inside of the airway) and <a href="/Fibrosis" title="Fibrosis">fibrosis</a> (further thickening and scarring of the airway wall).</span><span class="citable__li" citable_id="42"><a href="#citable__42"><strong>^</strong></a> <c_txt>Over time, the persistent inflammation leads to destruction of lung tissue, accumulation of mucus, and thickening of small airways (Reilly et al., 2005).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="42"><a href="#citable__42"><strong>^</strong></a> <c_txt>There is no cure for COPD (which can come in two forms, emphysema and chronic bronchitis), and it is a major cause of illness and death.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="42"><a href="#citable__42"><strong>^</strong></a> <c_txt>The chronic bronchitis aspect of COPD causes other changes in the small airways, reducing their internal volume still farther: .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__159" class="citable__local-anchor">.</a><span class='citationPopup' rel="159">The consequence of these changes is a limitation of airflow.</span><span class="citable__li" citable_id="159"><a href="#citable__159"><strong>^</strong></a> <c_txt>These processes lead to the clinical hallmarks of COPD, which are airflow limitation and dyspnea or shortness of breath.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Anxiety and Chronic Obstructive Pulmonary Disease: Prevalence, Impact, and Treatment -- Brenes 65 (6): 963 -- Psychosomatic Medicine</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.psychosomaticmedicine.org/cgi/content/full/65/6/963">www.psychosomaticmedicine.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_kc_26_0" class="reference"><a href="#cite_note-kc-26"><span>[</span>27<span>]</span></a></sup></div> <div style="margin: 1.12em 0; display:block"><a name="citable__234" class="citable__local-anchor">.</a><span class='citationPopup' rel="234">Patients with advanced COPD that have primarily chronic bronchitis rather than emphysema were commonly referred to as "blue bloaters" because of the bluish color of the skin and lips (cyanosis) seen in them.</span><span class="citable__li" citable_id="234"><a href="#citable__234"><strong>^</strong></a> <c_txt>This form of COPD is called chronic bronchitis .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="234"><a href="#citable__234"><strong>^</strong></a> <c_txt>COPD includes the diagnoses of chronic obstructive bronchitis and emphysema.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic Obstructive Pulmonary Disease: Chronic Obstructive Pulmonary Disease (COPD): Merck Manual Home Edition </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.merck.com/mmhe/sec04/ch045/ch045a.html">www.merck.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="234"><a href="#citable__234"><strong>^</strong></a> <c_txt>Most patients with emphysema have components of chronic bronchitis as well.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Respiratory Diseases: Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.therubins.com/illness/respcopd.htm">www.therubins.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_27" class="reference"><a href="#cite_note-27"><span>[</span>28<span>]</span></a></sup> The <a href="/Hypoxia_(medical)" title="Hypoxia (medical)">hypoxia</a> and <a href="/Water_retention_(medicine)" title="Water retention (medicine)">fluid retention</a> leads to them being called "Blue Bloaters."</div> <h4><span class="mw-headline" id="wikipedia_Emphysema">Emphysema</span></h4> <div class="thumb tright"> <div class="thumbinner" style="width:222px;"><img alt="" src="http://images-mediawiki-sites.thefullwiki.org/06/2/4/8/01884223455432306.jpg" width="220" height="147" class="thumbimage" /> <div class="thumbcaption"> <a name="citable__89" class="citable__local-anchor">.</a><span class='citationPopup' rel="89"><div class="magnify"><img src="http://images-mediawiki-sites.thefullwiki.org/09/7/4/4/3695493113783710.png" width="15" height="11" alt="" /></div> <a href="/Gross_pathology" title="Gross pathology">Gross pathology</a> of a lung showing centrilobular-type <a href="/Emphysema" title="Emphysema">emphysema</a> characteristic of smoking.</span><span class="citable__li" citable_id="89"><a href="#citable__89"><strong>^</strong></a> <c_txt>Affected individuals show a range of pathologies, including chronic bronchitis [ 4 ] , emphysema [ 5 ] , bronchiectasis or a combination of these.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genome Medicine | Full text | Chronic obstructive pulmonary disease: towards pharmacogenetics</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://genomemedicine.com/content/1/11/112">genomemedicine.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="89"><a href="#citable__89"><strong>^</strong></a> <c_txt>This disease is caused by inflammation of the lungs from many years of breathing in cigarette smoke or other types of pollution.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="89"><a href="#citable__89"><strong>^</strong></a> <c_txt>In the emphysematous form of COPD, lung parenchyma is progressively destroyed, usually in a pattern called centrilobular emphysema .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> This close-up of the <a href="/Fixation_(histology)" title="Fixation (histology)">fixed</a>, cut lung surface shows multiple cavities lined by heavy black carbon deposits.</div> </div> </div> <div class="rellink relarticle mainarticle">Main article: <a href="/Emphysema" title="Emphysema">emphysema</a></div> <div style="margin: 1.12em 0; display:block"><a name="citable__267" class="citable__local-anchor">.</a><span class='citationPopup' rel="267">Lung damage and inflammation of the air sacs (<a href="/Alveoli" title="Alveoli" class="mw-redirect">alveoli</a>) results in emphysema.</span><span class="citable__li" citable_id="267"><a href="#citable__267"><strong>^</strong></a> <c_txt>But with emphysema, these air sacs are damaged and lose their stretch.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="267"><a href="#citable__267"><strong>^</strong></a> <c_txt>The tiny air sacs (alveoli) at the end of the bronchial tubes are damaged.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="267"><a href="#citable__267"><strong>^</strong></a> <c_txt>COPD can damage the lung's structure and allow air to leak into the chest cavity.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__242" class="citable__local-anchor">.</a><span class='citationPopup' rel="242"><a href="/Emphysema" title="Emphysema">Emphysema</a> is defined as enlargement of the air spaces <a href="/Distal" title="Distal" class="mw-redirect">distal</a> to the <a href="/Terminal_bronchioles" title="Terminal bronchioles" class="mw-redirect">terminal bronchioles</a>, with destruction of their walls.</span><span class="citable__li" citable_id="242"><a href="#citable__242"><strong>^</strong></a> <c_txt>Emphysema is specifically defined 5–8 in pathologic terms as “alveolar wall destruction with irreversible enlargement of the air spaces distal to the terminal bronchioles and without evidence of fibrosis.” .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/chronic-obstructive-pulmonary-disease/">www.clevelandclinicmeded.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="242"><a href="#citable__242"><strong>^</strong></a> <c_txt>Emphysema is defined as an abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis [R] .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=14439">www.guidelines.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=14439&nbr=7229">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="242"><a href="#citable__242"><strong>^</strong></a> <c_txt>Morphometry included measurements of tissue loss (volume density of alveolar septa) and parenchymal air space enlargement (alveolar septa mean linear intercept, volume density of alveolar air space).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Respiratory Research | Full text | Models of chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://respiratory-research.com/content/5/1/18">respiratory-research.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_ohcm_25_1" class="reference"><a href="#cite_note-ohcm-25"><span>[</span>26<span>]</span></a></sup> <a name="citable__216" class="citable__local-anchor">.</a><span class='citationPopup' rel="216">The destruction of air space walls reduces the <a href="/Surface_area" title="Surface area">surface area</a> available for the exchange of oxygen and <a href="/Carbon_dioxide" title="Carbon dioxide">carbon dioxide</a> during breathing.</span><span class="citable__li" citable_id="216"><a href="#citable__216"><strong>^</strong></a> <c_txt>Poor exchange of the oxygen and carbon dioxide causes shortness of breath.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="216"><a href="#citable__216"><strong>^</strong></a> <c_txt>These air sacs are where the blood exchanges carbon dioxide (a by-product of metabolism ) for oxygen.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="216"><a href="#citable__216"><strong>^</strong></a> <c_txt>The large air sacs have less surface area for the exchange of oxygen and carbon dioxide than healthy air sacs.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__229" class="citable__local-anchor">.</a><span class='citationPopup' rel="229">It also reduces the elasticity of the lung itself, which results in a loss of support for the airways that are embedded in the lung.</span><span class="citable__li" citable_id="229"><a href="#citable__229"><strong>^</strong></a> <c_txt>The result is that the small airways collapse during expiration, leading to an obstructive form of lung disease (air is trapped in the lungs in obstructive lung diseases).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD & Emphysema Support Group - DailyStrength</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.dailystrength.org/c/COPD-Emphysema/support-group">www.dailystrength.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="229"><a href="#citable__229"><strong>^</strong></a> <c_txt>Emphysema is caused by long-term damage and enlargement of the Alveoli of the lungs by free radicals and reduces the elasticity of the lungs.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://nsc24.com/COPD.htm">nsc24.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="229"><a href="#citable__229"><strong>^</strong></a> <c_txt>This progressive and relentless loss of lung function is caused by emphysema due to destruction of lung parenchyma and by narrowing of small airways as a result of chronic inflammation and fibrosis and loss of elastic recoil.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>PLoS Medicine: Chronic Obstructive Pulmonary Disease: A Growing but Neglected Global Epidemic</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040112">www.plosmedicine.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__198" class="citable__local-anchor">.</a><span class='citationPopup' rel="198">These airways are more likely to collapse causing further limitation to airflow.</span><span class="citable__li" citable_id="198"><a href="#citable__198"><strong>^</strong></a> <c_txt>The airways collapse and obstruct the normal airflow.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease COPD </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://chronicobstructivepulmonarydisease.org/">chronicobstructivepulmonarydisease.org</a> [Source type: General]</li><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li><li> <em><c_title>Understanding COPD – Chronic Obstructive Pulmonary Disease | Womens Health Base</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.womenshealthbase.com/copd/all/1/">www.womenshealthbase.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="198"><a href="#citable__198"><strong>^</strong></a> <c_txt>The consequence of these changes is a limitation of airflow.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> COPD Clinical Trials </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.clinicalconnection.com/Clinical_Trials/Condition/copd.aspx">www.clinicalconnection.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="198"><a href="#citable__198"><strong>^</strong></a> <c_txt>Exacerbations are caused by those insults that increase airway inflammation, principally episodes of bronchial infection, but also pollutants or stimuli that directly affect expiratory flow limitation [ 3 ].</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>BioMed Central | Full text | Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.biomedcentral.com/1741-7015/7/40">www.biomedcentral.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> The effort made by patients suffering from emphysema during exhalation, causes a pink color in their faces, hence the term commonly used to refer to them, "pink puffers".</div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Pathophysiology">Pathophysiology</span></h3> <div style="margin: 1.12em 0; display:block"><a name="citable__232" class="citable__local-anchor">.</a><span class='citationPopup' rel="232">Narrowing of the airways reduces the rate at which air can flow to and from the air sacs (<a href="/Alveoli" title="Alveoli" class="mw-redirect">alveoli</a>) and limits the effectiveness of the lungs.</span><span class="citable__li" citable_id="232"><a href="#citable__232"><strong>^</strong></a> <c_txt>In COPD, much of the elastic quality of the airways and air sacs in the lung is gone.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="232"><a href="#citable__232"><strong>^</strong></a> <c_txt>The Lung Health Study: Airway responsiveness to inhaled methacholine in smokers with mild to moderate airflow limitation.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="232"><a href="#citable__232"><strong>^</strong></a> <c_txt>The airways in the lungs become narrowed, and in some people, the airways become clogged with mucus.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__202" class="citable__local-anchor">.</a><span class='citationPopup' rel="202">In COPD, the greatest reduction in air flow occurs when breathing out (during expiration) because the pressure in the chest tends to compress rather than expand the airways.</span><span class="citable__li" citable_id="202"><a href="#citable__202"><strong>^</strong></a> <c_txt>If you have COPD, you can feel out of breath because: .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic obstructive pulmonary disease - More about symptoms</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.consumerreports.org/health/conditions-and-treatments/chronic-obstructive-pulmonary-disease/what-are-the-symptoms/more-about-symptoms.htm">www.consumerreports.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="202"><a href="#citable__202"><strong>^</strong></a> <c_txt>The result is that the small airways collapse during expiration, leading to an obstructive form of lung disease (air is trapped in the lungs in obstructive lung diseases).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD & Emphysema Support Group - DailyStrength</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.dailystrength.org/c/COPD-Emphysema/support-group">www.dailystrength.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="202"><a href="#citable__202"><strong>^</strong></a> <c_txt>Cough that doesn't go away and coughing up lots of mucus are common signs of COPD. These often occur years before air flow through the lungs are reduced.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>What Is Chronic Obstructive Pulmonary Disease (COPD)?</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://hubpages.com/hub/What-Is-Chronic-Obstructive-Pulmonary-Disease-COPD">hubpages.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__274" class="citable__local-anchor">.</a><span class='citationPopup' rel="274">In theory, air flow could be increased by breathing more forcefully, increasing the pressure in the chest during expiration.</span><span class="citable__li" citable_id="274"><a href="#citable__274"><strong>^</strong></a> <c_txt>The signs of COPD are: Shortness of breath during physical activities Increased mucus production and Frequent cough .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease: Are you at risk?</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.mdhealthnetwork.org/mc-chronic-obstructive-pulmonary-disease.html">www.mdhealthnetwork.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="274"><a href="#citable__274"><strong>^</strong></a> <c_txt>You breathe forcefully into a tube, and the machine at the other end measures how much air you are moving.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="274"><a href="#citable__274"><strong>^</strong></a> <c_txt>These are usually characterized by an increase in shortness of breath, cough, and/or sputum production that lasts for more than 2 days and that warrants a change in medication.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) - a knol by Stephen C. Lazarus</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://knol.google.com/k/chronic-obstructive-pulmonary-disease-copd">knol.google.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__186" class="citable__local-anchor">.</a><span class='citationPopup' rel="186">In COPD, there is often a limit to how much this can actually increase air flow, a situation known as expiratory flow limitation.</span><span class="citable__li" citable_id="186"><a href="#citable__186"><strong>^</strong></a> <c_txt>Increased work of breathing from increased airways resistance/expiratory flow limitation .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="186"><a href="#citable__186"><strong>^</strong></a> <c_txt>Increased airways resistance and expiratory flow limitation increase the work of breathing.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="186"><a href="#citable__186"><strong>^</strong></a> <c_txt>A cough that doesn't go away and coughing up lots of mucus are common symptoms of COPD. These often occur years before the flow of air in and out of the lungs is reduced.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD Symptoms - COPD Treatment</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.iifar.org/COPD_Symptoms.html">www.iifar.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_calverley_28_0" class="reference"><a href="#cite_note-calverley-28"><span>[</span>29<span>]</span></a></sup></div> <div style="margin: 1.12em 0; display:block"><a name="citable__37" class="citable__local-anchor">.</a><span class='citationPopup' rel="37">If the rate of airflow is too low, a person with COPD may not be able to completely finish breathing out (expiration) before he or she needs to take another breath.</span><span class="citable__li" citable_id="37"><a href="#citable__37"><strong>^</strong></a> <c_txt>Every breath you take What is COPD ?</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Copd Rehabilitation - a comprehensive view - Wellsphere</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.wellsphere.com/wellpage/copd-rehabilitation">www.wellsphere.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="37"><a href="#citable__37"><strong>^</strong></a> <c_txt>Opening the airways Relaxing the breathing passages Decreasing inflammation Helping thin secretions and bring up mucus from the lungs Treating lung infections (antibiotics) If you have chronic bronchitis and mild-to-moderate COPD, you may not need antibiotics.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease – UPMC, Pittsburgh, PA, USA</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.upmc.com/healthAtoZ/Pages/HealthLibrary.aspx?chunkiid=11931">www.upmc.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="37"><a href="#citable__37"><strong>^</strong></a> <c_txt>Please note that some of these translations were made for past World COPD Days and you may need to update these documents before using them in your upcoming World COPD Day event.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> World COPD Day </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.goldcopd.org/Translations.asp?l1=3&l2=6">www.goldcopd.org</a> [Source type: Reference]</li></ul></c_src></small></div><br></span> <a name="citable__105" class="citable__local-anchor">.</a><span class='citationPopup' rel="105">This is particularly common during exercise when breathing has to be faster.</span><span class="citable__li" citable_id="105"><a href="#citable__105"><strong>^</strong></a> <c_txt>Breathlessness during mild exercise is the most common reason that people with COPD first seek out a doctor.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="105"><a href="#citable__105"><strong>^</strong></a> <c_txt>Bending forward while breathing may reduce shortness of breath in those with severe COPD, both at rest and during exercise.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>WellSpan Health Library</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.wellspan.org/default.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw257776">www.wellspan.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="105"><a href="#citable__105"><strong>^</strong></a> <c_txt>Celli BR, Rassulo J, Make BJ. Dyssynchronous breathing during arm but not leg exercise in patients with chronic airflow obstruction.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__45" class="citable__local-anchor">.</a><span class='citationPopup' rel="45">A little of the air of the previous breath remains within the lungs when the next breath is started.</span><span class="citable__li" citable_id="45"><a href="#citable__45"><strong>^</strong></a> <c_txt>Because the lung is so full, even at the end of an exhalation, there is very little space for inhalation – and this is perceived as shortness of breath.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) - a knol by Stephen C. Lazarus</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://knol.google.com/k/chronic-obstructive-pulmonary-disease-copd">knol.google.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="45"><a href="#citable__45"><strong>^</strong></a> <c_txt>People with normal lungs can expel most of the air in their lungs within 1 to 2 seconds.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="45"><a href="#citable__45"><strong>^</strong></a> <c_txt>When you breathe out, it measures how much air your lungs can hold and how fast you can blow the air out of your lungs.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>What Is Chronic Obstructive Pulmonary Disease (COPD)?</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://hubpages.com/hub/What-Is-Chronic-Obstructive-Pulmonary-Disease-COPD">hubpages.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__236" class="citable__local-anchor">.</a><span class='citationPopup' rel="236">When this happens, there is an increase in the volume of air in the lungs, a process called dynamic hyperinflation.</span><span class="citable__li" citable_id="236"><a href="#citable__236"><strong>^</strong></a> <c_txt>Lung volume (increased in COPD) .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>U.S. Department of Veterans Affairs</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.hiv.va.gov/vahiv?page=pcm-204_copd&pf=vahiv-pcm-pf&pp=pf">www.hiv.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="236"><a href="#citable__236"><strong>^</strong></a> <c_txt>"Hyperinflation" of the lungs and Dynamic Hyperinflation .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Yoga-Based Program for Emphysema/COPD</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.mindpub.com/art560.htm">www.mindpub.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="236"><a href="#citable__236"><strong>^</strong></a> <c_txt>Impaired lung emptying/dynamic hyperinflation .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_calverley_28_1" class="reference"><a href="#cite_note-calverley-28"><span>[</span>29<span>]</span></a></sup></div> <div style="margin: 1.12em 0; display:block"><a name="citable__284" class="citable__local-anchor">.</a><span class='citationPopup' rel="284">Dynamic hyperinflation is closely linked to shortness of breath (<a href="/Dyspnea" title="Dyspnea" class="mw-redirect">dyspnea</a>) in COPD.<sup id="wikipedia_cite_ref_o_27donnell_29_0" class="reference"><a href="#cite_note-o.27donnell-29"><span>[</span>30<span>]</span></a></sup> It is less comfortable to breathe with hyperinflation because it takes more effort to move the lungs and <a href="/Chest_wall" title="Chest wall" class="mw-redirect">chest wall</a> when they are already stretched by hyperinflation.</span><span class="citable__li" citable_id="284"><a href="#citable__284"><strong>^</strong></a> <c_txt>Shortness of breath gets worse as COPD gets worse.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="284"><a href="#citable__284"><strong>^</strong></a> <c_txt>In COPD, difficulty in breathing is worsened by excessively expanded (hyperinflated) lungs.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="284"><a href="#citable__284"><strong>^</strong></a> <c_txt>More shortness of breath than usual.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__276" class="citable__local-anchor">.</a><span class='citationPopup' rel="276">Another factor contributing to shortness of breath in COPD is the loss of the <a href="/Surface_area" title="Surface area">surface area</a> available for the exchange of oxygen and <a href="/Carbon_dioxide" title="Carbon dioxide">carbon dioxide</a> with emphysema.</span><span class="citable__li" citable_id="276"><a href="#citable__276"><strong>^</strong></a> <c_txt>Shortness of breath gets worse as COPD gets worse.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="276"><a href="#citable__276"><strong>^</strong></a> <c_txt>A review of studies has found that the inactivated flu shot may reduce the risk of a sudden increase in shortness of breath ( COPD exacerbation) .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="276"><a href="#citable__276"><strong>^</strong></a> <c_txt>Arterial blood gases test measures the amount of oxygen, carbon dioxide, and acid in the blood.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__76" class="citable__local-anchor">.</a><span class='citationPopup' rel="76">This reduces the rate of transfer of these gasses between the body and the atmosphere and can lead to low oxygen and high carbon dioxide levels in the body.</span><span class="citable__li" citable_id="76"><a href="#citable__76"><strong>^</strong></a> <c_txt>In the later stages, carbon dioxide levels increase and oxygen levels fall.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic Obstructive Pulmonary Disease: Chronic Obstructive Pulmonary Disease (COPD): Merck Manual Home Edition </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.merck.com/mmhe/sec04/ch045/ch045a.html">www.merck.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="76"><a href="#citable__76"><strong>^</strong></a> <c_txt>These abnormalities impair the exchange of oxygen and carbon dioxide between the alveoli and the blood.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic Obstructive Pulmonary Disease: Chronic Obstructive Pulmonary Disease (COPD): Merck Manual Home Edition </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.merck.com/mmhe/sec04/ch045/ch045a.html">www.merck.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="76"><a href="#citable__76"><strong>^</strong></a> <c_txt>Home oxygen therapy can improve survival in patients with advanced COPD who have hypoxemia - low blood oxygen levels.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease - Symptoms, Treatment and Prevention</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthscout.com/ency/68/540/main.html">www.healthscout.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__77" class="citable__local-anchor">.</a><span class='citationPopup' rel="77">A person with emphysema may have to breathe faster or more deeply to compensate, which can be difficult to do if there is also flow limitation or hyperinflation.</span><span class="citable__li" citable_id="77"><a href="#citable__77"><strong>^</strong></a> <c_txt>This may make breathing more difficult.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>WellSpan Health Library</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.wellspan.org/default.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=ug2668">www.wellspan.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="77"><a href="#citable__77"><strong>^</strong></a> <c_txt>Breathe more deeply.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>British Lung Foundation | Living with a lung condition | COPD: Living with chronic obstructive pulmonary disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.lunguk.org/you-and-your-lungs/living-with-a-lung-condition/copd-living-with-chronic-obstructive-pulmonary-disease-copd.htm">www.lunguk.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="77"><a href="#citable__77"><strong>^</strong></a> <c_txt>COPD is a lung disease that makes it difficult to breathe and, over time, interferes with a person’s ability to perform daily physical activities.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD Forums | COPD Treatment Options, News, and Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.copdforums.com/">www.copdforums.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__199" class="citable__local-anchor">.</a><span class='citationPopup' rel="199">Some people with advanced COPD do manage to breathe fast to compensate, but usually have <a href="/Dyspnea" title="Dyspnea" class="mw-redirect">dyspnea</a> as a result.</span><span class="citable__li" citable_id="199"><a href="#citable__199"><strong>^</strong></a> <c_txt>Some people with COPD may have asthma too.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="199"><a href="#citable__199"><strong>^</strong></a> <c_txt>Mild COPD is usually treated with short-acting bronchodilators, which are used as needed for dyspnea.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="199"><a href="#citable__199"><strong>^</strong></a> <c_txt>It stops people from exercising, and it is the major symptom that severely limits the activities of people with COPD. The inability to exercise without developing shortness of breath gets worse as COPD progresses.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__25" class="citable__local-anchor">.</a><span class='citationPopup' rel="25">Others, who may be less short of breath, tolerate low oxygen and high carbon dioxide levels in their bodies but this can eventually lead to headaches, drowsiness and heart failure.</span><span class="citable__li" citable_id="25"><a href="#citable__25"><strong>^</strong></a> <c_txt>In COPD, blood tests may show low levels of oxygen, or the effects on the body's metabolism of not breathing off enough carbon dioxide.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD - Health & Wellbeing</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.abc.net.au/health/library/stories/2008/08/12/2317968.htm">www.abc.net.au</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="25"><a href="#citable__25"><strong>^</strong></a> <c_txt>Eating less because of shortness of breath.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>WellSpan Health Library</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.wellspan.org/default.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=ug2668">www.wellspan.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="25"><a href="#citable__25"><strong>^</strong></a> <c_txt>It may ease shortness of breath.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__313" class="citable__local-anchor">.</a><span class='citationPopup' rel="313">Advanced COPD can lead to complications beyond the lungs such as weight loss (<a href="/Cachexia" title="Cachexia">cachexia</a>), <a href="/Pulmonary_hypertension" title="Pulmonary hypertension">pulmonary hypertension</a> and right-sided heart failure (<a href="/Cor_pulmonale" title="Cor pulmonale">cor pulmonale</a>).</span><span class="citable__li" citable_id="313"><a href="#citable__313"><strong>^</strong></a> <c_txt>Pulmonary hypertension can cause right-sided heart failure (cor pulmonale), and this will lead to jugular venous distension and edema of the legs and ankles.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="313"><a href="#citable__313"><strong>^</strong></a> <c_txt>Worse still, in COPD the heart often has to contend with pulmonary hypertension .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="313"><a href="#citable__313"><strong>^</strong></a> <c_txt>Second, COPD can cause pulmonary hypertension, which strains the right ventricle of the heart.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a href="/Osteoporosis" title="Osteoporosis">Osteoporosis</a>, <a href="/Heart_disease" title="Heart disease">heart disease</a>, <a href="/Muscle_wasting" title="Muscle wasting" class="mw-redirect">muscle wasting</a> and <a href="/Major_depressive_disorder" title="Major depressive disorder">depression</a> are all more common in people with COPD.<sup id="wikipedia_cite_ref_pmid17507545_1_2" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup></div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Acute_exacerbations_of_COPD">Acute exacerbations of COPD</span></h3> <div class="rellink relarticle mainarticle">Main article: <a href="/Acute_exacerbation_of_chronic_obstructive_pulmonary_disease" title="Acute exacerbation of chronic obstructive pulmonary disease">Acute exacerbation of chronic obstructive pulmonary disease</a></div> <div style="margin: 1.12em 0; display:block"><a name="citable__149" class="citable__local-anchor">.</a><span class='citationPopup' rel="149">An acute exacerbation of COPD is a sudden worsening of COPD symptoms (shortness of breath, quantity and color of phlegm) that typically lasts for several days.</span><span class="citable__li" citable_id="149"><a href="#citable__149"><strong>^</strong></a> <c_txt>Shortness of breath gets worse as COPD gets worse.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="149"><a href="#citable__149"><strong>^</strong></a> <c_txt>Signs and symptoms of an acute exacerbation of COPD may include any of the following: .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=14439">www.guidelines.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=14439&nbr=7229">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="149"><a href="#citable__149"><strong>^</strong></a> <c_txt>The weather can also bring a worsening of COPD symptoms.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD Forums | COPD Treatment Options, News, and Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.copdforums.com/">www.copdforums.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__80" class="citable__local-anchor">.</a><span class='citationPopup' rel="80">It may be triggered by an infection with bacteria or viruses or by environmental pollutants.</span><span class="citable__li" citable_id="80"><a href="#citable__80"><strong>^</strong></a> <c_txt>Infections may be caused by viruses or bacteria.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="80"><a href="#citable__80"><strong>^</strong></a> <c_txt>Your medications will also vary with different triggers such as viral infections, allergens, pollution, cold air, and exercise.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> COPD Medication Guidelines</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://my.clevelandclinic.org/disorders/Chronic_Obstructive_Pulmonary_Disease/hic_COPD_Medication_Guidelines.aspx">my.clevelandclinic.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="80"><a href="#citable__80"><strong>^</strong></a> <c_txt>Residents may also have a history of smoking, multiple infections, and environmental exposure to dusts, pollutants, chemicals, and occupational agents.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>AMDA: Publications - Caring for the Ages - October 2003</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.amda.com/publications/caring/october2003/copd.cfm">www.amda.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__324" class="citable__local-anchor">.</a><span class='citationPopup' rel="324">Typically, infections cause 75% or more of the exacerbations; bacteria can roughly be found in 25% of cases, viruses in another 25%, and both viruses and bacteria in another 25%.</span><span class="citable__li" citable_id="324"><a href="#citable__324"><strong>^</strong></a> <c_txt>The remaining 25 to 30 percent of cases are usually caused by viruses.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD: Management of Acute Exacerbations and Chronic Stable Disease - August 15, 2001 - American Family Physician</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.aafp.org/afp/20010815/603.html">www.aafp.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="324"><a href="#citable__324"><strong>^</strong></a> <c_txt>Infections may be caused by viruses or bacteria.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="324"><a href="#citable__324"><strong>^</strong></a> <c_txt>Exacerbations are caused by those insults that increase airway inflammation, principally episodes of bronchial infection, but also pollutants or stimuli that directly affect expiratory flow limitation [ 3 ].</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>BioMed Central | Full text | Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.biomedcentral.com/1741-7015/7/40">www.biomedcentral.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a href="/Pulmonary_Embolism" title="Pulmonary Embolism" class="mw-redirect">Pulmonary Embolism</a> can also cause exacerbations of COPD. <a name="citable__144" class="citable__local-anchor">.</a><span class='citationPopup' rel="144">Airway inflammation is increased during the exacerbation resulting in increased hyperinflation, reduced expiratory air flow and worsening of gas transfer.</span><span class="citable__li" citable_id="144"><a href="#citable__144"><strong>^</strong></a> <c_txt>Increased work of breathing from increased airways resistance/expiratory flow limitation .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="144"><a href="#citable__144"><strong>^</strong></a> <c_txt>Reduced small airway inflammation .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="144"><a href="#citable__144"><strong>^</strong></a> <c_txt>Increased airways resistance and expiratory flow limitation increase the work of breathing.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> This can also lead to hypo ventilation and eventually hypoxia, thus can lead to insufficient tissue perfusion then cell necrosis. <sup id="wikipedia_cite_ref_pmid17507545_1_3" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup></div> <h2><span class="mw-headline" id="wikipedia_Diagnosis">Diagnosis</span></h2> <div style="margin: 1.12em 0; display:block"><a name="citable__240" class="citable__local-anchor">.</a><span class='citationPopup' rel="240">The diagnosis of COPD should be considered in anyone who has <a href="/Dyspnea" title="Dyspnea" class="mw-redirect">dyspnea</a>, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease such as regular tobacco smoking.</span><span class="citable__li" citable_id="240"><a href="#citable__240"><strong>^</strong></a> <c_txt>Chronic cough (duration greater than three months) with or without sputum production Dyspnea with or without wheezing COPD should also be considered if the patient has one or more of the following risk factors: .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=14439">www.guidelines.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=14439&nbr=7229">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="240"><a href="#citable__240"><strong>^</strong></a> <c_txt>Diagnosis and management of chronic obstructive pulmonary disease (COPD).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=14439">www.guidelines.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=14439&nbr=7229">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="240"><a href="#citable__240"><strong>^</strong></a> <c_txt>Chronic mucus (sputum) production when you cough.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid17507545_1_4" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup><sup id="wikipedia_cite_ref_pmid7956395_30_0" class="reference"><a href="#cite_note-pmid7956395-30"><span>[</span>31<span>]</span></a></sup> <a name="citable__69" class="citable__local-anchor">.</a><span class='citationPopup' rel="69">No single symptom or sign can adequately confirm or exclude the diagnosis of COPD<sup id="wikipedia_cite_ref_pmid7815660_31_0" class="reference"><a href="#cite_note-pmid7815660-31"><span>[</span>32<span>]</span></a></sup> although COPD is uncommon under the age of 40 years.</span><span class="citable__li" citable_id="69"><a href="#citable__69"><strong>^</strong></a> <c_txt>Children under age 5 years .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="69"><a href="#citable__69"><strong>^</strong></a> <c_txt>Signs/symptoms for which COPD may be suspected: .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=14439">www.guidelines.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=14439&nbr=7229">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="69"><a href="#citable__69"><strong>^</strong></a> <c_txt>Weight loss Effort intolerance Waking at night Ankle swelling Fatigue Occupational hazards Chest pain Haemoptysis Note: These last two symptoms are uncommon in COPD and raise the possibility of an alternative diagnosis.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=5061&nbr=003545&string=Chronic+AND+obstructive+AND+pulmonary+AND+disease">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> </div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Spirometry">Spirometry</span></h3> <div style="margin: 1.12em 0; display:block"><a name="citable__41" class="citable__local-anchor">.</a><span class='citationPopup' rel="41">The diagnosis of COPD is confirmed by <a href="/Spirometry" title="Spirometry">spirometry</a>,<sup id="wikipedia_cite_ref_pmid17507545_1_5" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup> a test that measures breathing.</span><span class="citable__li" citable_id="41"><a href="#citable__41"><strong>^</strong></a> <c_txt>Spirometry is necessary for the diagnosis of COPD [R] .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=14439">www.guidelines.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=14439&nbr=7229">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="41"><a href="#citable__41"><strong>^</strong></a> <c_txt>Spirometry is necessary for COPD diagnosis.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=14439">www.guidelines.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=14439&nbr=7229">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="41"><a href="#citable__41"><strong>^</strong></a> <c_txt>Measurements included exhaled carbon monoxide, spirometry, genetic testing, and carotid and femoral ultrasonography.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force — Ann Intern Med </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.annals.org/lookup/pmid?view=long&pmid=18316746">www.annals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__220" class="citable__local-anchor">.</a><span class='citationPopup' rel="220">Spirometry measures the forced expiratory volume in one second (FEV<sub>1</sub>) which is the greatest volume of air that can be breathed out in the first second of a large breath.</span><span class="citable__li" citable_id="220"><a href="#citable__220"><strong>^</strong></a> <c_txt>The natural history of forced expiratory volumes.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Developing COPD: a 25 year follow up study of the general population -- Løkke et al. 61 (11): 935 -- Thorax </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://thorax.bmj.com/content/61/11/935.full">thorax.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="220"><a href="#citable__220"><strong>^</strong></a> <c_txt>(FEV 1 = forced expiratory volume in one second.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease: Diagnostic Considerations - February 15, 2006 - American Family Physician</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.aafp.org/afp/20060215/669.html">www.aafp.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="220"><a href="#citable__220"><strong>^</strong></a> <c_txt>The “horse-racing effect” and predicting decline in forced expiratory volume in one second from screening spirometry.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Developing COPD: a 25 year follow up study of the general population -- Løkke et al. 61 (11): 935 -- Thorax </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://thorax.bmj.com/content/61/11/935.full">thorax.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__53" class="citable__local-anchor">.</a><span class='citationPopup' rel="53">Spirometry also measures the forced vital capacity (FVC) which is the greatest volume of air that can be breathed out in a whole large breath.</span><span class="citable__li" citable_id="53"><a href="#citable__53"><strong>^</strong></a> <c_txt>Not all of the air in the lungs is removed when measuring the vital capacity.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>What Is Chronic Obstructive Pulmonary Disease– Support Plus Medical</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.supportplusmedical.com/copd.php">www.supportplusmedical.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="53"><a href="#citable__53"><strong>^</strong></a> <c_txt>The volume of exhaled air is the vital capacity.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="53"><a href="#citable__53"><strong>^</strong></a> <c_txt>Spirometry can measure how much air you can breathe out in one second (forced expiratory volume, or FEV1) and the amount of air you can breathe out after taking a deep breath (forced vital capacity, or FVC).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> Normally at least 70% of the FVC comes out in the first second (i.e. the FEV<sub>1</sub>/FVC ratio is >70%). In COPD, this ratio is less than normal, (i.e. FEV<sub>1</sub>/FVC ratio is <70%) even after a <a href="/Bronchodilator" title="Bronchodilator">bronchodilator</a> medication has been given.</div> <div style="margin: 1.12em 0; display:block">Spirometry can help to determine the severity of COPD.<sup id="wikipedia_cite_ref_pmid17507545_1_6" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup> The FEV<sub>1</sub> (measured post-bronchodilator) is expressed as a percent of a predicted "normal" value based on a person's age, gender, height and weight:</div> <table class="wikitable" style="text-align:center;width:100%;"> <tr> <th>Severity of COPD</th> <th>FEV<sub>1</sub> % predicted</th> </tr> <tr> <td>Mild</td> <td>≥80</td> </tr> <tr> <td>Moderate</td> <td>50–79</td> </tr> <tr> <td>Severe</td> <td>30–49</td> </tr> <tr> <td>Very severe</td> <td><30 or Chronic respiratory failure symptoms</td> </tr> </table> <div style="margin: 1.12em 0; display:block"><a name="citable__279" class="citable__local-anchor">.</a><span class='citationPopup' rel="279">The severity of COPD also depends on the severity of dyspnea and exercise limitation.</span><span class="citable__li" citable_id="279"><a href="#citable__279"><strong>^</strong></a> <c_txt>People with COPD may have heart problems, such as coronary artery disease (CAD) or high blood pressure , that may limit exercise options.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.jhsmiami.org/body.cfm?xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw257776">www.jhsmiami.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="279"><a href="#citable__279"><strong>^</strong></a> <c_txt>Exercise lasted until the patient felt limited by dyspnea, which occurred after ~10 min.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Exercise causes blood glutathione oxidation in chronic obstructive pulmonary disease: prevention by O2 therapy -- Viña et al. 81 (5): 2199 -- Journal of Applied Physiology</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://jap.physiology.org/cgi/content/full/81/5/2199">jap.physiology.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="279"><a href="#citable__279"><strong>^</strong></a> <c_txt>Another limitation is that severity of underlying COPD could not be studied as potential source of heterogeneity.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Respiratory Research | Full text | Exacerbations of chronic obstructive pulmonary disease: When are antibiotics indicated? A systematic review</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://respiratory-research.com/content/8/1/30">respiratory-research.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__92" class="citable__local-anchor">.</a><span class='citationPopup' rel="92">These and other factors can be combined with spirometry results to obtain a COPD severity score that takes multiple dimensions of the disease into account.</span><span class="citable__li" citable_id="92"><a href="#citable__92"><strong>^</strong></a> <c_txt>Taking into account the expected aging of the U.S. population over the next 10 to 30 years as well as the improved management of other smoking-related diseases, any decline in the proportion of persons with COPD is unlikely without substantial changes in risk factors, mainly reductions in cigarette smoking.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="92"><a href="#citable__92"><strong>^</strong></a> <c_txt>Although the results of several of these studies show an aggregation of COPD in families, there is no clear Mendelian pattern of inheritance.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genetic Risk Factors for Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://tobaccodocuments.org/pm/2063633573-3584.html">tobaccodocuments.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="92"><a href="#citable__92"><strong>^</strong></a> <c_txt>Second, although prior studies have shown systemic inflammation in severe COPD, 23–26 none of these studies have established a link between systemic inflammation in COPD and cardiac injury.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Why Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Diseases?: The Potential Role of Systemic Inflammation in Chronic Obstructive Pulmonary Disease -- Sin and Man 107 (11): 1514 -- Circulation</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://circ.ahajournals.org/cgi/content/full/107/11/1514">circ.ahajournals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_32" class="reference"><a href="#cite_note-32"><span>[</span>33<span>]</span></a></sup></div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Other_tests">Other tests</span></h3> <div style="margin: 1.12em 0; display:block"><a name="citable__241" class="citable__local-anchor">.</a><span class='citationPopup' rel="241">An x-ray of the chest may show an over-expanded lung (hyperinflation) and can be useful to help exclude other lung diseases.</span><span class="citable__li" citable_id="241"><a href="#citable__241"><strong>^</strong></a> <c_txt>A chest x ray is a picture of the lungs.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease - Medpedia</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://wiki.medpedia.com/Chronic_Obstructive_Pulmonary_Disease">wiki.medpedia.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="241"><a href="#citable__241"><strong>^</strong></a> <c_txt>A chest X ray will probably be ordered which will likely reveal over-expanded (hyperinflated) areas in the lungs.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic obstructive pulmonary disease - Mother Earth's Storehouse Kingston</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.motherearthstorehouse.com/common/adam/DisplayMonograph.asp?storeID=94C44AD9U7S92L960G03N0ET9M7HBGC0&DocID=33_000036">www.motherearthstorehouse.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="241"><a href="#citable__241"><strong>^</strong></a> <c_txt>A chest x-ray is a picture of your lungs.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://catalog.nucleusinc.com/displaymonograph.php?MID=29">catalog.nucleusinc.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__143" class="citable__local-anchor">.</a><span class='citationPopup' rel="143">Complete pulmonary function tests with measurements of lung volumes and gas transfer may also show hyperinflation and can discriminate between COPD with emphysema and COPD without emphysema.</span><span class="citable__li" citable_id="143"><a href="#citable__143"><strong>^</strong></a> <c_txt>Your doctor may order tests to determine your lung function.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic obstructive pulmonary disease - Alternative Medicine Report</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.qualityhealth.com/health-encyclopedia/alternative-medicine/chronic-obstructive-pulmonary-disease">www.qualityhealth.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="143"><a href="#citable__143"><strong>^</strong></a> <c_txt>Beyond office spirometry, complete pulmonary function testing may show increased total lung capacity, functional residual capacity, and residual volume.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease: Diagnostic Considerations - February 15, 2006 - American Family Physician</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.aafp.org/afp/20060215/669.html">www.aafp.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="143"><a href="#citable__143"><strong>^</strong></a> <c_txt>Lung function tests .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__170" class="citable__local-anchor">.</a><span class='citationPopup' rel="170">A high-resolution <a href="/Computed_tomography" title="Computed tomography" class="mw-redirect">computed tomography</a> scan of the chest may show the distribution of emphysema throughout the lungs and can also be useful to exclude other lung diseases.</span><span class="citable__li" citable_id="170"><a href="#citable__170"><strong>^</strong></a> <c_txt>It may be used to get a detailed look at lung damage caused by emphysema.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="170"><a href="#citable__170"><strong>^</strong></a> <c_txt>Emphysema can be further subdivided according to its appearance and distribution on high resolution computed tomography (CT) scan.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genome Medicine | Full text | Chronic obstructive pulmonary disease: towards pharmacogenetics</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://genomemedicine.com/content/1/11/112">genomemedicine.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="170"><a href="#citable__170"><strong>^</strong></a> <c_txt>Computed tomography (CT) scan of the thorax .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=5061&nbr=003545&string=Chronic+AND+obstructive+AND+pulmonary+AND+disease">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__148" class="citable__local-anchor">.</a><span class='citationPopup' rel="148">A blood sample taken from an <a href="/Artery" title="Artery">artery</a> can be tested for blood gas levels which may show low oxygen levels (hypoxemia) and/or high carbon dioxide levels (respiratory acidosis).</span><span class="citable__li" citable_id="148"><a href="#citable__148"><strong>^</strong></a> <c_txt>Arterial blood gases test measures the amount of oxygen, carbon dioxide, and acid in the blood.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="148"><a href="#citable__148"><strong>^</strong></a> <c_txt>Confusion (because of too little oxygen and too much carbon dioxide in the blood).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="148"><a href="#citable__148"><strong>^</strong></a> <c_txt>This test measures how much oxygen, carbon dioxide, and acid is in your blood.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__207" class="citable__local-anchor">.</a><span class='citationPopup' rel="207">A blood sample taken from a <a href="/Vein" title="Vein">vein</a> may show a high blood count (reactive polycythemia), a reaction to long-term hypoxemia.</span><span class="citable__li" citable_id="207"><a href="#citable__207"><strong>^</strong></a> <c_txt>Long-term (chronic) mucus production and inflammation over many years may lead to permanent lung damage and may make it more likely that you will get lung infections.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="207"><a href="#citable__207"><strong>^</strong></a> <c_txt>Galizia, A., and Kinney, P.L. Long-term residence in areas of high ozone: Associations with respiratory health in a nationwide sample of nonsmoking young adults.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="207"><a href="#citable__207"><strong>^</strong></a> <c_txt>Spirometry may be done at the checkup, and the results of this test may show that you need an arterial blood gas test.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> </div> <h2><span class="mw-headline" id="wikipedia_Management">Management</span></h2> <div style="margin: 1.12em 0; display:block"><a name="citable__323" class="citable__local-anchor">.</a><span class='citationPopup' rel="323">There is currently no cure for COPD; however, COPD is both a preventable and treatable disease.</span><span class="citable__li" citable_id="323"><a href="#citable__323"><strong>^</strong></a> <c_txt>However, COPD cannot be cured.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD Symptoms - COPD Treatment</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.iifar.org/COPD_Symptoms.html">www.iifar.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="323"><a href="#citable__323"><strong>^</strong></a> <c_txt>Although the results of several of these studies show an aggregation of COPD in families, there is no clear Mendelian pattern of inheritance.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genetic Risk Factors for Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://tobaccodocuments.org/pm/2063633573-3584.html">tobaccodocuments.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="323"><a href="#citable__323"><strong>^</strong></a> <c_txt>Asthma is another common lung disease that causes obstruction of the pulmonary airways; however, episodes of asthma are reversible, while COPD is not.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__245" class="citable__local-anchor">.</a><span class='citationPopup' rel="245"><a href="/Clinical_practice_guideline" title="Clinical practice guideline" class="mw-redirect">Clinical practice guidelines</a> for the management of COPD are available from the Global Initiative for Chronic Obstructive Lung Disease (GOLD),<sup id="wikipedia_cite_ref_33" class="reference"><a href="#cite_note-33"><span>[</span>34<span>]</span></a></sup> a collaboration that includes the World Health Organization and the U.S. National Heart, Lung, and Blood Institute.</span><span class="citable__li" citable_id="245"><a href="#citable__245"><strong>^</strong></a> <c_txt>Chronic obstructive pulmonary disease with lung cancer and/or cardiovascular disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="245"><a href="#citable__245"><strong>^</strong></a> <c_txt>Learning about chronic obstructive pulmonary disease (COPD): .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="245"><a href="#citable__245"><strong>^</strong></a> <c_txt>Chronic obstructive pulmonary disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=5061&nbr=003545&string=Chronic+AND+obstructive+AND+pulmonary+AND+disease">www.guideline.gov</a> [Source type: Academic]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Genome Medicine | Full text | Chronic obstructive pulmonary disease: towards pharmacogenetics</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://genomemedicine.com/content/1/11/112">genomemedicine.com</a> [Source type: Academic]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__304" class="citable__local-anchor">.</a><span class='citationPopup' rel="304">The major current directions of COPD management are to assess and monitor the disease, reduce the risk factors, manage stable COPD, prevent and treat acute exacerbations and manage <a href="/Comorbidity" title="Comorbidity">comorbidity</a>.</span><span class="citable__li" citable_id="304"><a href="#citable__304"><strong>^</strong></a> <c_txt>Fein A, Fein AM. Management of acute exacerbations in chronic obstructive pulmonary disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD: Management of Acute Exacerbations and Chronic Stable Disease - August 15, 2001 - American Family Physician</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.aafp.org/afp/20010815/603.html">www.aafp.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="304"><a href="#citable__304"><strong>^</strong></a> <c_txt>Preventing acute exacerbations helps to reduce long-term complications.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD: Management of Acute Exacerbations and Chronic Stable Disease - August 15, 2001 - American Family Physician</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.aafp.org/afp/20010815/603.html">www.aafp.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="304"><a href="#citable__304"><strong>^</strong></a> <c_txt>Manage Exacerbations (flare-ups) of COPD .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) - a knol by Stephen C. Lazarus</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://knol.google.com/k/chronic-obstructive-pulmonary-disease-copd">knol.google.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid17507545_1_7" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup></div> <div style="margin: 1.12em 0; display:block"><a name="citable__95" class="citable__local-anchor">.</a><span class='citationPopup' rel="95">The only measures that have been shown to reduce mortality is smoking cessation and supplemental oxygen.</span><span class="citable__li" citable_id="95"><a href="#citable__95"><strong>^</strong></a> <c_txt>Among smokers of comparable smoking exposure, reduced FEV 1 was associated with as much as a 3–4 fold greater cardiovascular mortality.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="95"><a href="#citable__95"><strong>^</strong></a> <c_txt>To date, none of these “preventive therapies” have been convincingly shown to reduce cardiorespiratory mortality or morbidity and therefore are unlikely to account for a confounding effect from statin use.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="95"><a href="#citable__95"><strong>^</strong></a> <c_txt>Third, currently recommended therapies for COPD merely control symptoms and have not been shown to reduce morbidity or mortality convincingly.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_Drummond08_34_0" class="reference"><a href="#cite_note-Drummond08-34"><span>[</span>35<span>]</span></a></sup></div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Risk_factor_reduction">Risk factor reduction</span></h3> <h4><span class="mw-headline" id="wikipedia_Smoking_cessation">Smoking cessation</span></h4> <div class="rellink relarticle mainarticle">Main article: <a href="/Smoking_cessation" title="Smoking cessation">Smoking cessation</a></div> <div style="margin: 1.12em 0; display:block"><a name="citable__147" class="citable__local-anchor">.</a><span class='citationPopup' rel="147">Smoking cessation is one of the most important factors in slowing down the progression of COPD. Once COPD has been diagnosed, stopping smoking slows down the rate of progression of the disease.</span><span class="citable__li" citable_id="147"><a href="#citable__147"><strong>^</strong></a> <c_txt>Meanwhile, quitting smoking is the single most important thing you can do to slow the progress of the disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="147"><a href="#citable__147"><strong>^</strong></a> <c_txt>Smoking cessation is one of the most important aspects of COPD management ( 2 , 25 ).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic Obstructive Pulmonary Disease: The Disease and Its Burden to Society -- Halpin and Miravitlles 3 (7): 619 -- Proceedings of the American Thoracic Society</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pats.atsjournals.org/cgi/content/full/3/7/619">pats.atsjournals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="147"><a href="#citable__147"><strong>^</strong></a> <c_txt>Quitting smoking is the single most important thing that one can do to reduce the risk of developing chronic obstructive pulmonary disease (COPD) and slow the progress of the disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease - Medpedia</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://wiki.medpedia.com/Chronic_Obstructive_Pulmonary_Disease">wiki.medpedia.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__294" class="citable__local-anchor">.</a><span class='citationPopup' rel="294">Even at a late stage of the disease it can significantly reduce the rate of deterioration in lung function and delay the onset of disability and death.</span><span class="citable__li" citable_id="294"><a href="#citable__294"><strong>^</strong></a> <c_txt>The benefit of smoking cessation is shown here because the deterioration in lung function parallels that of a nonsmoker, even in late stages of the disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease: Differential Diagnoses & Workup - eMedicine Pulmonology</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://emedicine.medscape.com/article/297664-diagnosis">emedicine.medscape.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="294"><a href="#citable__294"><strong>^</strong></a> <c_txt>It is never too late to stop at any stage of the disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease | Health | Patient UK</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.patient.co.uk/health/Chronic-Obstructive-Pulmonary-Disease.htm">www.patient.co.uk</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Chronic Obstructive Pulmonary Disease | Health | Patient UK</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.patient.co.uk/showdoc/23068705/">www.patient.co.uk</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="294"><a href="#citable__294"><strong>^</strong></a> <c_txt>Chronic Obstructive Pulmonary Disease (COPD) is a major cause of disability, the fourth leading cause of death in the United States and is on a trajectory to becoming the third by 2020.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.thoracic.org/sections/clinical-information/best-of-the-web/pages/obstructive-disease/chronic-obstructive-pulmonary-disease.html">www.thoracic.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_kc_26_1" class="reference"><a href="#cite_note-kc-26"><span>[</span>27<span>]</span></a></sup> It is the only standard intervention that can improve the rate of progression of COPD.<sup id="wikipedia_cite_ref_Drummond08_34_1" class="reference"><a href="#cite_note-Drummond08-34"><span>[</span>35<span>]</span></a></sup></div> <div style="margin: 1.12em 0; display:block"><a name="citable__116" class="citable__local-anchor">.</a><span class='citationPopup' rel="116">Smoking cessation starts with an individual decision to stop smoking that leads to an attempt at quitting.</span><span class="citable__li" citable_id="116"><a href="#citable__116"><strong>^</strong></a> <c_txt>Has individual completely stopped smoking?</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>http://www.mdguidelines.com/chronic-obstructive-pulmonary-disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.mdguidelines.com/chronic-obstructive-pulmonary-disease">www.mdguidelines.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="116"><a href="#citable__116"><strong>^</strong></a> <c_txt>Thus, smoking cessation is the single most important intervention for individuals with COPD, and the earlier this is accomplished, the greater the beneficial impact on lung function over time (5).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) - a knol by Stephen C. Lazarus</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://knol.google.com/k/chronic-obstructive-pulmonary-disease-copd">knol.google.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="116"><a href="#citable__116"><strong>^</strong></a> <c_txt>Although simply advising smokers to quit is rarely effective, healthcare professionals are less likely to offer smoking cessation assistance with their advice (CDC, 2007).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__15" class="citable__local-anchor">.</a><span class='citationPopup' rel="15">Often several attempts are required before long-term smoking cessation is achieved.</span><span class="citable__li" citable_id="15"><a href="#citable__15"><strong>^</strong></a> <c_txt>Most people with COPD are long-term smokers, and research shows that smoking cigarettes increases the risk of getting COPD: 2 .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="15"><a href="#citable__15"><strong>^</strong></a> <c_txt>Among patients with severe COPD receiving long-term oxygen therapy, women are more likely to die than men.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Update in Chronic Obstructive Pulmonary Disease 2006 -- Rabe et al. 175 (12): 1222 -- American Journal of Respiratory and Critical Care Medicine</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://ajrccm.atsjournals.org/cgi/content/full/175/12/1222">ajrccm.atsjournals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="15"><a href="#citable__15"><strong>^</strong></a> <c_txt>Long-term smokers are likely to develop COPD, but the severity of the disease varies from person to person, even among heavy smokers.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_WHO_35_0" class="reference"><a href="#cite_note-WHO-35"><span>[</span>36<span>]</span></a></sup> <a name="citable__100" class="citable__local-anchor">.</a><span class='citationPopup' rel="100">Some smokers can achieve long-term smoking cessation through "willpower" alone.</span><span class="citable__li" citable_id="100"><a href="#citable__100"><strong>^</strong></a> <c_txt>For smokers, smoking cessation should be emphasized.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>U.S. Department of Veterans Affairs</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.hiv.va.gov/vahiv?page=pcm-204_copd&pf=vahiv-pcm-pf&pp=pf">www.hiv.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="100"><a href="#citable__100"><strong>^</strong></a> <c_txt>Although simply advising smokers to quit is rarely effective, healthcare professionals are less likely to offer smoking cessation assistance with their advice (CDC, 2007).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="100"><a href="#citable__100"><strong>^</strong></a> <c_txt>Frankly, I like to smoke, and I know people who have lived a long time even though they were smokers.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__43" class="citable__local-anchor">.</a><span class='citationPopup' rel="43">However smoking is highly addictive<sup id="wikipedia_cite_ref_36" class="reference"><a href="#cite_note-36"><span>[</span>37<span>]</span></a></sup> and many smokers need further support to quit.</span><span class="citable__li" citable_id="43"><a href="#citable__43"><strong>^</strong></a> <c_txt>Many smokers gain weight when they quit, but it is usually less than 10 pounds.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="43"><a href="#citable__43"><strong>^</strong></a> <c_txt>However, not all smokers develop COPD, and not all patients with COPD are smokers or have smoked in the past.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="43"><a href="#citable__43"><strong>^</strong></a> <c_txt>Smokers who need their first cigarette within a half-hour of getting up in the morning are likely to be highly addicted to nicotine.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__190" class="citable__local-anchor">.</a><span class='citationPopup' rel="190">The chance of successfully stopping smoking can be greatly improved through social support, engagement in a smoking cessation programme and the use of drugs such as <a href="/Nicotine_replacement_therapy" title="Nicotine replacement therapy">nicotine replacement therapy</a>, <a href="/Bupropion" title="Bupropion">bupropion</a> and <a href="/Varenicline" title="Varenicline">varenicline</a>.</span><span class="citable__li" citable_id="190"><a href="#citable__190"><strong>^</strong></a> <c_txt>Nicotine replacement therapy .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="190"><a href="#citable__190"><strong>^</strong></a> <c_txt>Simultaneous use of multiple strategies is most effective: establishment of a quit date, behavior modification techniques, group support sessions, nicotine replacement therapy (by gum, transdermal patch, inhaler, lozenge, or nasal spray), bupropion, and physician encouragement.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>THE MERCK MANUAL OF GERIATRICS, Ch. 78, Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.merck.com/mkgr/mmg/sec10/ch78/ch78a.jsp">www.merck.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="190"><a href="#citable__190"><strong>^</strong></a> <c_txt>(ADLs) exercises for physical conditioning and improved endurance stress management, relaxation exercises, and emotional support smoking cessation programs nutritional counseling patient and family education and counseling vocational counseling .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.sharp.com/healthinfo/content.cfm?pageid=P01155">www.sharp.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_WHO_35_1" class="reference"><a href="#cite_note-WHO-35"><span>[</span>36<span>]</span></a></sup></div> <div style="margin: 1.12em 0; display:block"><a name="citable__46" class="citable__local-anchor">.</a><span class='citationPopup' rel="46">The <a href="/Tobacco_smoking" title="Tobacco smoking">policies</a> of governments, public health agencies and anti-smoking organizations can reduce smoking rates by encouraging smoking cessation and discouraging people from starting smoking.</span><span class="citable__li" citable_id="46"><a href="#citable__46"><strong>^</strong></a> <c_txt>Smoking cessation is one of the most important factors in slowing down the progression of COPD. Even at a late stage of the disease it can reduce the rate of deterioration and prolong the time taken for disability and death.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> COPD Clinical Trials </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.clinicalconnection.com/Clinical_Trials/Condition/copd.aspx">www.clinicalconnection.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="46"><a href="#citable__46"><strong>^</strong></a> <c_txt>All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=5061&nbr=003545&string=Chronic+AND+obstructive+AND+pulmonary+AND+disease">www.guideline.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=14439">www.guidelines.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=14439&nbr=7229">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="46"><a href="#citable__46"><strong>^</strong></a> <c_txt>Smoking cessation is the single most effective and cost effective intervention – both to reduce the risk of developing COPD and to stop its progression (3).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) - a knol by Stephen C. Lazarus</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://knol.google.com/k/chronic-obstructive-pulmonary-disease-copd">knol.google.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_WHO_35_2" class="reference"><a href="#cite_note-WHO-35"><span>[</span>36<span>]</span></a></sup> These policies are important strategies in the prevention of COPD.<sup class="Template-Fact" title="This claim needs references to reliable sources from November 2009" style="white-space:nowrap;">[<em>citation needed</em>]</sup></div> <h4><span class="mw-headline" id="wikipedia_Occupational_health">Occupational health</span></h4> <div style="margin: 1.12em 0; display:block"><a name="citable__150" class="citable__local-anchor">.</a><span class='citationPopup' rel="150">Measures can be taken to reduce the likelihood that workers in at-risk industries such as coal mining will develop COPD. Some examples of these measures are: education of workers and management about the risks, promoting <a href="/Smoking_cessation" title="Smoking cessation">smoking cessation</a>, <a href="/Disease_surveillance" title="Disease surveillance">surveillance</a> of workers for early signs of COPD, the use of personal dust monitors, the use of <a href="/Respirators" title="Respirators" class="mw-redirect">respirators</a> and dust control.</span><span class="citable__li" citable_id="150"><a href="#citable__150"><strong>^</strong></a> <c_txt>Taking into account the expected aging of the U.S. population over the next 10 to 30 years as well as the improved management of other smoking-related diseases, any decline in the proportion of persons with COPD is unlikely without substantial changes in risk factors, mainly reductions in cigarette smoking.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="150"><a href="#citable__150"><strong>^</strong></a> <c_txt>The most common spirometric measurement used to characterize a patient's COPD is the one-second forced expiratory volume (FEV1).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="150"><a href="#citable__150"><strong>^</strong></a> <c_txt>Long-term exposure to lung irritants such as industrial dust and chemical fumes.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_37" class="reference"><a href="#cite_note-37"><span>[</span>38<span>]</span></a></sup> <a name="citable__59" class="citable__local-anchor">.</a><span class='citationPopup' rel="59">Dust control can be achieved by improving ventilation, using water sprays and by using mining techniques that minimize dust generation.</span><span class="citable__li" citable_id="59"><a href="#citable__59"><strong>^</strong></a> <c_txt>Continuous positive airway pressure (CPAP) is used as an adjunct to weaning from mechanical ventilation to minimize dyspnea during exercise.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>What Is Chronic Obstructive Pulmonary Disease– Support Plus Medical</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.supportplusmedical.com/copd.php">www.supportplusmedical.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="59"><a href="#citable__59"><strong>^</strong></a> <c_txt>Controlled coughing, drinking plenty of water and using a humidifier may help.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.cnn.com/HEALTH/library/copd/DS00916.html">www.cnn.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__57" class="citable__local-anchor">.</a><span class='citationPopup' rel="57">If a worker develops COPD, further lung damage can be reduced by avoiding ongoing dust exposure, for example by changing the work role.</span><span class="citable__li" citable_id="57"><a href="#citable__57"><strong>^</strong></a> <c_txt>Avoid work-related exposures to dusts and fumes.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>What Is Chronic Obstructive Pulmonary Disease– Support Plus Medical</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.supportplusmedical.com/copd.php">www.supportplusmedical.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="57"><a href="#citable__57"><strong>^</strong></a> <c_txt>Exposure to solid biomass fuels, commonly used for indoor cooking and heating, is a risk factor for COPD, particularly in the developing world.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease: Diagnostic Considerations - February 15, 2006 - American Family Physician</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.aafp.org/afp/20060215/669.html">www.aafp.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="57"><a href="#citable__57"><strong>^</strong></a> <c_txt>Smoking, especially if you have a history of smoking one pack per day for 20 years or the equivalent (for example, 2 packs per day for 10 years) Inherited deficiency of an enzyme called alpha-1 anti-trypsin that normally helps protect the lungs from damage Passive smoking (ongoing exposure to cigarette smoke from others) Being over age 50 Work exposure to toxic chemicals such as silica or cadmium Working around industrial smoke, excessive dust, or other air pollutants (for example, miners, furnace workers, and grain farmers) .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic obstructive pulmonary disease - Mother Earth's Storehouse Kingston</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.motherearthstorehouse.com/common/adam/DisplayMonograph.asp?storeID=94C44AD9U7S92L960G03N0ET9M7HBGC0&DocID=33_000036">www.motherearthstorehouse.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> </div> <h4><span class="mw-headline" id="wikipedia_Air_pollution_2">Air pollution</span></h4> <div style="margin: 1.12em 0; display:block"><a name="citable__66" class="citable__local-anchor">.</a><span class='citationPopup' rel="66">Air quality can be improved by <a href="/Air_pollution" title="Air pollution">pollution reduction efforts</a> which should lead to health gains for people with COPD. A person who has COPD may experience fewer symptoms if they stay indoors on days when air quality is poor.</span><span class="citable__li" citable_id="66"><a href="#citable__66"><strong>^</strong></a> <c_txt>Indoor air pollution.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="66"><a href="#citable__66"><strong>^</strong></a> <c_txt>Reduction in symptoms and quality of life .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="66"><a href="#citable__66"><strong>^</strong></a> <c_txt>Air pollution may make COPD worse.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid17507545_1_8" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup></div> <div style="display:table-cell;clear:both;"></div><h3><span class="mw-headline" id="wikipedia_Management_of_stable_COPD">Management of stable COPD</span></h3> <h4><span class="mw-headline" id="wikipedia_Bronchodilators">Bronchodilators</span></h4> <div style="margin: 1.12em 0; display:block"><a name="citable__173" class="citable__local-anchor">.</a><span class='citationPopup' rel="173"><a href="/Bronchodilators" title="Bronchodilators" class="mw-redirect">Bronchodilators</a> are medicines that relax <a href="/Smooth_muscle" title="Smooth muscle">smooth muscle</a> around the airways, increasing the calibre of the airways and improving air flow.</span><span class="citable__li" citable_id="173"><a href="#citable__173"><strong>^</strong></a> <c_txt>Long-acting or maintenance Methylxanthine: Oral bronchodilator that relaxes the muscles around the airways .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="173"><a href="#citable__173"><strong>^</strong></a> <c_txt>Bronchodilators work by relaxing the muscles in the walls of the lung's airways.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="173"><a href="#citable__173"><strong>^</strong></a> <c_txt>Bronchodilatation and smooth muscle relaxation .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__321" class="citable__local-anchor">.</a><span class='citationPopup' rel="321">They can reduce the symptoms of shortness of breath, wheeze and exercise limitation, resulting in an improved quality of life for people with COPD.<sup id="wikipedia_cite_ref_pmid11834677_38_0" class="reference"><a href="#cite_note-pmid11834677-38"><span>[</span>39<span>]</span></a></sup> They do not slow down the rate of progression of the underlying disease.</span><span class="citable__li" citable_id="321"><a href="#citable__321"><strong>^</strong></a> <c_txt>Shortness of breath gets worse as COPD gets worse.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="321"><a href="#citable__321"><strong>^</strong></a> <c_txt>It stops people from exercising, and it is the major symptom that severely limits the activities of people with COPD. The inability to exercise without developing shortness of breath gets worse as COPD progresses.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="321"><a href="#citable__321"><strong>^</strong></a> <c_txt>COPD is a life-long disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid17507545_1_9" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup> <a name="citable__106" class="citable__local-anchor">.</a><span class='citationPopup' rel="106">Bronchodilators are usually administered with an <a href="/Inhaler" title="Inhaler">inhaler</a> or via a <a href="/Nebulizer" title="Nebulizer">nebulizer</a>.</span><span class="citable__li" citable_id="106"><a href="#citable__106"><strong>^</strong></a> <c_txt>Ipratropium is usually administered via a metered-dose inhaler (MDI), although there are other formulations.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="106"><a href="#citable__106"><strong>^</strong></a> <c_txt>Bronchodilators and inhaled corticosteroids are often used with a metered-dose inhaler (MDI), a dry powder inhaler (DPI), or through a mouthpiece or mask ( nebulizer ).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__286" class="citable__local-anchor">.</a><span class='citationPopup' rel="286">There are two major types of bronchodilator, β<sub>2</sub> agonists and anticholinergics.</span><span class="citable__li" citable_id="286"><a href="#citable__286"><strong>^</strong></a> <c_txt>There are two categories of bronchodilators: anticholinergic agents and beta-2 agonists.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>AMDA: Publications - Caring for the Ages - October 2003</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.amda.com/publications/caring/october2003/copd.cfm">www.amda.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="286"><a href="#citable__286"><strong>^</strong></a> <c_txt>The two main types of bronchodilators are: Anticholinergics (such as ipratropium and tiotropium).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="286"><a href="#citable__286"><strong>^</strong></a> <c_txt>Short-acting bronchodilator as needed: beta-agonists such as albuterol, levalbuterol, and pirbuterol, and/or anticholinergics such as ipratropium .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>U.S. Department of Veterans Affairs</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.hiv.va.gov/vahiv?page=pcm-204_copd&pf=vahiv-pcm-pf&pp=pf">www.hiv.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__21" class="citable__local-anchor">.</a><span class='citationPopup' rel="21">Anticholinergics appear to be superior to β<sub>2</sub> agonists in COPD. Anticholinergeics reduce respiratory deaths while β<sub>2</sub> agonists have no effect on respiratory deaths.</span><span class="citable__li" citable_id="21"><a href="#citable__21"><strong>^</strong></a> <c_txt>Meta-analysis: Anticholinergics, but not β-agonists, Reduce Severe Exacerbations and Respiratory Mortality in COPD .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Pulmonary Disease - Chronic Obstructive Pulmonary Disease : eClips Consult</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://eclipsconsult.com/eclips/topicsList?issn=8756-3452&doctopic=Chronic%20Obstructive%20Pulmonary%20Disease">eclipsconsult.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="21"><a href="#citable__21"><strong>^</strong></a> <c_txt>Ipratropium is often the first drug tried because it lasts longer than short-acting beta2 agonists and, as an anticholinergic drug, it does not have the sympathetic drugs' side effects.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="21"><a href="#citable__21"><strong>^</strong></a> <c_txt>COPD is one of the most common respiratory conditions among adults worldwide and is the fourth leading cause of death in the United States.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_39" class="reference"><a href="#cite_note-39"><span>[</span>40<span>]</span></a></sup> <a name="citable__40" class="citable__local-anchor">.</a><span class='citationPopup' rel="40">Each type may be either long-acting (with an effect lasting 12 hours or more) or short-acting (with a rapid onset of effect that does not last as long).</span><span class="citable__li" citable_id="40"><a href="#citable__40"><strong>^</strong></a> <c_txt>Long-acting bronchodilators last about 12 hours or more and are used every day.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease COPD </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://chronicobstructivepulmonarydisease.org/">chronicobstructivepulmonarydisease.org</a> [Source type: General]</li><li> <em><c_title>Chronic Obstructive Pulmonary Disease - Medpedia</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://wiki.medpedia.com/Chronic_Obstructive_Pulmonary_Disease">wiki.medpedia.com</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://catalog.nucleusinc.com/displaymonograph.php?MID=29">catalog.nucleusinc.com</a> [Source type: General]</li><li> <em><c_title>Chronic Obstructive Lung Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.metrohealth.org/body.cfm?id=1553">www.metrohealth.org</a> [Source type: General]</li><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li><li> <em><c_title>Chronic Obstructive Lung Disease (COPD)</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.metrohealth.org/body.cfm?id=1553&oTopID=1551">www.metrohealth.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="40"><a href="#citable__40"><strong>^</strong></a> <c_txt>Bronchodilators can be either short-acting or long-acting.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://catalog.nucleusinc.com/displaymonograph.php?MID=29">catalog.nucleusinc.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="40"><a href="#citable__40"><strong>^</strong></a> <c_txt>Bronchodilators can be either short acting or long acting.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease COPD </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://chronicobstructivepulmonarydisease.org/">chronicobstructivepulmonarydisease.org</a> [Source type: General]</li><li> <em><c_title>Chronic Obstructive Pulmonary Disease - Medpedia</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://wiki.medpedia.com/Chronic_Obstructive_Pulmonary_Disease">wiki.medpedia.com</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Chronic Obstructive Lung Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.metrohealth.org/body.cfm?id=1553">www.metrohealth.org</a> [Source type: General]</li><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li><li> <em><c_title>Chronic Obstructive Lung Disease (COPD)</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.metrohealth.org/body.cfm?id=1553&oTopID=1551">www.metrohealth.org</a> [Source type: General]</li><li> <em><c_title>Understanding COPD – Chronic Obstructive Pulmonary Disease | Womens Health Base</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.womenshealthbase.com/copd/all/1/">www.womenshealthbase.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> </div> <h5><span class="mw-headline" id="wikipedia__CE_B22_agonists">β<sub>2</sub> agonists</span></h5> <div style="margin: 1.12em 0; display:block">β<sub>2</sub> agonists stimulate β<sub>2</sub> <a name="citable__125" class="citable__local-anchor">.</a><span class='citationPopup' rel="125"><a href="/Receptor_(biochemistry)" title="Receptor (biochemistry)">receptors</a> on airway smooth muscles, causing them to relax.</span><span class="citable__li" citable_id="125"><a href="#citable__125"><strong>^</strong></a> <c_txt>Bronchodilatation and smooth muscle relaxation .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="125"><a href="#citable__125"><strong>^</strong></a> <c_txt>Long-acting or maintenance Methylxanthine: Oral bronchodilator that relaxes the muscles around the airways .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="125"><a href="#citable__125"><strong>^</strong></a> <c_txt>Bronchodilators Your doctor may recommend medicines called bronchodilators that work by relaxing the muscles around your airways.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Lung Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.metrohealth.org/body.cfm?id=1553">www.metrohealth.org</a> [Source type: General]</li><li> <em><c_title>Chronic Obstructive Lung Disease (COPD)</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.metrohealth.org/body.cfm?id=1553&oTopID=1551">www.metrohealth.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__56" class="citable__local-anchor">.</a><span class='citationPopup' rel="56">There are several β<sub>2</sub> agonists available.</span><span class="citable__li" citable_id="56"><a href="#citable__56"><strong>^</strong></a> <c_txt>Agonists There are several highly specific β2 agonists available.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> COPD Clinical Trials </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.clinicalconnection.com/Clinical_Trials/Condition/copd.aspx">www.clinicalconnection.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="56"><a href="#citable__56"><strong>^</strong></a> <c_txt>There are several commercially available spacer devices.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.emphysemafoundation.org/pulmonary-disease/57-copd.html">www.emphysemafoundation.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="56"><a href="#citable__56"><strong>^</strong></a> <c_txt>There are several types of bronchodilators used clinically with varying efficacy: β2 agonists, M3 antimuscarinics, leukotriene antagonists, cromones and xanthines.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> COPD Clinical Trials </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.clinicalconnection.com/Clinical_Trials/Condition/copd.aspx">www.clinicalconnection.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__60" class="citable__local-anchor">.</a><span class='citationPopup' rel="60"><a href="/Albuterol" title="Albuterol" class="mw-redirect">Albuterol</a> (common brand name: Ventolin) and <a href="/Terbutaline" title="Terbutaline">terbutaline</a> are widely used short acting β<sub>2</sub> agonists and provide rapid relief of COPD symptoms.</span><span class="citable__li" citable_id="60"><a href="#citable__60"><strong>^</strong></a> <c_txt>Ipratropium is often the first drug tried because it lasts longer than short-acting beta2 agonists and, as an anticholinergic drug, it does not have the sympathetic drugs' side effects.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="60"><a href="#citable__60"><strong>^</strong></a> <c_txt>Mild COPD is usually treated with short-acting bronchodilators, which are used as needed for dyspnea.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="60"><a href="#citable__60"><strong>^</strong></a> <c_txt>It stops people from exercising, and it is the major symptom that severely limits the activities of people with COPD. The inability to exercise without developing shortness of breath gets worse as COPD progresses.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__222" class="citable__local-anchor">.</a><span class='citationPopup' rel="222">Long acting β<sub>2</sub> agonists (LABAs) such as <a href="/Salmeterol" title="Salmeterol">salmeterol</a> and <a href="/Formoterol" title="Formoterol">formoterol</a> are used as maintenance therapy and lead to improved airflow, exercise capacity, and quality of life.</span><span class="citable__li" citable_id="222"><a href="#citable__222"><strong>^</strong></a> <c_txt>Long-acting beta2 agonists bronchodilators include formoterol (Foradil) and salmeterol (Serevent).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="222"><a href="#citable__222"><strong>^</strong></a> <c_txt>Beta2-agonists (such as salmeterol and arformoterol).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="222"><a href="#citable__222"><strong>^</strong></a> <c_txt>Beta2-agonists (such as salmeterol and fluticasone).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid17314337_40_0" class="reference"><a href="#cite_note-pmid17314337-40"><span>[</span>41<span>]</span></a></sup></div> <h5><span class="mw-headline" id="wikipedia_Anticholinergics">Anticholinergics</span></h5> <div style="margin: 1.12em 0; display:block"><a name="citable__255" class="citable__local-anchor">.</a><span class='citationPopup' rel="255">Anticholinergic drugs cause airway smooth muscles to relax by blocking stimulation from <a href="/Cholinergic" title="Cholinergic">cholinergic</a> nerves.</span><span class="citable__li" citable_id="255"><a href="#citable__255"><strong>^</strong></a> <c_txt>Beta2 agonists stimulate the beta2-adrenergic neuroreceptors and cause smooth muscles to relax; this widens airways in the lung.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="255"><a href="#citable__255"><strong>^</strong></a> <c_txt>These drugs relax the smooth muscles of the airway allowing for improved airflow.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> COPD Clinical Trials </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.clinicalconnection.com/Clinical_Trials/Condition/copd.aspx">www.clinicalconnection.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="255"><a href="#citable__255"><strong>^</strong></a> <c_txt>The parasympathetic bronchodilators are anticholinergic drugs , which relax airway muscles by blocking the effect of acetylcholine.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__208" class="citable__local-anchor">.</a><span class='citationPopup' rel="208"><a href="/Ipratropium" title="Ipratropium">Ipratropium</a> is the most widely prescribed short acting anticholinergic drug.</span><span class="citable__li" citable_id="208"><a href="#citable__208"><strong>^</strong></a> <c_txt>Short-acting anticholinergics include ipratropium (Atrovent), the most commonly prescribed parasympathetic bronchodilator.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="208"><a href="#citable__208"><strong>^</strong></a> <c_txt>Short-acting bronchodilators include: Anticholinergics (such as ipratropium).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="208"><a href="#citable__208"><strong>^</strong></a> <c_txt>Most drugs work by keeping airways as wide open as possible (Hall & Ahmed, 2007).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__320" class="citable__local-anchor">.</a><span class='citationPopup' rel="320">Like short-acting β<sub>2</sub> agonists, short-acting anticholinergics provide rapid relief of COPD symptoms and a combination of the two is commonly used for a greater bronchodilator effect.</span><span class="citable__li" citable_id="320"><a href="#citable__320"><strong>^</strong></a> <c_txt>Mild COPD is usually treated with short-acting bronchodilators, which are used as needed for dyspnea.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="320"><a href="#citable__320"><strong>^</strong></a> <c_txt>Short-acting bronchodilators ease your symptoms.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="320"><a href="#citable__320"><strong>^</strong></a> <c_txt>Bronchodilators can be either short-acting or long-acting.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://catalog.nucleusinc.com/displaymonograph.php?MID=29">catalog.nucleusinc.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__64" class="citable__local-anchor">.</a><span class='citationPopup' rel="64"><a href="/Tiotropium" title="Tiotropium">Tiotropium</a> is the most commonly prescribed long-acting anticholinergic drug in COPD. It is has more specificity for M<sub>3</sub> muscarinic receptors so may have fewer side-effects than other anticholinergic drugs.</span><span class="citable__li" citable_id="64"><a href="#citable__64"><strong>^</strong></a> <c_txt>The observed effects were comparable to those seen with the long-acting anticholinergic bronchodilator tiotropium.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Update in Chronic Obstructive Pulmonary Disease 2006 -- Rabe et al. 175 (12): 1222 -- American Journal of Respiratory and Critical Care Medicine</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://ajrccm.atsjournals.org/cgi/content/full/175/12/1222">ajrccm.atsjournals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="64"><a href="#citable__64"><strong>^</strong></a> <c_txt>Long-acting bronchodilators include: Anticholinergics (such as tiotropium).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="64"><a href="#citable__64"><strong>^</strong></a> <c_txt>These drugs are more expensive than albuterol or metaproterenol, but a typical dose lasts for at least 12 hours.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__174" class="citable__local-anchor">.</a><span class='citationPopup' rel="174">Regular use is associated with improvements in airflow, exercise capacity, quality of life and possibly a longer life.</span><span class="citable__li" citable_id="174"><a href="#citable__174"><strong>^</strong></a> <c_txt>Grade D - Ambulatory oxygen therapy should be considered in patients who have exercise desaturation, are shown to have an improvement in exercise capacity and/or dyspnoea with oxygen, and have the motivation to use oxygen.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=5061&nbr=003545&string=Chronic+AND+obstructive+AND+pulmonary+AND+disease">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="174"><a href="#citable__174"><strong>^</strong></a> <c_txt>The study showed that in a very select group of patients (those with emphysema involving predominantly the upper lobes of the lungs, and with a low exercise capacity), those who received surgery had a greater survival rate, better improvement in exercise capacity, and better quality of life than those who received medical therapy.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) - a knol by Stephen C. Lazarus</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://knol.google.com/k/chronic-obstructive-pulmonary-disease-copd">knol.google.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="174"><a href="#citable__174"><strong>^</strong></a> <c_txt>Bronchial airflow limitation, smoking, body mass index, and statin use are strongly associated with the C-reactive protein level in the elderly.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid18836213_41_0" class="reference"><a href="#cite_note-pmid18836213-41"><span>[</span>42<span>]</span></a></sup><sup id="wikipedia_cite_ref_pmid15218994_42_0" class="reference"><a href="#cite_note-pmid15218994-42"><span>[</span>43<span>]</span></a></sup> <em>In January 2010, a new research has shown that ipratropium used to treat COPD has increased cardiovascular morbidity in treatment of COPD.</em><sup id="wikipedia_cite_ref_43" class="reference"><a href="#cite_note-43"><span>[</span>44<span>]</span></a></sup> <em>At the same time Tiotropium was shown to be effective in eliminating the risk of all cause mortality, cardiovascular mortality and cardiovascular events.</em><sup id="wikipedia_cite_ref_44" class="reference"><a href="#cite_note-44"><span>[</span>45<span>]</span></a></sup></div> <h4><span class="mw-headline" id="wikipedia_Corticosteroids">Corticosteroids</span></h4> <div style="margin: 1.12em 0; display:block"><a name="citable__253" class="citable__local-anchor">.</a><span class='citationPopup' rel="253">Corticosteroids act to reduce the inflammation in the airways, in theory reducing lung damage and airway narrowing caused by inflammation.</span><span class="citable__li" citable_id="253"><a href="#citable__253"><strong>^</strong></a> <c_txt>Inflammation and excess mucus cause coughing and narrow the airways.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="253"><a href="#citable__253"><strong>^</strong></a> <c_txt>Bronchitis is inflammation of the bronchi (the airways of the lungs).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease | Health | Patient UK</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.patient.co.uk/health/Chronic-Obstructive-Pulmonary-Disease.htm">www.patient.co.uk</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Chronic Obstructive Pulmonary Disease | Health | Patient UK</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.patient.co.uk/showdoc/23068705/">www.patient.co.uk</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="253"><a href="#citable__253"><strong>^</strong></a> <c_txt>They help by reducing the extra inflammation in the airways caused by infections.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease | Health | Patient UK</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.patient.co.uk/health/Chronic-Obstructive-Pulmonary-Disease.htm">www.patient.co.uk</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Chronic Obstructive Pulmonary Disease | Health | Patient UK</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.patient.co.uk/showdoc/23068705/">www.patient.co.uk</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_45" class="reference"><a href="#cite_note-45"><span>[</span>46<span>]</span></a></sup> <a name="citable__223" class="citable__local-anchor">.</a><span class='citationPopup' rel="223">Unlike bronchodilators, they do not act directly on the airway smooth muscle and do not provide immediate relief of symptoms.</span><span class="citable__li" citable_id="223"><a href="#citable__223"><strong>^</strong></a> <c_txt>Short-acting bronchodilators as needed for symptoms .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=14439">www.guidelines.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=14439&nbr=7229">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="223"><a href="#citable__223"><strong>^</strong></a> <c_txt>Standard treatment for COPD includes using bronchodilators, such as ipratropium and albuterol, to reduce muscle spasms, and corticosteroids to control inflammation in the airways.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic Obstructive Pulmonary Disease | Lifescript.com</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.lifescript.com/Health/A-Z/Alternative-Therapies_A-Z/ByCondition/C/Chronic_Obstructive_Pulmonary_Disease.aspx">www.lifescript.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="223"><a href="#citable__223"><strong>^</strong></a> <c_txt>Long-acting or maintenance Methylxanthine: Oral bronchodilator that relaxes the muscles around the airways .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__151" class="citable__local-anchor">.</a><span class='citationPopup' rel="151">Some of the more common corticosteroids in use are <a href="/Prednisone" title="Prednisone">prednisone</a>, <a href="/Fluticasone" title="Fluticasone">fluticasone</a>, <a href="/Budesonide" title="Budesonide">budesonide</a>, <a href="/Mometasone_furoate" title="Mometasone furoate">mometasone</a>, and <a href="/Beclomethasone" title="Beclomethasone" class="mw-redirect">beclomethasone</a>.</span><span class="citable__li" citable_id="151"><a href="#citable__151"><strong>^</strong></a> <c_txt>Anti-inflammatory medications such as corticosteroids may be taken orally, such as prednisone, or inhaled, such as beclomethasone dipropionate or fluticasone propionate.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="151"><a href="#citable__151"><strong>^</strong></a> <c_txt>Anti-inflammatory medicines such as corticosteroids may be taken orally, such as prednisone, or inhaled, such as beclomethasone dipropionate or fluticasone propionate.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="151"><a href="#citable__151"><strong>^</strong></a> <c_txt>Oral corticosteroids (prednisone) may be used in pill form for a COPD exacerbation or in an inhaled form to prevent COPD exacerbations.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__273" class="citable__local-anchor">.</a><span class='citationPopup' rel="273">Corticosteroids are used in tablet or inhaled form to treat and prevent acute exacerbations of COPD. Well-inhaled corticosteroids (ICS) have not been shown to be of benefit for people with mild COPD, however, they have been shown to decrease acute exacerbations in those with either moderate or severe COPD.<sup id="wikipedia_cite_ref_46" class="reference"><a href="#cite_note-46"><span>[</span>47<span>]</span></a></sup> They however have no effect on overall one-year mortality and are associated with increased rates of pneumonia.</span><span class="citable__li" citable_id="273"><a href="#citable__273"><strong>^</strong></a> <c_txt>COPD patients taking statins have morbidity/mortality benefits irrespective of concomitant use of inhaled corticosteroids.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="273"><a href="#citable__273"><strong>^</strong></a> <c_txt>However, they are rarely treated surgically.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="273"><a href="#citable__273"><strong>^</strong></a> <c_txt>Oral corticosteroids (prednisone) may be used in pill form for a COPD exacerbation or in an inhaled form to prevent COPD exacerbations.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_47" class="reference"><a href="#cite_note-47"><span>[</span>48<span>]</span></a></sup></div> <h4><span class="mw-headline" id="wikipedia_Other_medication">Other medication</span></h4> <div style="margin: 1.12em 0; display:block"><a name="citable__239" class="citable__local-anchor">.</a><span class='citationPopup' rel="239"><a href="/Theophylline" title="Theophylline">Theophylline</a> is a bronchodilator and <a href="/Phosphodiesterase" title="Phosphodiesterase">phosphodiesterase</a> inhibitor that in high doses can reduce symptoms for some people who have COPD. More often, side effects such as nausea and stimulation of the heart limit its use.</span><span class="citable__li" citable_id="239"><a href="#citable__239"><strong>^</strong></a> <c_txt>This is mainly used for people with more severe symptoms, or for people who have frequent flare-ups of symptoms.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease | Health | Patient UK</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.patient.co.uk/health/Chronic-Obstructive-Pulmonary-Disease.htm">www.patient.co.uk</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Chronic Obstructive Pulmonary Disease | Health | Patient UK</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.patient.co.uk/showdoc/23068705/">www.patient.co.uk</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="239"><a href="#citable__239"><strong>^</strong></a> <c_txt>CPAP treatment may cause side effects in some people.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="239"><a href="#citable__239"><strong>^</strong></a> <c_txt>Manage symptoms or side effects from treatment.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid17507545_1_10" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup> <a name="citable__300" class="citable__local-anchor">.</a><span class='citationPopup' rel="300">In lower doses, it may slightly reduce the number of COPD exacerbations.</span><span class="citable__li" citable_id="300"><a href="#citable__300"><strong>^</strong></a> <c_txt>When patients have flares or “exacerbations” of COPD, they typically get better with administration of medication, but their lung function never normalizes, although it may return to their pre-exacerbation baseline.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) - a knol by Stephen C. Lazarus</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://knol.google.com/k/chronic-obstructive-pulmonary-disease-copd">knol.google.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="300"><a href="#citable__300"><strong>^</strong></a> <c_txt>A review of studies has found that the inactivated flu shot may reduce the risk of a sudden increase in shortness of breath ( COPD exacerbation) .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="300"><a href="#citable__300"><strong>^</strong></a> <c_txt>Ipratropium may be added to produce additive bronchodilation and allow the use of lower doses of albuterol.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=14439">www.guidelines.gov</a> [Source type: Academic]</li><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=14439&nbr=7229">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid16916334_48_0" class="reference"><a href="#cite_note-pmid16916334-48"><span>[</span>49<span>]</span></a></sup> <a name="citable__265" class="citable__local-anchor">.</a><span class='citationPopup' rel="265">The investigative phosphodiesterase-4 antagonists, <a href="/Roflumilast" title="Roflumilast">roflumilast</a> and <a href="/Cilomilast" title="Cilomilast">cilomilast</a> have completed Phase-2 clinical trials.</span><span class="citable__li" citable_id="265"><a href="#citable__265"><strong>^</strong></a> <c_txt>Two newer phosphodiesterase inhibitors, cilomilast (Ariflo) and roflumilast (Daxas), appear to be safer drugs than theophylline.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__306" class="citable__local-anchor">.</a><span class='citationPopup' rel="306">Tumor necrosis factor antagonists such as infliximab suppress the immune system and reduce inflammation.</span><span class="citable__li" citable_id="306"><a href="#citable__306"><strong>^</strong></a> <c_txt>Tumor necrosis factor caused no change in hepatic GSH but resulted in a lower GSH concentration in lung in rats fed the alanine-supplemented diet.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>EMPHYSEMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE Page 3</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.lef.org/protocols/abstracts/abstr-046b.html">www.lef.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="306"><a href="#citable__306"><strong>^</strong></a> <c_txt>Churg A, Wang RD, Tai H, Wang X, Xie C, Dai J, Shapiro SD, Wright JL: Macrophage metalloelastase mediates acute cigarette smoke-induced inflammation via tumor necrosis factor-[Alpha;] release.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Respiratory Research | Full text | Models of chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://respiratory-research.com/content/5/1/18">respiratory-research.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="306"><a href="#citable__306"><strong>^</strong></a> <c_txt>The relationship between chronic hypoxemia and activation of the tumor necrosis factor–alpha system in patients with chronic obstructive pulmonary disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Why Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Diseases?: The Potential Role of Systemic Inflammation in Chronic Obstructive Pulmonary Disease -- Sin and Man 107 (11): 1514 -- Circulation</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://circ.ahajournals.org/cgi/content/full/107/11/1514">circ.ahajournals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__209" class="citable__local-anchor">.</a><span class='citationPopup' rel="209">Infliximab has been trialled in COPD but there was no evidence of benefit with the possibility of harm.</span><span class="citable__li" citable_id="209"><a href="#citable__209"><strong>^</strong></a> <c_txt>No statistically significant benefits of pneumococcal vaccination in patients with COPD were observed for secondary end points of pneumonia, emergency department visits, hospitalizations, or mortality.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force — Ann Intern Med </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.annals.org/lookup/pmid?view=long&pmid=18316746">www.annals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="209"><a href="#citable__209"><strong>^</strong></a> <c_txt>Although the results of several of these studies show an aggregation of COPD in families, there is no clear Mendelian pattern of inheritance.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genetic Risk Factors for Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://tobaccodocuments.org/pm/2063633573-3584.html">tobaccodocuments.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="209"><a href="#citable__209"><strong>^</strong></a> <c_txt>The herbs ivy leaf and plantain have been suggested for chronic bronchitis, but there is no meaningful evidence that they actually help.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic Obstructive Pulmonary Disease | Lifescript.com</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.lifescript.com/Health/A-Z/Alternative-Therapies_A-Z/ByCondition/C/Chronic_Obstructive_Pulmonary_Disease.aspx">www.lifescript.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_49" class="reference"><a href="#cite_note-49"><span>[</span>50<span>]</span></a></sup></div> <h4><span class="mw-headline" id="wikipedia_Supplemental_oxygen">Supplemental oxygen</span></h4> <div class="thumb tright"> <div class="thumbinner" style="width:222px;"><img alt="" src="http://images-mediawiki-sites.thefullwiki.org/02/2/5/6/02205343836785735.jpg" width="220" height="293" class="thumbimage" /> <div class="thumbcaption"> <a name="citable__290" class="citable__local-anchor">.</a><span class='citationPopup' rel="290"><div class="magnify"><img src="http://images-mediawiki-sites.thefullwiki.org/09/7/4/4/3695493113783710.png" width="15" height="11" alt="" /></div> Oxygen can be delivered in different forms: in large containers, in smaller containers with <a href="/Liquid_oxygen" title="Liquid oxygen">liquid oxygen</a>, or with the use of a <a href="/Oxygen_concentrator" title="Oxygen concentrator">oxygen concentrator</a> (<em>shown here</em>) which derives oxygen from room air.</span><span class="citable__li" citable_id="290"><a href="#citable__290"><strong>^</strong></a> <c_txt>Home oxygen can be purchased as liquid O 2 or as compressed gas, or it can be "manufactured" directly by home oxygen concentrators.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="290"><a href="#citable__290"><strong>^</strong></a> <c_txt>These large air sacs move less oxygen into the blood.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> The latter two options improve mobility of people requiring long-term oxygen therapy.</div> </div> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__86" class="citable__local-anchor">.</a><span class='citationPopup' rel="86">Supplemental oxygen can be given to people with COPD who have low oxygen levels in the body.</span><span class="citable__li" citable_id="86"><a href="#citable__86"><strong>^</strong></a> <c_txt>And it can help people with very bad COPD and low oxygen levels live longer.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="86"><a href="#citable__86"><strong>^</strong></a> <c_txt>For people with COPD, supplemental oxygen also slows the rate at which muscles fatigue.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="86"><a href="#citable__86"><strong>^</strong></a> <c_txt>On the other hand, in people who develop COPD the activity level of antiproteases is low.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__325" class="citable__local-anchor">.</a><span class='citationPopup' rel="325">Oxygen is provided from an <a href="/Gas_cylinder" title="Gas cylinder">oxygen cylinder</a> or an <a href="/Oxygen_concentrator" title="Oxygen concentrator">oxygen concentrator</a> and delivered to a person through tubing via a <a href="/Nasal_cannula" title="Nasal cannula">nasal cannula</a> or <a href="/Oxygen_mask" title="Oxygen mask">oxygen mask</a>.</span><span class="citable__li" citable_id="325"><a href="#citable__325"><strong>^</strong></a> <c_txt>Inside the home, long tubes can connect the nasal cannulas to stationary oxygen delivery units, so patients can move around.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="325"><a href="#citable__325"><strong>^</strong></a> <c_txt>Low-flow (2–3 liter/min) oxygen inhaled through nasal cannulas is usually sufficient to raise a COPD patient's blood PaO 2 to 65–80 mm Hg (an oxygen saturation of 88–94%).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="325"><a href="#citable__325"><strong>^</strong></a> <c_txt>Noninvasive positive pressure ventilation (NIPPV), which delivers air under pressure to the lungs through a mask.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__169" class="citable__local-anchor">.</a><span class='citationPopup' rel="169">Supplemental oxygen does not greatly improve shortness of breath but can allow people with COPD and low oxygen levels to do more exercise and household activity.</span><span class="citable__li" citable_id="169"><a href="#citable__169"><strong>^</strong></a> <c_txt>Shortness of breath gets worse as COPD gets worse.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="169"><a href="#citable__169"><strong>^</strong></a> <c_txt>Exercise improves shortness of breath and will help you be more active.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="169"><a href="#citable__169"><strong>^</strong></a> <c_txt>More shortness of breath than usual.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__24" class="citable__local-anchor">.</a><span class='citationPopup' rel="24"><a href="/Oxygen_therapy" title="Oxygen therapy">Long-term oxygen therapy</a> for at least 16 hours a day can improve the quality of life and survival for people with COPD and arterial <a href="/Hypoxemia" title="Hypoxemia">hypoxemia</a> or with complications of hypoxemia such as <a href="/Pulmonary_hypertension" title="Pulmonary hypertension">pulmonary hypertension</a>, <a href="/Cor_pulmonale" title="Cor pulmonale">cor pulmonale</a>, or secondary <a href="/Erythrocytosis" title="Erythrocytosis" class="mw-redirect">erythrocytosis</a>.</span><span class="citable__li" citable_id="24"><a href="#citable__24"><strong>^</strong></a> <c_txt>COPD is a life-long disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="24"><a href="#citable__24"><strong>^</strong></a> <c_txt>Cullen DL. Long term oxygen therapy adherence and copd: What we don't know.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Update in Chronic Obstructive Pulmonary Disease 2006 -- Rabe et al. 175 (12): 1222 -- American Journal of Respiratory and Critical Care Medicine</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://ajrccm.atsjournals.org/cgi/content/full/175/12/1222">ajrccm.atsjournals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="24"><a href="#citable__24"><strong>^</strong></a> <c_txt>You require long-term oxygen or corticosteroid therapy.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_50" class="reference"><a href="#cite_note-50"><span>[</span>51<span>]</span></a></sup> <a name="citable__22" class="citable__local-anchor">.</a><span class='citationPopup' rel="22">High concentrations of supplemental oxygen can lead to the accumulation of carbon dioxide and <a href="/Respiratory_acidosis" title="Respiratory acidosis">respiratory acidosis</a> for some people with severe COPD; lower oxygen flow rates are generally safer for these individuals.</span><span class="citable__li" citable_id="22"><a href="#citable__22"><strong>^</strong></a> <c_txt>Some people with COPD may have asthma too.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="22"><a href="#citable__22"><strong>^</strong></a> <c_txt>People with very severe COPD have a FEV1 of less than 30% of predicted value or 30% to 49% of predicted value plus chronic respiratory failure (carbon dioxide remains in the lungs).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="22"><a href="#citable__22"><strong>^</strong></a> <c_txt>In very severe COPD, you have some of the symptoms of stages 1 through 3, plus you may have: .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> </div> <h4><span class="mw-headline" id="wikipedia_Pulmonary_rehabilitation">Pulmonary rehabilitation</span></h4> <div style="margin: 1.12em 0; display:block"><a name="citable__298" class="citable__local-anchor">.</a><span class='citationPopup' rel="298"><a href="/Pulmonary_rehabilitation" title="Pulmonary rehabilitation">Pulmonary rehabilitation</a> is a program of exercise, disease management and counselling coordinated to benefit the individual.</span><span class="citable__li" citable_id="298"><a href="#citable__298"><strong>^</strong></a> <c_txt>Ask whether you will benefit from a pulmonary rehab program—a coordinated program of exercise, physical therapy, disease management training, advice on diet, and counseling.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="298"><a href="#citable__298"><strong>^</strong></a> <c_txt>Exercise conditioning in the rehabilitation of patients with chronic obstructive pulmonary disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="298"><a href="#citable__298"><strong>^</strong></a> <c_txt>Pulmonary rehabilitation programs are tailored to the needs of each individual.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_51" class="reference"><a href="#cite_note-51"><span>[</span>52<span>]</span></a></sup> <a name="citable__2" class="citable__local-anchor">.</a><span class='citationPopup' rel="2">Pulmonary rehabilitation has been shown to improve shortness of breath and exercise capacity.</span><span class="citable__li" citable_id="2"><a href="#citable__2"><strong>^</strong></a> <c_txt>Ginseng improves pulmonary functions and exercise capacity in patients with COPD. .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic obstructive pulmonary disease - Alternative Medicine Report</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.qualityhealth.com/health-encyclopedia/alternative-medicine/chronic-obstructive-pulmonary-disease">www.qualityhealth.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="2"><a href="#citable__2"><strong>^</strong></a> <c_txt>Exercise improves shortness of breath and will help you be more active.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="2"><a href="#citable__2"><strong>^</strong></a> <c_txt>Pulmonary rehabilitation improves quality of life.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.jhsmiami.org/body.cfm?xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw257776">www.jhsmiami.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <a name="citable__197" class="citable__local-anchor">.</a><span class='citationPopup' rel="197">It has also been shown to improve the sense of control a patient has over their disease as well as their emotions.</span><span class="citable__li" citable_id="197"><a href="#citable__197"><strong>^</strong></a> <c_txt>Gallefoss F, Bakke PS, Kjaersgaard P. Quality of life assessment after patient education in a randomized controlled study on asthma and chronic obstructive pulmonary disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://qol.thoracic.org/sections/specific-diseases/copd.html">qol.thoracic.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="197"><a href="#citable__197"><strong>^</strong></a> <c_txt>Emotional status does no alter exercise tolerance in patients with chronic obstructive pulmonary disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Anxiety and Chronic Obstructive Pulmonary Disease: Prevalence, Impact, and Treatment -- Brenes 65 (6): 963 -- Psychosomatic Medicine</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.psychosomaticmedicine.org/cgi/content/full/65/6/963">www.psychosomaticmedicine.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="197"><a href="#citable__197"><strong>^</strong></a> <c_txt>Although randomised control trials are yet to be reported, non-randomised studies have consistently shown benefit in COPD patients taking statins compared with those not.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Potential benefits of statins on morbidity and mortality in chronic obstructive pulmonary disease: a review of the evidence -- Young et al. 85 (1006): 414 -- Postgraduate Medical Journal </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://pmj.bmj.com/content/85/1006/414.full">pmj.bmj.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid12137716_52_0" class="reference"><a href="#cite_note-pmid12137716-52"><span>[</span>53<span>]</span></a></sup></div> <h4><span class="mw-headline" id="wikipedia_Nutrition">Nutrition</span></h4> <div style="margin: 1.12em 0; display:block"><a name="citable__281" class="citable__local-anchor">.</a><span class='citationPopup' rel="281">Being either underweight or overweight can affect the symptoms, degree of disability and prognosis of COPD. People with COPD who are underweight can improve their breathing muscle strength by increasing their calorie intake.</span><span class="citable__li" citable_id="281"><a href="#citable__281"><strong>^</strong></a> <c_txt>N-acetyl cysteine (NAC) may improve breathing in people with COPD. .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Chronic Obstructive Pulmonary Disease | Lifescript.com</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.lifescript.com/Health/A-Z/Alternative-Therapies_A-Z/ByCondition/C/Chronic_Obstructive_Pulmonary_Disease.aspx">www.lifescript.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="281"><a href="#citable__281"><strong>^</strong></a> <c_txt>We made an untested assumption that patients with airflow obstruction who do not recognize or report symptoms would benefit to the same degree as patients with symptoms studied in the clinical trials.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force — Ann Intern Med </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.annals.org/lookup/pmid?view=long&pmid=18316746">www.annals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="281"><a href="#citable__281"><strong>^</strong></a> <c_txt>A review of studies has found that the inactivated flu shot may reduce the risk of a sudden increase in shortness of breath ( COPD exacerbation) .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid17507545_1_11" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup> <a name="citable__26" class="citable__local-anchor">.</a><span class='citationPopup' rel="26">When combined with regular exercise or a pulmonary rehabilitation programme, this can lead to improvements in COPD symptoms.</span><span class="citable__li" citable_id="26"><a href="#citable__26"><strong>^</strong></a> <c_txt>An exercise program or pulmonary rehabilitation .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="26"><a href="#citable__26"><strong>^</strong></a> <c_txt>Participating in an exercise program or pulmonary rehabilitation .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="26"><a href="#citable__26"><strong>^</strong></a> <c_txt>Chronic stable COPD: Treatment of chronic stable COPD aims to prevent exacerbations and provide long-term improvement in lung and physical function through drug and O 2 therapy, smoking cessation, exercise, enhancement of nutrition, and pulmonary rehabilitation.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>THE MERCK MANUAL OF GERIATRICS, Ch. 78, Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.merck.com/mkgr/mmg/sec10/ch78/ch78a.jsp">www.merck.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> </div> <h4><span class="mw-headline" id="wikipedia_Cold_weather_protection">Cold weather protection</span></h4> <div style="margin: 1.12em 0; display:block"><a name="citable__176" class="citable__local-anchor">.</a><span class='citationPopup' rel="176">One of the major winter hazards for individuals with respiratory problems is breathing cold air.</span><span class="citable__li" citable_id="176"><a href="#citable__176"><strong>^</strong></a> <c_txt>Shortness of breath that is persistent and gets worse, occurs during exercise, and gets worse during respiratory infections, such as colds.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="176"><a href="#citable__176"><strong>^</strong></a> <c_txt>It is not yet known whether secondhand smoke can lead to COPD. But people who are exposed to secondhand smoke for a long time are more likely to have breathing problems and respiratory diseases.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="176"><a href="#citable__176"><strong>^</strong></a> <c_txt>Infections, especially respiratory infections, from colds to pneumonias, will trigger a sudden worsening of COPD, and acute exacerbations occur more often in the winter, the season with the most viral infections.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__268" class="citable__local-anchor">.</a><span class='citationPopup' rel="268">For many people with COPD, breathing cold air causes <a href="/Bronchospasm" title="Bronchospasm">bronchospasm</a> and increased breathlessness.</span><span class="citable__li" citable_id="268"><a href="#citable__268"><strong>^</strong></a> <c_txt>COPD is an insidious disease, and it develops over many years before it compromises people enough that they go to a doctor.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="268"><a href="#citable__268"><strong>^</strong></a> <c_txt>A review of studies has found that the inactivated flu shot may reduce the risk of a sudden increase in shortness of breath ( COPD exacerbation) .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="268"><a href="#citable__268"><strong>^</strong></a> <c_txt>Breathlessness during mild exercise is the most common reason that people with COPD first seek out a doctor.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__247" class="citable__local-anchor">.</a><span class='citationPopup' rel="247">Correctly managing symptoms and protecting against breathing cold air in the winter can help prevent breathing problems like <a href="/Exacerbation" title="Exacerbation" class="mw-redirect">exacerbations</a>.</span><span class="citable__li" citable_id="247"><a href="#citable__247"><strong>^</strong></a> <c_txt>Long-acting bronchodilators help prevent breathing problems.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="247"><a href="#citable__247"><strong>^</strong></a> <c_txt>Talk with your health professional about getting a yearly flu shot and the pneumococcal vaccine (which can help protect against complications of pneumonia).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="247"><a href="#citable__247"><strong>^</strong></a> <c_txt>If you have a rapid, sometimes sudden, and prolonged increase in symptoms (cough, amount of mucus, and/or shortness of breath), you may be having a COPD exacerbation .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__203" class="citable__local-anchor">.</a><span class='citationPopup' rel="203">Exacerbations are common in the winter months and cause a significant rise in COPD hospital admissions.</span><span class="citable__li" citable_id="203"><a href="#citable__203"><strong>^</strong></a> <c_txt>Importantly, participation in PR can also lead to reductions in COPD exacerbations [104] and time spent in the hospital [96,105].</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="203"><a href="#citable__203"><strong>^</strong></a> <c_txt>COPD is one of the most common respiratory conditions among adults worldwide and is the fourth leading cause of death in the United States.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="203"><a href="#citable__203"><strong>^</strong></a> <c_txt>It usually takes many years for the lung damage to start causing symptoms, so COPD is most common in people who are older than 60.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__16" class="citable__local-anchor">.</a><span class='citationPopup' rel="16">The <a href="/Common_cold" title="Common cold">common cold</a> or other forms of respiratory tract infections may also be potentially serious for the COPD patient.</span><span class="citable__li" citable_id="16"><a href="#citable__16"><strong>^</strong></a> <c_txt>However, further work is needed to clarify the potential role of these treatments for patients with COPD since (1) selected subgroups may benefit more than others, and (2) we may not as yet have identified the optimal anabolic hormone regimen and type of concomitant training program needed to achieve benefits.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="16"><a href="#citable__16"><strong>^</strong></a> <c_txt>Methylxanthines , which generally are used for severe cases of COPD. They may have serious side effects and so are not usually recommended.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="16"><a href="#citable__16"><strong>^</strong></a> <c_txt>The existing published guidelines for pulmonary rehabilitation have been referenced in this evidence-based review article, as they offer additional discussion of the current recommendations for exercise, as well as recommendations on the educational, behavioral, and psychosocial facets of pulmonary rehabilitation for patients with COPD and other forms of respiratory disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> Many respiratory tract infections are contagious. <a name="citable__238" class="citable__local-anchor">.</a><span class='citationPopup' rel="238">During the winter, the incidence of the common cold and <a href="/Upper_respiratory_tract" title="Upper respiratory tract">upper respiratory tract</a> infections is much higher than during other times of the year.</span><span class="citable__li" citable_id="238"><a href="#citable__238"><strong>^</strong></a> <c_txt>In other words, an FEV1 of 100% means the lungs are working normally; 80% is less than normal; 30% is very much less than normal.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="238"><a href="#citable__238"><strong>^</strong></a> <c_txt>The rates were higher in boys under age 18 years than in girls in the same age group.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="238"><a href="#citable__238"><strong>^</strong></a> <c_txt>Shortness of breath that is persistent and gets worse, occurs during exercise, and gets worse during respiratory infections, such as colds.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__44" class="citable__local-anchor">.</a><span class='citationPopup' rel="44">For people with COPD, it is important to maintain a healthy lifestyle and keep active during fall and winter.</span><span class="citable__li" citable_id="44"><a href="#citable__44"><strong>^</strong></a> <c_txt>COPD: Keeping your diet healthy .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="44"><a href="#citable__44"><strong>^</strong></a> <c_txt>Breathlessness during mild exercise is the most common reason that people with COPD first seek out a doctor.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="44"><a href="#citable__44"><strong>^</strong></a> <c_txt>Many people with severe COPD have trouble keeping their weight up and their bodies strong.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> They should dress appropriately for cold temperatures by wearing insulated winter clothing and keeping the head and face warm. During short exposures the body can lose a lot of heat and energy if not properly protected.</div> <div style="margin: 1.12em 0; display:block"><a name="citable__261" class="citable__local-anchor">.</a><span class='citationPopup' rel="261">People with COPD should have annual <a href="/Flu" title="Flu" class="mw-redirect">flu</a> and <a href="/Pneumonia" title="Pneumonia">pneumonia</a> <a href="/Vaccinations" title="Vaccinations" class="mw-redirect">vaccinations</a> and avoid exposure to contaminates to avoid catching a cold.</span><span class="citable__li" citable_id="261"><a href="#citable__261"><strong>^</strong></a> <c_txt>You should also get the pneumonia vaccine.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="261"><a href="#citable__261"><strong>^</strong></a> <c_txt>Pneumonia shots: People with COPD often get pneumonia.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="261"><a href="#citable__261"><strong>^</strong></a> <c_txt>Quitting smoking, staying away from people who are smoking, and avoiding exposure to other lung irritants are the most important ways to reduce your risk of developing COPD or to slow the progress of the disease if you have it.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__196" class="citable__local-anchor">.</a><span class='citationPopup' rel="196">They should also wash their hands regularly and drink large amounts of fluids.</span><span class="citable__li" citable_id="196"><a href="#citable__196"><strong>^</strong></a> <c_txt>Large amounts of the Z variant of the AT protein accumulate in hepatocytes, where they can cause liver disease [35].</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Genetic Risk Factors for Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://tobaccodocuments.org/pm/2063633573-3584.html">tobaccodocuments.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="196"><a href="#citable__196"><strong>^</strong></a> <c_txt>You should also avoid close contact with people who have a cold or the flu, and wash your hands often to help you stay healthy.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__270" class="citable__local-anchor">.</a><span class='citationPopup' rel="270">Avoiding contact with people who are suffering from a cold will also reduce the risk.</span><span class="citable__li" citable_id="270"><a href="#citable__270"><strong>^</strong></a> <c_txt>Screening is often recommended for adults who are at increased risk for developing COPD. These people include: .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="270"><a href="#citable__270"><strong>^</strong></a> <c_txt>Persons with asthma who receive assistance with assessing and reducing exposure to environmental risk factors in their home, school, and work environments.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="270"><a href="#citable__270"><strong>^</strong></a> <c_txt>Quitting smoking, staying away from people who are smoking, and avoiding exposure to other lung irritants are the most important ways to reduce your risk of developing COPD or to slow the progress of the disease if you have it.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__10" class="citable__local-anchor">.</a><span class='citationPopup' rel="10">To improve comfort during cold exposure, a <a href="/Facemask" title="Facemask" class="mw-redirect">facemask</a> that is designed to warm breathed air can be worn.</span><span class="citable__li" citable_id="10"><a href="#citable__10"><strong>^</strong></a> <c_txt>Working around certain kinds of chemicals and breathing in the fumes for many years Working in a dusty area over many years Heavy exposure to air pollution.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD Symptoms - COPD Treatment</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.iifar.org/COPD_Symptoms.html">www.iifar.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="10"><a href="#citable__10"><strong>^</strong></a> <c_txt>Shortness of breath that is persistent and gets worse, occurs during exercise, and gets worse during respiratory infections, such as colds.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> A facemask can protect against cold weather hazards.</div> <h4><span class="mw-headline" id="wikipedia_Surgery">Surgery</span></h4> <div style="margin: 1.12em 0; display:block"><a name="citable__120" class="citable__local-anchor">.</a><span class='citationPopup' rel="120">Surgery is sometimes helpful for COPD in selected cases.</span><span class="citable__li" citable_id="120"><a href="#citable__120"><strong>^</strong></a> <c_txt>These results may be especially helpful in advanced COPD cases.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>AMDA: Publications - Caring for the Ages - October 2003</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.amda.com/publications/caring/october2003/copd.cfm">www.amda.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="120"><a href="#citable__120"><strong>^</strong></a> <c_txt>Grade B - Physiotherapy using positive expiratory pressure masks should be considered for selected patients with exacerbations of COPD, to help with clearing sputum.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> NGC - NGC Summary </c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.guideline.gov/summary/summary.aspx?doc_id=5061&nbr=003545&string=Chronic+AND+obstructive+AND+pulmonary+AND+disease">www.guideline.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="120"><a href="#citable__120"><strong>^</strong></a> <c_txt>A test for plasma levels of brain natriuretic peptide may be helpful in some cases for distinguishing dyspnea due to heart failure from dyspnea due to COPD. .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>THE MERCK MANUAL OF GERIATRICS, Ch. 78, Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.merck.com/mkgr/mmg/sec10/ch78/ch78a.jsp">www.merck.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__292" class="citable__local-anchor">.</a><span class='citationPopup' rel="292">A bullectomy is the surgical removal of a bulla, a large air-filled space that can squash the surrounding, more normal lung.</span><span class="citable__li" citable_id="292"><a href="#citable__292"><strong>^</strong></a> <c_txt>A bulla is a large air sac.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://catalog.nucleusinc.com/displaymonograph.php?MID=29">catalog.nucleusinc.com</a> [Source type: General]</li><li> <em><c_title>Chronic Obstructive Lung Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.metrohealth.org/body.cfm?id=1553">www.metrohealth.org</a> [Source type: General]</li><li> <em><c_title>Birdsong Medical Devices- Education and information for people suffering from Asthma, Chronic Obstructive Pulmonary Disease (COPD) or Sleep Apnea</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.birdsongmedical.com/education.htm">www.birdsongmedical.com</a> [Source type: General]</li><li> <em><c_title>Chronic Obstructive Lung Disease (COPD)</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.metrohealth.org/body.cfm?id=1553&oTopID=1551">www.metrohealth.org</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="292"><a href="#citable__292"><strong>^</strong></a> <c_txt>Bullectomy removes bullae from the lungs in those who mainly have emphysema.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="292"><a href="#citable__292"><strong>^</strong></a> <c_txt>A bullectomy , which removes bullae from the lungs in those who mainly have emphysema.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__175" class="citable__local-anchor">.</a><span class='citationPopup' rel="175"><a href="/Lung_volume_reduction_surgery" title="Lung volume reduction surgery">Lung volume reduction surgery</a> is similar; parts of the lung that are particularly damaged by emphysema are removed allowing the remaining, relatively good lung to expand and work better.</span><span class="citable__li" citable_id="175"><a href="#citable__175"><strong>^</strong></a> <c_txt>Lung volume reduction surgery .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="175"><a href="#citable__175"><strong>^</strong></a> <c_txt>Removes part of one or both lungs, making room for the rest of the lung to work better.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="175"><a href="#citable__175"><strong>^</strong></a> <c_txt>Lung volume reduction surgery removes a portion of one or both lungs, making room for the remaining lung tissue to work more efficiently.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__283" class="citable__local-anchor">.</a><span class='citationPopup' rel="283"><a href="/Lung_transplantation" title="Lung transplantation">Lung transplantation</a> is sometimes performed for severe COPD, particularly in younger individuals.</span><span class="citable__li" citable_id="283"><a href="#citable__283"><strong>^</strong></a> <c_txt>People with severe COPD are the most common recipients of lung transplants.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="283"><a href="#citable__283"><strong>^</strong></a> <c_txt>Three-quarters of COPD patients who receive lung transplants live for ≥2 years after the operation, and many of the survivors have substantially improved abilities to exercise.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="283"><a href="#citable__283"><strong>^</strong></a> <c_txt>In brief, arm training has been studied because patients with moderate to severe COPD, particularly those with mechanical disadvantage of the diaphragm due to lung hyperinflation, have difficulty performing ADLs that involve the use of the upperlimbs.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> </div> <h2><span class="mw-headline" id="wikipedia_Prognosis">Prognosis</span></h2> <div style="margin: 1.12em 0; display:block"><a name="citable__195" class="citable__local-anchor">.</a><span class='citationPopup' rel="195">COPD usually gradually gets worse over time and can lead to death.</span><span class="citable__li" citable_id="195"><a href="#citable__195"><strong>^</strong></a> <c_txt>Shortness of breath gets worse as COPD gets worse.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="195"><a href="#citable__195"><strong>^</strong></a> <c_txt>COPD gradually gets worse over time.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="195"><a href="#citable__195"><strong>^</strong></a> <c_txt>Chronic obstructive pulmonary disease (COPD) gradually gets worse over time.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> The rate at which it gets worse varies between individuals. The factors that predict a poorer prognosis are:<sup id="wikipedia_cite_ref_pmid17507545_1_12" class="reference"><a href="#cite_note-pmid17507545-1"><span>[</span>2<span>]</span></a></sup></div> <ul> <li>Severe airflow obstruction (low FEV<sub>1</sub>)</li> <li>Poor exercise capacity</li> <li>Shortness of breath</li> <li>Significantly underweight or overweight</li> <li>Complications like respiratory failure or cor pulmonale</li> <li>Continued smoking</li> <li>Frequent acute exacerbations</li> </ul> <h2><span class="mw-headline" id="wikipedia_Epidemiology">Epidemiology</span></h2> <div class="thumb tright"> <div class="thumbinner" style="width:222px;"><img alt="" src="http://images-mediawiki-sites.thefullwiki.org/08/3/7/6/94607321175588943.png" width="220" height="97" class="thumbimage" /> <div class="thumbcaption"> <div class="magnify"><img src="http://images-mediawiki-sites.thefullwiki.org/09/7/4/4/3695493113783710.png" width="15" height="11" alt="" /></div> <a href="/Disability-adjusted_life_year" title="Disability-adjusted life year">Disability-adjusted life year</a> for chronic obstructive pulmonary disease per 100,000 inhabitants in 2004.<sup id="wikipedia_cite_ref_53" class="reference"><a href="#cite_note-53"><span>[</span>54<span>]</span></a></sup> <div class="references-small" style="-moz-column-count:3; column-count:3;"><span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#b3b3b3 solid 1px;; background-color:#b3b3b3; color:#b3b3b3">    </span> no data</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#ffff65 solid 1px;; background-color:#ffff65; color:#ffff65">    </span> less than 110</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#fff200 solid 1px;; background-color:#fff200; color:#fff200">    </span> 110-220</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#ffdc00 solid 1px;; background-color:#ffdc00; color:#ffdc00">    </span> 220-330</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#ffc600 solid 1px;; background-color:#ffc600; color:#ffc600">    </span> 330-440</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#ffb000 solid 1px;; background-color:#ffb000; color:#ffb000">    </span> 440-550</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#ff9a00 solid 1px;; background-color:#ff9a00; color:#ff9a00">    </span> 550-660</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#ff8400 solid 1px;; background-color:#ff8400; color:#ff8400">    </span> 660-770</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#ff6e00 solid 1px;; background-color:#ff6e00; color:#ff6e00">    </span> 770-880</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#ff5800 solid 1px;; background-color:#ff5800; color:#ff5800">    </span> 880-990</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#ff4200 solid 1px;; background-color:#ff4200; color:#ff4200">    </span> 990-1100</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#ff2c00 solid 1px;; background-color:#ff2c00; color:#ff2c00">    </span> 1100-1350</span> <span style="margin:0px; padding-bottom:1px; font-size:90%; display:block;"><span style="border:#cb0000 solid 1px;; background-color:#cb0000; color:#cb0000">    </span> more than 1350</span></div> </div> </div> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__18" class="citable__local-anchor">.</a><span class='citationPopup' rel="18">In the United States, the <a href="/Prevalence" title="Prevalence">prevalence</a> of COPD is approximately 1 in 20 or 5%, totalling approximately 13.5 million people in USA,<sup id="wikipedia_cite_ref_54" class="reference"><a href="#cite_note-54"><span>[</span>55<span>]</span></a></sup> or possibly approximately 25 million people if undiagnosed cases are included.</span><span class="citable__li" citable_id="18"><a href="#citable__18"><strong>^</strong></a> <c_txt>In 2004 a comparison of the two major heart/lung diseases in the United States revealed 24 million cases of COPD (estimated, half still undiagnosed) and 79.4 million cases of cardiovascular disease (NHLBI, 2007).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="18"><a href="#citable__18"><strong>^</strong></a> <c_txt>In the United States, higher rates of COPD are found among white people, blue-collar workers, and people with less formal education.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="18"><a href="#citable__18"><strong>^</strong></a> <c_txt>An estimated 14.9 million persons in the United States have asthma.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>24 Respiratory Diseases</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.healthypeople.gov/document/HTML/Volume2/24Respiratory.htm">www.healthypeople.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_55" class="reference"><a href="#cite_note-55"><span>[</span>56<span>]</span></a></sup></div> <h2><span class="mw-headline" id="wikipedia_History">History</span></h2> <div style="margin: 1.12em 0; display:block"><a name="citable__171" class="citable__local-anchor">.</a><span class='citationPopup' rel="171">COPD has probably always existed but has been called by different names in the past.</span><span class="citable__li" citable_id="171"><a href="#citable__171"><strong>^</strong></a> <c_txt>In the United Kingdom, over the past 30 years, mortality from COPD has fallen in men and risen in women, and the remaining sex differences will probably disappear in the near future ( 21 ).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Update in Chronic Obstructive Pulmonary Disease 2006 -- Rabe et al. 175 (12): 1222 -- American Journal of Respiratory and Critical Care Medicine</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://ajrccm.atsjournals.org/cgi/content/full/175/12/1222">ajrccm.atsjournals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="171"><a href="#citable__171"><strong>^</strong></a> <c_txt>In the past, COPD patients with emphysema were said to have type A and were sometimes called "pink puffers."</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__137" class="citable__local-anchor">.</a><span class='citationPopup' rel="137">Bonet described a condition of “voluminous lungs” in 1679. In 1769, <a href="/Giovanni_Morgagni" title="Giovanni Morgagni" class="mw-redirect">Giovanni Morgagni</a> described 19 cases where the lungs were “turgid” particularly from air.</span><span class="citable__li" citable_id="137"><a href="#citable__137"><strong>^</strong></a> <c_txt>Avoiding conditions that may irritate your lungs, such as indoor and outdoor air pollution, smog, cold dry air, hot humid air, or high altitudes.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="137"><a href="#citable__137"><strong>^</strong></a> <c_txt>Avoid conditions that may irritate your lungs, such as indoor and outdoor air pollution, smog, cold dry air, hot humid air, or high altitudes.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="137"><a href="#citable__137"><strong>^</strong></a> <c_txt>Avoid conditions that may irritate your lungs , such as indoor and outdoor air pollution, smog, cold dry air, hot humid air, or high altitudes.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid18046898_56_0" class="reference"><a href="#cite_note-pmid18046898-56"><span>[</span>57<span>]</span></a></sup> <a name="citable__182" class="citable__local-anchor">.</a><span class='citationPopup' rel="182">The first description and illustration of the enlarged airspaces in emphysema was provided by Ruysh in 1721.<span class="citation web"><a href="http://www.mhprofessional.com/downloads/products/0071457399/0071457399_chap40.pdf" class="external text" rel="nofollow">"History of pathologic descriptions of COPD"</a> (PDF)<span class="printonly">.</span><span class="citable__li" citable_id="182"><a href="#citable__182"><strong>^</strong></a> <c_txt>AAT is a protein that helps protect the lungs from the damage caused by inflammation that can lead to emphysema and COPD. A computed tomography (CT) scan provides a detailed image of the lungs.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="182"><a href="#citable__182"><strong>^</strong></a> <c_txt>They develop COPD-like lesions and emphysema-like airspace enlargement within a few months of active tobacco smoke exposure [ 99 ].</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Respiratory Research | Full text | Models of chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://respiratory-research.com/content/5/1/18">respiratory-research.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="182"><a href="#citable__182"><strong>^</strong></a> <c_txt>Other approaches are based on genetically-targeted mice which develop COPD-like lesions with emphysema, and such mice provide deep insights into pathophysiological mechanisms.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Respiratory Research | Full text | Models of chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://respiratory-research.com/content/5/1/18">respiratory-research.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__302" class="citable__local-anchor">.</a><span class='citationPopup' rel="302"><a href="http://www.mhprofessional.com/downloads/products/0071457399/0071457399_chap40.pdf" class="external free" rel="nofollow">http://www.mhprofessional.com/downloads/products/0071457399/0071457399_chap40.pdf</a></span>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=History+of+pathologic+descriptions+of+COPD&rft.atitle=&rft_id=http%3A%2F%2Fwww.mhprofessional.com%2Fdownloads%2Fproducts%2F0071457399%2F0071457399_chap40.pdf&rfr_id=info:sid/en.wikipedia.org:Chronic_obstructive_pulmonary_disease"><span style="display: none;"> </span></span> <a href="/Matthew_Baillie" title="Matthew Baillie">Matthew Baillie</a> illustrated an emphysematous lung in 1789 and described the destructive character of the condition.</span><span class="citable__li" citable_id="302"><a href="#citable__302"><strong>^</strong></a> <c_txt>Freedom From Smoking® Online American Lung Association's online smoking cessation program http://www.lungusa.org .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="302"><a href="#citable__302"><strong>^</strong></a> <c_txt>American Lung Association Smoking Cessation Resources Fact Sheet http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=44456 .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="302"><a href="#citable__302"><strong>^</strong></a> <c_txt>The brochure is printed on their website at http://www.lungusa.org, and it can be downloaded in PDF format.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid18046898_56_1" class="reference"><a href="#cite_note-pmid18046898-56"><span>[</span>57<span>]</span></a></sup> <a name="citable__181" class="citable__local-anchor">.</a><span class='citationPopup' rel="181">Badham used the word "catarrh" to describe the cough and mucus hypersecretion of chronic bronchitis in 1814. He recognised that chronic bronchitis was a disabling disorder.</span><span class="citable__li" citable_id="181"><a href="#citable__181"><strong>^</strong></a> <c_txt>Chronic bronchitis is defined as productive cough for most days of the week for at least 3 mo in 2 successive yr.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>THE MERCK MANUAL OF GERIATRICS, Ch. 78, Chronic Obstructive Pulmonary Disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.merck.com/mkgr/mmg/sec10/ch78/ch78a.jsp">www.merck.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="181"><a href="#citable__181"><strong>^</strong></a> <c_txt>Exacerbation Sputum Breathlessness Chronic cough Productive cough Productive cough Cough up mucus Frequent respiratory infections Chest tightness Bronchospasm more...</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Copd - Kosmix : Reference, Videos, Images, News, Shopping and more... </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.kosmix.com/topic/COPD">www.kosmix.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="181"><a href="#citable__181"><strong>^</strong></a> <c_txt>This compound definition uses the combination of chronic bronchitis defined in clinical terms, emphysema in anatomical terms, and airflow obstruction representing a physiologic state.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Nosology for Our Day: Its Application to Chronic Obstructive Pulmonary Disease -- Snider 167 (5): 678 -- American Journal of Respiratory and Critical Care Medicine</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://ajrccm.atsjournals.org/cgi/content/full/167/5/678">ajrccm.atsjournals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> </div> <div style="margin: 1.12em 0; display:block"><a name="citable__130" class="citable__local-anchor">.</a><span class='citationPopup' rel="130"><a href="/Ren%C3%A9_Laennec" title="René Laennec">René Laennec</a>, the physician who invented the <a href="/Stethoscope" title="Stethoscope">stethoscope</a>, used the term "emphysema" in his book <em>A Treatise on the Diseases of the Chest and of Mediate Auscultation</em> (1837) to describe lungs that did not collapse when he opened the chest during an autopsy.</span><span class="citable__li" citable_id="130"><a href="#citable__130"><strong>^</strong></a> <c_txt>In acute exacerbations of COPD, chest x-rays are used to look for pneumothorax, pneumonia, and atelectasis (collapse of part of a lung) (Wise, 2007).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="130"><a href="#citable__130"><strong>^</strong></a> <c_txt>When the chest is surgically opened, however, the lungs recoil, as the innate elasticity of the lungs pulls them back to their resting size.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="130"><a href="#citable__130"><strong>^</strong></a> <c_txt>It may be used to get a detailed look at lung damage caused by emphysema.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <a name="citable__128" class="citable__local-anchor">.</a><span class='citationPopup' rel="128">He noted that they did not collapse as usual because they were full of air and the airways were filled with mucus.</span><span class="citable__li" citable_id="128"><a href="#citable__128"><strong>^</strong></a> <c_txt>The airways and air sacs in the lung are normally elastic-that is, they try to spring back to their original shape after being stretched or filled with air, just the way a new rubber band or balloon would.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD)</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://catalog.nucleusinc.com/displaymonograph.php?MID=29">catalog.nucleusinc.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="128"><a href="#citable__128"><strong>^</strong></a> <c_txt>Cells in the airways make more mucus (sputum) than usual, which tends to clog the airways.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Understanding COPD – Chronic Obstructive Pulmonary Disease | Womens Health Base</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.womenshealthbase.com/copd/all/1/">www.womenshealthbase.com</a> [Source type: General]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="128"><a href="#citable__128"><strong>^</strong></a> <c_txt>As a result, the airways produce more mucus than they normally would.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>COPD (Chronic Obstructive Pulmonary Disease) - Yahoo! Health</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.yahoo.com/respiratory-overview/copd-chronic-obstructive-pulmonary-disease/healthwise--hw32559.html">health.yahoo.com</a> [Source type: General]</li><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid18046898_56_2" class="reference"><a href="#cite_note-pmid18046898-56"><span>[</span>57<span>]</span></a></sup></div> <div style="margin: 1.12em 0; display:block"><a name="citable__218" class="citable__local-anchor">.</a><span class='citationPopup' rel="218">In 1842, <a href="/John_Hutchinson" title="John Hutchinson">John Hutchinson</a> invented the <a href="/Spirometer" title="Spirometer">spirometer</a>, which allowed the measurement of vital capacity of the lungs.</span><span class="citable__li" citable_id="218"><a href="#citable__218"><strong>^</strong></a> <c_txt>When measuring vital capacity this way, the result is also called the forced vital capacity (FVC) (Wanger & West, 2005).</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="218"><a href="#citable__218"><strong>^</strong></a> <c_txt>A normal person has an FEV1/FVC between 0.70 and 0.80; in other words, a person with normal lungs can exhale between 70% and 80% of their vital capacity in the first second.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="218"><a href="#citable__218"><strong>^</strong></a> <c_txt>This ratio, FEV1/FVC (the percent of the vital capacity that can be exhaled in one second), declines as a person ages, but even elderly people will have FEV1/FVC > 0.70 if their lungs are normal.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <a name="citable__72" class="citable__local-anchor">.</a><span class='citationPopup' rel="72">However, his spirometer could only measure volume, not airflow.</span><span class="citable__li" citable_id="72"><a href="#citable__72"><strong>^</strong></a> <c_txt>For COPD, the two general classes of breathing tests are (1) measurements of effective lung volumes, and (2) measurements of airflow rates and airflow volumes.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <sup id="wikipedia_cite_ref_pmid15849329_57_0" class="reference"><a href="#cite_note-pmid15849329-57"><span>[</span>58<span>]</span></a></sup> Tiffeneau in 1947 and Gaensler in 1950 and 1951 described the principles of measuring airflow.</div> <div style="margin: 1.12em 0; display:block"><a name="citable__280" class="citable__local-anchor">.</a><span class='citationPopup' rel="280">The terms chronic bronchitis and emphysema were formally defined at the CIBA guest symposium of physicians in 1959. The term COPD was first used by William Briscoe in 1965 and has gradually overtaken other terms to become established today as the preferred name for this disease.</span><span class="citable__li" citable_id="280"><a href="#citable__280"><strong>^</strong></a> <c_txt>This form of COPD is called chronic bronchitis .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Chronic Obstructive Pulmonary Disease (COPD) | Occupational Therapy Continuing Education (CE) | TherapyCEU.com | Wild Iris Medical Education</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.nursingceu.com/courses/217/index_ot.html">www.nursingceu.com</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="280"><a href="#citable__280"><strong>^</strong></a> <c_txt>Chronic bronchitis and emphysema are what fall under the COPD umbrella.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Copd - Kosmix : Reference, Videos, Images, News, Shopping and more... </c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.kosmix.com/topic/COPD">www.kosmix.com</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="280"><a href="#citable__280"><strong>^</strong></a> <c_txt>COPD is often a mix of two diseases, chronic bronchitis and emphysema .</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Healthwise Knowledgebase</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://health.med.umich.edu/blank.cfm?xyzpdqabc=0&id=6&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">health.med.umich.edu</a> [Source type: FILTERED WITH BAYES]</li><li> <em><c_title>Health Information</c_title></em> <c_date>10 February 2010 12:51 UTC</c_date> <a href="http://www.jhsmiami.org/blank.cfm?print=yes&xyzpdqabc=0&id=9190&action=detail&AEProductID=HW_Knowledgebase&AEArticleID=hw32559">www.jhsmiami.org</a> [Source type: FILTERED WITH BAYES]</li></ul></c_src></small></div><br></span> </div> <h2><span class="mw-headline" id="wikipedia_See_also">See also</span></h2> <ul> <li><a href="/COPD_Awareness_Month" title="COPD Awareness Month">COPD Awareness Month</a></li> <li><a href="/Restrictive_lung_disease" title="Restrictive lung disease">Restrictive lung disease</a></li> <li><a href="/Obstructive_lung_disease" title="Obstructive lung disease">Obstructive lung disease</a></li> </ul> <h2><span class="mw-headline" id="wikipedia_Footnotes">Footnotes</span></h2> <div class="references-small references-column-count references-column-count-2" style="-moz-column-count:2; column-count:2;"> <ol class="references"> <li id="wikipedia_cite_note_0"><strong><a href="#cite_ref-0">^</a></strong> <a href="http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html" class="external text" rel="nofollow">U.S. National Heart Lung and Blood Institute - What is COPD</a></li> <li id="wikipedia_cite_note_pmid17507545_1">^ <a href="#cite_ref-pmid17507545_1-0"><sup><em><strong>a</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-1"><sup><em><strong>b</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-2"><sup><em><strong>c</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-3"><sup><em><strong>d</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-4"><sup><em><strong>e</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-5"><sup><em><strong>f</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-6"><sup><em><strong>g</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-7"><sup><em><strong>h</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-8"><sup><em><strong>i</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-9"><sup><em><strong>j</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-10"><sup><em><strong>k</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-11"><sup><em><strong>l</strong></em></sup></a> <a href="#cite_ref-pmid17507545_1-12"><sup><em><strong>m</strong></em></sup></a> <span class="citation Journal">Rabe KF, Hurd S, Anzueto A, <em>et al.</em> (2007). "Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary". <em>Am. J. Respir. Crit. Care Med.</em> <strong>176</strong> (6): 532–55. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a href="http://dx.doi.org/10.1164%2Frccm.200703-456SO" class="external text" rel="nofollow">10.1164/rccm.200703-456SO</a>. <a href="/PubMed_Identifier" title="PubMed Identifier" class="mw-redirect">PMID</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/17507545" class="external text" rel="nofollow">17507545</a>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Global+Strategy+for+the+Diagnosis%2C+Management%2C+and+Prevention+of+Chronic+Obstructive+Pulmonary+Disease%3A+GOLD+Executive+Summary&rft.jtitle=Am.+J.+Respir.+Crit.+Care+Med.&rft.aulast=Rabe+KF%2C+Hurd+S%2C+Anzueto+A%2C+%27%27et+al.%27%27&rft.au=Rabe+KF%2C+Hurd+S%2C+Anzueto+A%2C+%27%27et+al.%27%27&rft.date=2007&rft.volume=176&rft.issue=6&rft.pages=532%E2%80%9355&rft_id=info:doi/10.1164%2Frccm.200703-456SO&rft_id=info:pmid/17507545&rfr_id=info:sid/en.wikipedia.org:Chronic_obstructive_pulmonary_disease"><span style="display: none;"> </span></span></li> <li id="wikipedia_cite_note_Hogg_2"><strong><a href="#cite_ref-Hogg_2-0">^</a></strong> <span class="citation Journal">Hogg JC, Chu F, Utokaparch S, <em>et al.</em> (2004). "The Nature of Small-Airway Obstruction in Chronic Obstructive Pulmonary Disease". <em>N. Engl. J. Med.</em> <strong>350</strong> (26): 2645–53. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a href="http://dx.doi.org/10.1056%2FNEJMoa032158" class="external text" rel="nofollow">10.1056/NEJMoa032158</a>. <a href="/PubMed_Identifier" title="PubMed Identifier" class="mw-redirect">PMID</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/15215480" class="external text" rel="nofollow">15215480</a>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+Nature+of+Small-Airway+Obstruction+in+Chronic+Obstructive+Pulmonary+Disease&rft.jtitle=N.+Engl.+J.+Med.&rft.aulast=Hogg+JC%2C+Chu+F%2C+Utokaparch+S%2C+%27%27et+al.%27%27&rft.au=Hogg+JC%2C+Chu+F%2C+Utokaparch+S%2C+%27%27et+al.%27%27&rft.date=2004&rft.volume=350&rft.issue=26&rft.pages=2645%E2%80%9353&rft_id=info:doi/10.1056%2FNEJMoa032158&rft_id=info:pmid/15215480&rfr_id=info:sid/en.wikipedia.org:Chronic_obstructive_pulmonary_disease"><span style="display: none;"> </span></span></li> <li id="wikipedia_cite_note_3"><strong><a href="#cite_ref-3">^</a></strong> <a href="http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0030442" class="external free" rel="nofollow">http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0030442</a></li> <li id="wikipedia_cite_note_4"><strong><a href="#cite_ref-4">^</a></strong> <a href="http://www.nhlbi.nih.gov/health/public/lung/copd/" class="external text" rel="nofollow">COPD (Chronic Obstructive Pulmonary Disease)</a></li> <li id="wikipedia_cite_note_NHLBI_chart_book_5"><strong><a href="#cite_ref-NHLBI_chart_book_5-0">^</a></strong> <span class="citation web"><a href="http://www.nhlbi.nih.gov/resources/docs/07a-chtbk.pdf" class="external text" rel="nofollow">"2007 NHLBI Morbidity and Mortality Chart Book"</a> (PDF)<span class="printonly">. <a href="http://www.nhlbi.nih.gov/resources/docs/07a-chtbk.pdf" class="external free" rel="nofollow">http://www.nhlbi.nih.gov/resources/docs/07a-chtbk.pdf</a></span><span class="reference-accessdate">. Retrieved 2008-06-06</span>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=2007+NHLBI+Morbidity+and+Mortality+Chart+Book&rft.atitle=&rft_id=http%3A%2F%2Fwww.nhlbi.nih.gov%2Fresources%2Fdocs%2F07a-chtbk.pdf&rfr_id=info:sid/en.wikipedia.org:Chronic_obstructive_pulmonary_disease"><span style="display: none;"> </span></span></li> <li id="wikipedia_cite_note_pmid16636091_6"><strong><a href="#cite_ref-pmid16636091_6-0">^</a></strong> <span class="citation Journal">Mahler DA (2006). 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Retrieved Nov. 11, 2009</span>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=WHO+Disease+and+injury+country+estimates&rft.atitle=World+Health+Organization&rft.date=2009&rft_id=http%3A%2F%2Fwww.who.int%2Fhealthinfo%2Fglobal_burden_disease%2Festimates_country%2Fen%2Findex.html&rfr_id=info:sid/en.wikipedia.org:Chronic_obstructive_pulmonary_disease"><span style="display: none;"> </span></span></li> <li id="wikipedia_cite_note_54"><strong><a href="#cite_ref-54">^</a></strong> <a href="http://www.wrongdiagnosis.com/c/copd/prevalence.htm" class="external text" rel="nofollow">wrongdiagnosis.com > Prevalence and Incidence of COPD</a> Retrieved on Mars 14, 2010</li> <li id="wikipedia_cite_note_55"><strong><a href="#cite_ref-55">^</a></strong> <a href="http://www.nhlbi.nih.gov/resources/docs/2009_ChartBook.pdf" class="external text" rel="nofollow">MORBIDITY & MORTALITY: 2009 CHART BOOK ON CARDIOVASCULAR, LUNG, AND BLOOD DISEASES</a> National Heart, Lung, and Blood Institute</li> <li id="wikipedia_cite_note_pmid18046898_56">^ <a href="#cite_ref-pmid18046898_56-0"><sup><em><strong>a</strong></em></sup></a> <a href="#cite_ref-pmid18046898_56-1"><sup><em><strong>b</strong></em></sup></a> <a href="#cite_ref-pmid18046898_56-2"><sup><em><strong>c</strong></em></sup></a> <span class="citation Journal">Petty TL (2006). "The history of COPD". <em>Int J Chron Obstruct Pulmon Dis</em> <strong>1</strong> (1): 3–14. <a href="/PubMed_Identifier" title="PubMed Identifier" class="mw-redirect">PMID</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/18046898" class="external text" rel="nofollow">18046898</a>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+history+of+COPD&rft.jtitle=Int+J+Chron+Obstruct+Pulmon+Dis&rft.aulast=Petty+TL&rft.au=Petty+TL&rft.date=2006&rft.volume=1&rft.issue=1&rft.pages=3%E2%80%9314&rft_id=info:pmid/18046898&rfr_id=info:sid/en.wikipedia.org:Chronic_obstructive_pulmonary_disease"><span style="display: none;"> </span></span></li> <li id="wikipedia_cite_note_pmid15849329_57"><strong><a href="#cite_ref-pmid15849329_57-0">^</a></strong> <span class="citation Journal">Fishman AP (May 2005). "One hundred years of chronic obstructive pulmonary disease". <em>Am. J. Respir. Crit. Care Med.</em> <strong>171</strong> (9): 941–8. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a href="http://dx.doi.org/10.1164%2Frccm.200412-1685OE" class="external text" rel="nofollow">10.1164/rccm.200412-1685OE</a>. <a href="/PubMed_Identifier" title="PubMed Identifier" class="mw-redirect">PMID</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/15849329" class="external text" rel="nofollow">15849329</a>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=One+hundred+years+of+chronic+obstructive+pulmonary+disease&rft.jtitle=Am.+J.+Respir.+Crit.+Care+Med.&rft.aulast=Fishman+AP&rft.au=Fishman+AP&rft.date=May+2005&rft.volume=171&rft.issue=9&rft.pages=941%E2%80%938&rft_id=info:doi/10.1164%2Frccm.200412-1685OE&rft_id=info:pmid/15849329&rfr_id=info:sid/en.wikipedia.org:Chronic_obstructive_pulmonary_disease"><span style="display: none;"> </span></span></li> </ol> </div> <h2><span class="mw-headline" id="wikipedia_External_links">External links</span></h2> <a name="citable__180" class="citable__local-anchor">.</a><span class='citationPopup' rel="180"><ul> <li><a href="http://www.boldstudy.org" class="external text" rel="nofollow">COPD-BOLD International Research Platform</a></li> <li><a href="http://www.learnaboutcopd.org" class="external text" rel="nofollow">National Heart, Lung and Blood Institute - COPD</a> U.S. NHLBI Information for Patients and the Public page.</li> <li><a href="http://www.goldcopd.com" class="external text" rel="nofollow">Global Initiative for Chronic Obstructive Lung Disease (GOLD)</a></li> <li><span class="citation web"><a href="http://www.accesseconomics.com.au/publicationsreports/showreport.php?id=178" class="external text" rel="nofollow">"Economic Impact of COPD and Cost Effective Solutions"</a>.</span><span class="citable__li" citable_id="180"><a href="#citable__180"><strong>^</strong></a> <c_txt>[Abstract/ Free  Full Text] Austin M, Wood-Baker R. Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title> Update in Chronic Obstructive Pulmonary Disease 2006 -- Rabe et al. 175 (12): 1222 -- American Journal of Respiratory and Critical Care Medicine</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://ajrccm.atsjournals.org/cgi/content/full/175/12/1222">ajrccm.atsjournals.org</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="180"><a href="#citable__180"><strong>^</strong></a> <c_txt>Reduced muscle redox capacity after endurance training in patients with chronic obstructive pulmonary disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <span class="citable__li" citable_id="180"><a href="#citable__180"><strong>^</strong></a> <c_txt>Gea JG, Pasto M, Carmona MA, Orozco-Levi M, Palomeque J, Broquetas J. Metabolic characteristics of the deltoid muscle in patients with chronic obstructive pulmonary disease.</c_txt><div style="padding-left: 10px"><small><c_src><ul><li> <em><c_title>Exercise training in chronic obstructive pulmonary disease</c_title></em> <c_date>10 February 2010 13:25 UTC</c_date> <a href="http://www.rehab.research.va.gov/jour/03/40/5Sup2/Rochester.html">www.rehab.research.va.gov</a> [Source type: Academic]</li></ul></c_src></small></div><br></span> <em>Access Economics</em>. The Australian Lung Foundation. October 2008<span class="printonly">. <a href="http://www.accesseconomics.com.au/publicationsreports/showreport.php?id=178" class="external free" rel="nofollow">http://www.accesseconomics.com.au/publicationsreports/showreport.php?id=178</a></span>.</span><span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.btitle=Economic+Impact+of+COPD+and+Cost+Effective+Solutions&rft.atitle=Access+Economics&rft.date=October+2008&rft.pub=The+Australian+Lung+Foundation&rft_id=http%3A%2F%2Fwww.accesseconomics.com.au%2Fpublicationsreports%2Fshowreport.php%3Fid%3D178&rfr_id=info:sid/en.wikipedia.org:Chronic_obstructive_pulmonary_disease"><span style="display: none;"> </span></span></li> </ul> <table class="navbox" cellspacing="0" style=";"> <tr> <td style="padding:2px;"> <table cellspacing="0" class="nowraplinks collapsible collapsed" style="width:100%;background:transparent;color:inherit;;"> <tr> <th style=";background:Silver" colspan="2" class="navbox-title"><span class="" style="font-size:110%;"><a href="/Pathology" title="Pathology">Pathology</a> of <a href="/Respiratory_system" title="Respiratory system">respiratory system</a> (J, 460–519), <a href="/Respiratory_disease" title="Respiratory disease">respiratory diseases</a></span></th> </tr> <tr style="height:2px;"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:MistyRose;;"><a href="/Upper_respiratory_tract_infection" title="Upper respiratory tract infection">Upper RT</a><br /> (including <a href="/Upper_respiratory_tract_infection" title="Upper respiratory tract infection">URTIs</a>,<br /> <a href="/Common_cold" title="Common cold">Common cold</a>)</td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;"><a href="/Head" title="Head">Head</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"> <div style="margin: 1.12em 0; display:block"><em><a href="/Paranasal_sinuses" title="Paranasal sinuses">sinuses</a>:</em> <a href="/Sinusitis" title="Sinusitis">Sinusitis</a></div> <div style="margin: 1.12em 0; display:block"><em><a href="/Nose_disease" title="Nose disease" class="mw-redirect">nose</a>:</em> <a href="/Rhinitis" title="Rhinitis">Rhinitis</a> (<a href="/Vasomotor_rhinitis" title="Vasomotor rhinitis" class="mw-redirect">Vasomotor rhinitis</a>, <a href="/Atrophic_rhinitis" title="Atrophic rhinitis">Atrophic rhinitis</a>, <a href="/Hay_fever" title="Hay fever" class="mw-redirect">Hay fever</a>)<span style="font-weight:bold;"> ·</span> <a href="/Nasal_polyp" title="Nasal polyp">Nasal polyp</a><span style="font-weight:bold;"> ·</span> <a href="/Rhinorrhea" title="Rhinorrhea">Rhinorrhea</a><span style="font-weight:bold;"> ·</span> <em><a href="/Nasal_septum" title="Nasal septum">nasal septum</a></em> (<a href="/Nasal_septum_deviation" title="Nasal septum deviation">Nasal septum deviation</a>, <a href="/Nasal_septum_perforation" title="Nasal septum perforation">Nasal septum perforation</a>, <a href="/Nasal_septal_hematoma" title="Nasal septal hematoma">Nasal septal hematoma</a>)</div> <em><a href="/Tonsil" title="Tonsil">tonsil</a>:</em> <a href="/Tonsillitis" title="Tonsillitis">Tonsillitis</a><span style="font-weight:bold;"> ·</span> <a href="/Adenoid_hypertrophy" title="Adenoid hypertrophy">Adenoid hypertrophy</a><span style="font-weight:bold;"> ·</span> <a href="/Peritonsillar_abscess" title="Peritonsillar abscess">Peritonsillar abscess</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;"><a href="/Neck" title="Neck">Neck</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"> <div style="margin: 1.12em 0; display:block"><em><a href="/Pharynx" title="Pharynx" class="mw-redirect">pharynx</a>:</em> <a href="/Pharyngitis" title="Pharyngitis" class="mw-redirect">Pharyngitis</a> (<a href="/Streptococcal_pharyngitis" title="Streptococcal pharyngitis">Strep throat</a>)</div> <div style="margin: 1.12em 0; display:block"><em><a href="/Larynx" title="Larynx">larynx</a>:</em> <a href="/Laryngitis" title="Laryngitis">Laryngitis</a><span style="font-weight:bold;"> ·</span> <a href="/Croup" title="Croup">Croup</a><span style="font-weight:bold;"> ·</span> <a href="/Laryngospasm" title="Laryngospasm">Laryngospasm</a><span style="font-weight:bold;"> ·</span> <em><a href="/Vocal_folds" title="Vocal folds">vocal folds</a>:</em> <a href="/Vocal_fold_nodule" title="Vocal fold nodule">Vocal fold nodule</a><span style="font-weight:bold;"> ·</span> <em><a href="/Epiglottis" title="Epiglottis">epiglottis</a>:</em> <a href="/Epiglottitis" title="Epiglottitis">Epiglottitis</a></div> <div style="margin: 1.12em 0; display:block"><em><a href="/Tracheal_disease" title="Tracheal disease" class="mw-redirect">trachea</a>:</em> <a href="/Tracheitis" title="Tracheitis">Tracheitis</a><span style="font-weight:bold;"> ·</span> <a href="/Tracheal_stenosis" title="Tracheal stenosis">Tracheal stenosis</a></div> <a href="/Retropharyngeal_abscess" title="Retropharyngeal abscess">Retropharyngeal abscess</a></div> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:MistyRose;;"><a href="/Lower_respiratory_tract" title="Lower respiratory tract">Lower RT</a>/<a href="/Lung_disease" title="Lung disease" class="mw-redirect">lung disease</a><br /> (including <a href="/Lower_respiratory_tract_infection" title="Lower respiratory tract infection">LRTIs</a>)</td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;"><a href="/Bronchial_disease" title="Bronchial disease" class="mw-redirect">Bronchial</a>/<br /> <a href="/Obstructive_lung_disease" title="Obstructive lung disease">obstructive</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"> <div style="margin: 1.12em 0; display:block"><em>acute:</em> <a href="/Acute_bronchitis" title="Acute bronchitis">Acute bronchitis</a></div> <div style="margin: 1.12em 0; display:block"><em>chronic:</em> <strong class="selflink">COPD</strong> (<a href="/Chronic_bronchitis" title="Chronic bronchitis">Chronic bronchitis</a>, <a href="/Emphysema" title="Emphysema">Emphysema</a>, <a href="/Diffuse_panbronchiolitis" title="Diffuse panbronchiolitis">Diffuse panbronchiolitis</a>)<span style="font-weight:bold;"> ·</span> <a href="/Asthma" title="Asthma">Asthma</a> (<a href="/Status_asthmaticus" title="Status asthmaticus">Status asthmaticus</a>)<span style="font-weight:bold;"> ·</span> <a href="/Bronchiectasis" title="Bronchiectasis">Bronchiectasis</a></div> <em>unspecified:</em> <a href="/Bronchitis" title="Bronchitis">Bronchitis</a><span style="font-weight:bold;"> ·</span> <a href="/Bronchiolitis" title="Bronchiolitis">Bronchiolitis</a> (<a href="/Bronchiolitis_obliterans" title="Bronchiolitis obliterans">Bronchiolitis obliterans</a>)</div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;"><a href="/Interstitial_lung_disease" title="Interstitial lung disease">Interstitial</a>/<br /> <a href="/Restrictive_lung_disease" title="Restrictive lung disease">restrictive</a><br /> (<a href="/Pulmonary_fibrosis" title="Pulmonary fibrosis">fibrosis</a>)</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;">External agents/<br /> <a href="/Occupational_disease" title="Occupational disease">occupational</a><br /> <a href="/Occupational_lung_disease" title="Occupational lung disease">lung disease</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/Pneumoconiosis" title="Pneumoconiosis">Pneumoconiosis</a> (<a href="/Asbestosis" title="Asbestosis">Asbestosis</a>, <a href="/Baritosis" title="Baritosis">Baritosis</a>, <a href="/Bauxite_fibrosis" title="Bauxite fibrosis">Bauxite fibrosis</a>, <a href="/Berylliosis" title="Berylliosis">Berylliosis</a>, <a href="/Caplan%27s_syndrome" title="Caplan's syndrome">Caplan's syndrome</a>, <a href="/Chalicosis" title="Chalicosis">Chalicosis</a>, <a href="/Coalworker%27s_pneumoconiosis" title="Coalworker's pneumoconiosis" class="mw-redirect">Coalworker's pneumoconiosis</a>, <a href="/Siderosis" title="Siderosis">Siderosis</a>, <a href="/Silicosis" title="Silicosis">Silicosis</a>, <a href="/Byssinosis" title="Byssinosis">Byssinosis</a>)<br /> <a href="/Hypersensitivity_pneumonitis" title="Hypersensitivity pneumonitis">Hypersensitivity pneumonitis</a> (<a href="/Bagassosis" title="Bagassosis">Bagassosis</a>, <a href="/Bird_fancier%27s_lung" title="Bird fancier's lung">Bird fancier's lung</a>, <a href="/Farmer%27s_lung" title="Farmer's lung">Farmer's lung</a>)</div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;">Other</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"> <div style="margin: 1.12em 0; display:block"><a href="/Acute_respiratory_distress_syndrome" title="Acute respiratory distress syndrome">ARDS</a><span style="font-weight:bold;"> ·</span> <a href="/Pulmonary_edema" title="Pulmonary edema">Pulmonary edema</a><span style="font-weight:bold;"> ·</span> <a href="/L%C3%B6ffler%27s_syndrome" title="Löffler's syndrome">Löffler's syndrome</a>/<a href="/Eosinophilic_pneumonia" title="Eosinophilic pneumonia">Eosinophilic pneumonia</a><span style="font-weight:bold;"> ·</span> <a href="/Respiratory_hypersensitivity" title="Respiratory hypersensitivity" class="mw-redirect">Respiratory hypersensitivity</a> (<a href="/Allergic_bronchopulmonary_aspergillosis" title="Allergic bronchopulmonary aspergillosis">Allergic bronchopulmonary aspergillosis</a>)</div> <br /> <a href="/Hamman-Rich_syndrome" title="Hamman-Rich syndrome">Hamman-Rich syndrome</a><span style="font-weight:bold;"> ·</span> <a href="/Idiopathic_pulmonary_fibrosis" title="Idiopathic pulmonary fibrosis">Idiopathic pulmonary fibrosis</a><span style="font-weight:bold;"> ·</span> <a href="/Sarcoidosis" title="Sarcoidosis">Sarcoidosis</a></div> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;">Obstructive or<br /> restrictive</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;"><a href="/Pneumonia" title="Pneumonia">Pneumonia</a>/<br /> <a href="/Pneumonitis" title="Pneumonitis">pneumonitis</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;">By pathogen</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/Viral_pneumonia" title="Viral pneumonia">Viral</a><span style="font-weight:bold;"> ·</span> <a href="/Bacterial_pneumonia" title="Bacterial pneumonia">Bacterial</a> (<a href="/Pneumococcal_infection" title="Pneumococcal infection">Pneumococcal</a>, <a href="/Klebsiella_pneumonia" title="Klebsiella pneumonia">Klebsiella</a>) / <a href="/Atypical_pneumonia" title="Atypical pneumonia">Atypical bacterial</a> (<a href="/Mycoplasma_pneumonia" title="Mycoplasma pneumonia">Mycoplasma</a>, <a href="/Legionellosis" title="Legionellosis">Legionnaires' disease</a>, <a href="/Chlamydiae" title="Chlamydiae">Chlamydiae</a>)<span style="font-weight:bold;"> ·</span> <a href="/Fungal_pneumonia" title="Fungal pneumonia">Fungal</a> (<a href="/Pneumocystis_pneumonia" title="Pneumocystis pneumonia">Pneumocystis</a>)<span style="font-weight:bold;"> ·</span> <a href="/Parasitic_pneumonia" title="Parasitic pneumonia">Parasitic</a><span style="font-weight:bold;"> ·</span> <em>noninfectious</em> (<a href="/Chemical_pneumonia" title="Chemical pneumonia" class="mw-redirect">Chemical</a>/<a href="/Mendelson%27s_syndrome" title="Mendelson's syndrome">Mendelson's syndrome</a>, <a href="/Aspiration_pneumonia" title="Aspiration pneumonia">Aspiration</a>/<a href="/Lipid_pneumonia" title="Lipid pneumonia">Lipid</a>)</div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;">By vector/route</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/Community-acquired_pneumonia" title="Community-acquired pneumonia">Community-acquired</a><span style="font-weight:bold;"> ·</span> <a href="/Healthcare-associated_pneumonia" title="Healthcare-associated pneumonia">Healthcare-associated</a><span style="font-weight:bold;"> ·</span> <a href="/Hospital-acquired_pneumonia" title="Hospital-acquired pneumonia">Hospital-acquired</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;">By distribution</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/Bronchopneumonia" title="Bronchopneumonia">Broncho-</a><span style="font-weight:bold;"> ·</span> <a href="/Lobar_pneumonia" title="Lobar pneumonia">Lobar</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;"><a href="/Idiopathic_interstitial_pneumonia" title="Idiopathic interstitial pneumonia">IIP</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/Usual_interstitial_pneumonia" title="Usual interstitial pneumonia">UIP</a><span style="font-weight:bold;"> ·</span> <a href="/Desquamative_interstitial_pneumonia" title="Desquamative interstitial pneumonia">DIP</a><span style="font-weight:bold;"> ·</span> <a href="/Bronchiolitis_obliterans_organizing_pneumonia" title="Bronchiolitis obliterans organizing pneumonia">BOOP-COP</a><span style="font-weight:bold;"> ·</span> <a href="/Nonspecific_interstitial_pneumonia" title="Nonspecific interstitial pneumonia" class="mw-redirect">NSIP</a><span style="font-weight:bold;"> ·</span> <a href="/Respiratory_bronchiolitis" title="Respiratory bronchiolitis">RB</a></div> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;"> <div style="padding:0em 0.75em;">Other</div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/Atelectasis" title="Atelectasis">Atelectasis</a><span style="font-weight:bold;"> ·</span> <em>circulatory</em> (<a href="/Pulmonary_hypertension" title="Pulmonary hypertension">Pulmonary hypertension</a>, <a href="/Pulmonary_embolism" title="Pulmonary embolism">Pulmonary embolism</a>)<span style="font-weight:bold;"> ·</span> <a href="/Lung_abscess" title="Lung abscess">Lung abscess</a></div> </td> </tr> </table> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:MistyRose;;"><a href="/Pleural_cavity" title="Pleural cavity">Pleural cavity</a>/<br /> <a href="/Mediastinum" title="Mediastinum">mediastinum</a></td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <table cellspacing="0" class="nowraplinks navbox-subgroup" style="width:100%;;;;"> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;;"> <div style="padding:0em 0.75em;"><a href="/Pleural_disease" title="Pleural disease">Pleural disease</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"> <div style="margin: 1.12em 0; display:block"><a href="/Pleurisy" title="Pleurisy">Pleuritis/pleurisy</a></div> <div style="margin: 1.12em 0; display:block"><a href="/Pneumothorax" title="Pneumothorax">Pneumothorax</a>/<a href="/Hemopneumothorax" title="Hemopneumothorax">Hemopneumothorax</a> (<a href="/Tension_pneumothorax" title="Tension pneumothorax">Tension pneumothorax</a>)<br /> </div> <div style="margin: 1.12em 0; display:block"><a href="/Pleural_effusion" title="Pleural effusion">Pleural effusion</a>: <a href="/Hemothorax" title="Hemothorax">Hemothorax</a><span style="font-weight:bold;"> ·</span> <a href="/Hydrothorax" title="Hydrothorax">Hydrothorax</a><span style="font-weight:bold;"> ·</span> <a href="/Chylothorax" title="Chylothorax">Chylothorax</a><span style="font-weight:bold;"> ·</span> <a href="/Pleural_empyema" title="Pleural empyema">Empyema/pyothorax</a><span style="font-weight:bold;"> ·</span> <a href="/Malignant_pleural_effusion" title="Malignant pleural effusion">Malignant</a></div> <a href="/Fibrothorax" title="Fibrothorax">Fibrothorax</a></div> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";padding-left:0em;padding-right:0em;background-color: MistyRose;;"> <div style="padding:0em 0.75em;"><a href="/Mediastinal_disease" title="Mediastinal disease" class="mw-redirect">Mediastinal disease</a></div> </td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-odd"> <div style="padding:0em 0.25em"><a href="/Mediastinitis" title="Mediastinitis">Mediastinitis</a><span style="font-weight:bold;"> ·</span> <a href="/Pneumomediastinum" title="Pneumomediastinum">Mediastinal emphysema</a></div> </td> </tr> </table> </td> </tr> <tr style="height:2px"> <td></td> </tr> <tr> <td class="navbox-group" style=";background:MistyRose;;">Other/general</td> <td style="text-align:left;border-left-width:2px;border-left-style:solid;width:100%;padding:0px;;;" class="navbox-list navbox-even"> <div style="padding:0em 0.25em"><a href="/Respiratory_failure" title="Respiratory failure">Respiratory failure</a><span style="font-weight:bold;"> ·</span> <a href="/Influenza" title="Influenza">Influenza</a><span style="font-weight:bold;"> ·</span> <a href="/Severe_acute_respiratory_syndrome" title="Severe acute respiratory syndrome">SARS</a><span style="font-weight:bold;"> ·</span> <a href="/Idiopathic_pulmonary_haemosiderosis" title="Idiopathic pulmonary haemosiderosis">Idiopathic pulmonary haemosiderosis</a><span style="font-weight:bold;"> ·</span> <a href="/Pulmonary_alveolar_proteinosis" title="Pulmonary alveolar proteinosis">Pulmonary alveolar proteinosis</a></div> </td> </tr> <tr style="height:2px;"> <td></td> </tr> <tr> <td class="navbox-abovebelow" style=";background:MistyRose;" colspan="2"><em><a href="/Respiratory_system" title="Respiratory system">respiratory system</a> navs: anat nose, larynx/lower+thoracic cavity/physio/dev, noncongen/congen/tumors, symptoms+signs/eponymous, proc, <a href="/ATC_code_R" title="ATC code R">meds:R</a> (1/2/3/5/6/7)</em></td> </tr> </table> </td> </tr> </table> <div style="margin: 1.12em 0; display:block"><span id="wikipedia_interwiki_pl_fa"></span></div> <div id='catlinks' class='catlinks'> <div id="wikipedia_mw_normal_catlinks">Categories: <span dir='ltr'><a href="/Category:Aging-associated_diseases" title="Category:Aging-associated diseases">Aging-associated diseases</a></span> | <span dir='ltr'><a href="/Category:Occupational_diseases" title="Category:Occupational diseases">Occupational diseases</a></span> | <span dir='ltr'><a href="/Category:Respiratory_diseases" title="Category:Respiratory diseases">Respiratory diseases</a></span> | <span dir='ltr'><a href="/Category:Smoking" title="Category:Smoking">Smoking</a></span></div> <div id="wikipedia_mw_hidden_catlinks" class="mw-hidden-cats-hidden">Hidden categories: <span dir='ltr'><a href="/Category:Pages_containing_cite_templates_with_deprecated_parameters" title="Category:Pages containing cite templates with deprecated parameters">Pages containing cite templates with deprecated parameters</a></span> | <span dir='ltr'><a href="/Category:All_articles_with_unsourced_statements" title="Category:All articles with unsourced statements">All articles with unsourced statements</a></span> | <span dir='ltr'><a href="/Category:Articles_with_unsourced_statements_from_November_2009" title="Category:Articles with unsourced statements from November 2009">Articles with unsourced statements from November 2009</a></span> | <span dir='ltr'><a href="/Category:Articles_needing_additional_references_from_November_2009" title="Category:Articles needing additional references from November 2009">Articles needing additional references from November 2009</a></span> | <span dir='ltr'><a href="/Category:All_articles_needing_additional_references" title="Category:All articles needing additional references">All articles needing additional references</a></span></div> </div> </div> </div> </div><br/> </div> <div class="section-delimeter"></div></div> <div id="core_panel_main" > <div class="section" id="citable_sentences"> <h1 class="section-title"> <a name="citable_sentences">Citable sentences</a> </h1> <div style="float:right"> <span class="core-uptodate">Up to date as of December 19, 2010</span> <br> </div> <div class="fragment"> <div id="citable_fragments"> <div id="citableSentencesList"> <p> Here are sentences from other pages on Chronic obstructive pulmonary disease, which are similar to those in the above article. <div id="citable__sentence_list"> </div> </p> </div> </div> </div><br/> </div> <div class="section-delimeter"></div> <div id="external_links_revision_history_tooltip"> </div> <script> $(document).ready(function() { $("#external_links_revision_history_fragments a[title]").tooltip({tip: '#external_links_revision_history_tooltip', effect: 'toggle', position: 'bottom right', offset: [-1,2], lazy: true, delay: 100}); $("#external_links_revision_history_fragments img[title]").tooltip({tip: '#external_links_revision_history_tooltip', position: 'bottom right', offset: [-1,0], lazy: true, effect: 'toggle'}); }); </script> <div class="section" id="related_links"> <h1 class="section-title"> <a name="related_links">Related links</a> </h1> <span class="core-uptodate">Up to date as of November 16, 2009</span> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>100%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.goldcopd.org" title="The Global Initiative for <B>Chronic</B> <B>Obstructive</B> Lung <B>Disease</B> (GOLD) works with health care professionals and public health officials to raise awareness of <B>Chronic</B> <B>Obstructive</B> <B>Pulmonary</B> <B>Disease</B> (COPD) and to improve prevention and treatment of this lung <B>disease</B> for patients around the world.<br><br><A HREF=http://www.goldcopd.org>http://www.goldcopd.org</A>">Global Initiative for Chronic Obstructive Lung Disease</a> - GOLD - the Global initiative for chronic Obstructive Lung Disease</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>95%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.learnaboutCOPD.org" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>COPD (<B>Chronic</B> <B>Obstructive</B> <B>Pulmonary</B> <B>Disease</B>) is a serious lung <B>disease</B> that, over time, makes it hard to breathe.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>More than 12 million people are currently diagnosed with COPD and an additional 12 million likely have the <B>disease</B> and don't even know it.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>You may have heard COPD called other names, like emphysema or <B>chronic</B> bronchitis.</TD></TR></TABLE><BR><A HREF=http://www.learnaboutCOPD.org>http://www.learnaboutCOPD.org</A>">National Heart, Lung and Blood Institute - COPD</a> - COPD (Chronic Obstructive Pulmonary Disease)</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>91%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.who.int/respiratory/copd/en" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD><B>Chronic</B> <B>Obstructive</B> <B>Pulmonary</B> <B>Disease</B> (COPD) is not one single <B>disease</B> but an umbrella term used to describe <B>chronic</B> lung <B>disease</B>s that cause limitations in lung airflow.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>World COPD Day is an annual event organized by the Global Initiative for <B>Chronic</B> <B>Obstructive</B> Lung <B>Disease</B> (GOLD) to improve awareness and care of <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B> (COPD) around the world.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>The more familiar terms '<B>chronic</B> bronchitis' and 'emphysema' are no longer used, but are now included within the COPD diagnosis.</TD></TR></TABLE><BR><A HREF=http://www.who.int/respiratory/copd/en>http://www.who.int/respiratory/copd/en</A>">WHO - COPD</a> - WHO | Chronic obstructive pulmonary disease (COPD)</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>86%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.nlm.nih.gov/medlineplus/ency/article/000091.htm" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD><B>Chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B> (COPD) is lung <B>disease</B> that makes it difficult to breathe.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Diagnosis and management of stable <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B>: a clinical practice guideline from the American College of Physicians.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Global strategy for the diagnosis, management, and prevention of <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B>: GOLD executive summary.</TD></TR></TABLE><BR><A HREF=http://www.nlm.nih.gov/medlineplus/ency/article/000091.htm>http://www.nlm.nih.gov/medlineplus/ency/article/000091.htm</A>">MedlinePlus Medical Encyclopedia</a> - MedlinePlus Medical Encyclopedia: Chronic obstructive pulmonary disease</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>86%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_SignsAndSymptoms.html" title="<A HREF=http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_SignsAndSymptoms.html>http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_SignsAndSymptoms.html</A>">U.S. National Heart Lung and Blood Institute - Signs and Symptoms</a> - COPD—signs and symptoms</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>86%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_Treatments.html" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the <B>disease</B>.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Other treatments for COPD may include medicines, vaccines, <B>pulmonary</B> rehabilitation (rehab), oxygen therapy, surgery, and managing complications.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Depending on how severe your <B>disease</B> is, your doctor may prescribe short-acting or long-acting bronchodilators.</TD></TR></TABLE><BR><A HREF=http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_Treatments.html>http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_Treatments.html</A>">U.S. National Heart Lung and Blood Institute - Treatment</a> - Chronic obstructive pulmonary disease (COPD)—Treatment</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>83%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/page4.htm" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>COPD - <B>Chronic</B> <B>Obstructive</B> <B>Pulmonary</B> <B>Disease</B> - symptoms, causes, and treatment options by MedicineNet.com</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>The symptoms of <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B> can vary greatly from patient to patient.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>In patients with <B>chronic</B> bronchitis as well as bronchiectasis, <B>chronic</B> cough and sputum production are the major symptoms.</TD></TR></TABLE><BR><A HREF=http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/page4.htm>http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/page4.htm</A>">MedicineNet.com - COPD signs & symptoms</a> - COPD - Chronic Obstructive Pulmonary Disease - symptoms, causes, and treatment options by MedicineNet.com</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>82%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.patient.co.uk/showdoc/40002357" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>It is reduced in restrictive <B>disease</B>, and in <B>obstructive</B> <B>disease</B> if air trapping occurs.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Normal in restrictive <B>disease</B> - reduced in <B>obstructive</B> <B>disease</B>.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>View and/or join in discussion about health, lifestyle and <B>disease</B> in our interactive forum.</TD></TR></TABLE><BR><A HREF=http://www.patient.co.uk/showdoc/40002357>http://www.patient.co.uk/showdoc/40002357</A>">PatientPlus - Spirometry</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>82%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.thoracic.org/go/copd" title="Care of the Child with a <B>Chronic</B> Tracheostomy<br><br><A HREF=http://www.thoracic.org/go/copd>http://www.thoracic.org/go/copd</A>">COPD Guidelines (2004)</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>80%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/C/CellSignaling.html" title="A recently-reported (Feb 2002) phase 2 study, found that almost 90% of the CML patients treated with the drug showed no further progression of their <B>disease</B>.<br><br><A HREF=http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/C/CellSignaling.html>http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/C/CellSignaling.html</A>">Cell Signaling</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>80%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.medscape.com/viewarticle/527629_print" title="<A HREF=http://www.medscape.com/viewarticle/527629_print>http://www.medscape.com/viewarticle/527629_print</A>">Log In Problems</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>79%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://clinicaltrials.gov/show/NCT00268216" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>A multicenter, randomized, double-blind, parallel group, placebo controlled study to investigate the effects of salmeterol/fluticasone 50/500mcg bd, salmeterol 50mcg bd, and fluticasone 500mcg bd, all delivered via the DISKUS/ACCUHALER inhaler, on the survival of subjects with <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B> over 3 years of treatment.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Effect of pharmacotherapy on rate of decline of lung function in <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B>: results from the TORCH study.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Salmeterol and fluticasone propionate and survival in <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B>.</TD></TR></TABLE><BR><A HREF=http://clinicaltrials.gov/show/NCT00268216>http://clinicaltrials.gov/show/NCT00268216</A>">Survival Of Subjects With Chronic Obstructive Pulmonary Disease (COPD) - Full Text View - ClinicalTrials.gov</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>79%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://content.nejm.org/cgi/content/short/356/8/775" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>Background Long-acting beta-agonists and inhaled corticosteroids are used to treat <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B> (COPD), but their effect on survival is unknown.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Bisoprolol in patients with heart failure and moderate to severe <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B>: a randomized controlled trial.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD><B>Chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B> is an independent predictor of death but not atherosclerotic events in patients with myocardial infarction: analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT).</TD></TR></TABLE><BR><A HREF=http://content.nejm.org/cgi/content/short/356/8/775>http://content.nejm.org/cgi/content/short/356/8/775</A>">NEJM -- Salmeterol and Fluticasone Propionate and Survival in Chronic Obstructive Pulmonary Disease</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>73%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://news.bbc.co.uk/2/hi/health/6647811.stm" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>Grouped under the umbrella term <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B> (COPD), they are expected to become the world's third leading cause of death by 2020.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>The Mediterranean diet contains a lot of fruit Eating a Mediterranean diet halves the risk of serious lung <B>disease</B> like emphysema and bronchitis, a study says.</TD></TR></TABLE><BR><A HREF=http://news.bbc.co.uk/2/hi/health/6647811.stm>http://news.bbc.co.uk/2/hi/health/6647811.stm</A>">BBC NEWS | Health | Med diet 'cuts lung disease risk'</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>64%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://linkinghub.elsevier.com/retrieve/pii/S014067368191970X" title="Low Flow oxygen, no more than 1 - 2L by nasal cannula, is extremely important because increased oxygen delivery diminishes the brain's respitory center and can cause respiratory failure in these patients.<br><br><A HREF=http://linkinghub.elsevier.com/retrieve/pii/S014067368191970X>http://linkinghub.elsevier.com/retrieve/pii/S014067368191970X</A>">Elsevier: Article Locator</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/tick-green-8x11.gif" align="bottom" title = "This page is marked authoritative because it has been included for <B>60%</B> of the life of the Wikipedia article."> </nobr></td><td><a href="http://www.nhlbi.nih.gov" title="and the<br><br><A HREF=http://www.nhlbi.nih.gov>http://www.nhlbi.nih.gov</A>">National Heart, Lung, and Blood Institute</a> - National Heart, Lung and Blood Institute</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://crd.sagepub.com" title="For an alternate route to <B>Chronic</B> Respiratory <B>Disease</B> Online use this URL: http://intl-crd.sagepub.com/<br><br><A HREF=http://crd.sagepub.com>http://crd.sagepub.com</A>">Chronic Respiratory Disease - leading research and articles on respiratory disease</a> - Chronic Respiratory Disease</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.bmj.com/cgi/content/full/320/7245/1297" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B>: the ISOLDE trial</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Objectives: To determine the effect of long term inhaled corticosteroids on lung function, exacerbations, and health status in patients with moderate to severe <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B>.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>These improvements in clinical outcomes support the use of this treatment in patients with moderate to severe <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B>.</TD></TR></TABLE><BR><A HREF=http://www.bmj.com/cgi/content/full/320/7245/1297>http://www.bmj.com/cgi/content/full/320/7245/1297</A>">Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial</a> - Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial -- Burge et al. 320 (7245): 1297 -- BMJ</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.pharmacyka.com/research/Guidelines_For_Diagnosis_And_Treatment_Of_Stable_COPD_Issued_By_The_ACP__Accompanying_Video_Included-100.html" title="<A HREF=http://www.pharmacyka.com/research/Guidelines_For_Diagnosis_And_Treatment_Of_Stable_COPD_Issued_By_The_ACP__Accompanying_Video_Included-100.html>http://www.pharmacyka.com/research/Guidelines_For_Diagnosis_And_Treatment_Of_Stable_COPD_Issued_By_The_ACP__Accompanying_Video_Included-100.html</A>">Guidelines for Diagnosis And Treatment Of Stable COPD</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.chemistry.org/portal/a/c/s/1/acsdisplay.html?DOC=HomeMolecule/archive/motw_xanthine_arch.html" title="<A HREF=http://www.chemistry.org/portal/a/c/s/1/acsdisplay.html?DOC=HomeMolecule/archive/motw_xanthine_arch.html>http://www.chemistry.org/portal/a/c/s/1/acsdisplay.html?DOC=HomeMolecule/archive/motw_xanthine_arch.html</A>">404</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.chemistry.org/portal/a/c/s/1/acsdisplay.html?DOC=HomeMolecule\archive\motw_xanthine_arch.html" title="class of drug. Teas are natural sources of methylxanthines, xanthines and<br><br><A HREF=http://www.chemistry.org/portal/a/c/s/1/acsdisplay.html?DOC=HomeMolecule\archive\motw_xanthine_arch.html>http://www.chemistry.org/portal/a/c/s/1/acsdisplay.html?DOC=HomeMolecule\archive\motw_xanthine_arch.html</A>">404</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?holding=npg&cmd=Retrieve&db=PubMed&list_uids=4166895&dopt=Abstract" title="<A HREF=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?holding=npg&cmd=Retrieve&db=PubMed&list_uids=4166895&dopt=Abstract>http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?holding=npg&cmd=Retrieve&db=PubMed&list_uids=4166895&dopt=Abstract</A>">A double-blind trial of disodium cromoglycate in t...[Lancet. 1967] - PubMed Result</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=13804592&dopt=Citation" title="<A HREF=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=13804592&dopt=Citation>http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=13804592&dopt=Citation</A>">The release of histamine and formation of a slow-r...[J Physiol. 1960] - PubMed Result</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.emedicine.com/med/topic209.htm" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>In addition, barotrauma can occur in patients with a wide range of underlying <B>pulmonary</B> conditions (eg, asthma, <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B>, interstitial lung <B>disease</B>, Pneumocystis jiroveci [Pneumocystis carinii] pneumonia).</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Although a mechanically ventilated patient with ARDS may be at risk for barotrauma, patients with blunt trauma, severe pneumonia, <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B>, or underlying interstitial lung <B>disease</B> may also be at risk.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Patients with <B>chronic</B> <B>obstructive</B> lung <B>disease</B> have the lowest incidence of barotrauma (2.9%).</TD></TR></TABLE><BR><A HREF=http://www.emedicine.com/med/topic209.htm>http://www.emedicine.com/med/topic209.htm</A>">eMedicine - Barotrauma</a> - Barotrauma and Mechanical Ventilation: eMedicine Pulmonology</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.wrongdiagnosis.com/c/copd/prognosis.htm" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>Cause of death rank: 5th top cause of death in 1999 is "<B>Chronic</B> Lower Respiratory <B>Disease</B>" (CDC)</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Then a <B>chronic</B> cough develops with clear, colorless sputum.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>As the <B>disease</B> progresses, the cough becomes more frequent and more and more effort is needed to get air into and out of the lungs.</TD></TR></TABLE><BR><A HREF=http://www.wrongdiagnosis.com/c/copd/prognosis.htm>http://www.wrongdiagnosis.com/c/copd/prognosis.htm</A>">Prognosis of COPD</a> - Prognosis of COPD - WrongDiagnosis.com</td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.webmd.com/news/20070417/study-copd-cured-meats-may-be-linked" title="April 17, 2007 -- A new study suggests a possible link between <B>chronic</B> <B>obstructive</B> <B>pulmonary</B> <B>disease</B> ( COPD) and cured meats such as bacon, sausage, and luncheon meats.<br><br><A HREF=http://www.webmd.com/news/20070417/study-copd-cured-meats-may-be-linked>http://www.webmd.com/news/20070417/study-copd-cured-meats-may-be-linked</A>">Study: Cured Meats, COPD May Be Linked</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.nlm.nih.gov/medlineplus/ency/article/000130.htm" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>Alternative Names Return to top Black lung <B>disease</B>;</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Coal worker's pneumoconiosis is a lung <B>disease</B> that results from breathing in dust from coal, graphite, or man-made carbon over a long period of time.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Your risk of developing the <B>disease</B> depends on how long you have been around the coal dust.</TD></TR></TABLE><BR><A HREF=http://www.nlm.nih.gov/medlineplus/ency/article/000130.htm>http://www.nlm.nih.gov/medlineplus/ency/article/000130.htm</A>">MedlinePlus Medical Encyclopedia: Coal worker's pneumoconiosis</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.medscape.com/viewarticle/422880" title="<A HREF=http://www.medscape.com/viewarticle/422880>http://www.medscape.com/viewarticle/422880</A>">Log In Problems</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.atsdr.cdc.gov/tfacts61.html" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>This <B>disease</B> is called asbestosis and is usually found in workers exposed to asbestos, but not in the general public.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Asbestosis is a serious <B>disease</B> and can eventually lead to disability and death.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>A thorough history, physical exam, and diagnostic tests are needed to evaluate asbestos-related <B>disease</B>.</TD></TR></TABLE><BR><A HREF=http://www.atsdr.cdc.gov/tfacts61.html>http://www.atsdr.cdc.gov/tfacts61.html</A>">ATSDR - ToxFAQs™: Asbestos</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.cdc.gov/niosh/topics/chestradiography/breader-info.html" title=". Unfortunately there are no effective management options available for pneumoconiosis.<br><br><A HREF=http://www.cdc.gov/niosh/topics/chestradiography/breader-info.html>http://www.cdc.gov/niosh/topics/chestradiography/breader-info.html</A>">NIOSH Topic: Chest Radiography: B Reader Information for Medical Professionals | CDC/NIOSH</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.allaboutmalignantmesothelioma.com/asbestosis-treatments.htm" title="<TABLE STYLE='font-size: 12;'><TR><TD VALIGN='TOP'>•</TD><TD>It is a <B>chronic</B> inflammatory lung <B>disease</B> that causes significant scarring of the parenchymal tissue lining the lungs.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Although not a malignant <B>disease</B> like mesothelioma, asbestosis is nonetheless a serious condition that can elicit and number of painful and debilitating symptoms.</TD></TR><TR><TD VALIGN='TOP'>&bull</TD><TD>Symptomatic treatment of a <B>disease</B> is otherwise known as palliation.</TD></TR></TABLE><BR><A HREF=http://www.allaboutmalignantmesothelioma.com/asbestosis-treatments.htm>http://www.allaboutmalignantmesothelioma.com/asbestosis-treatments.htm</A>">Asbestosis Treatments - Malignant Mesothelioma Information</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.epa.gov/radon/iowastudy.html" title="It confirms EPA's, the Center for <B>Disease</B> Control's, and the Surgeon General's positions that all homes should be tested for radon, and all homes testing over 4 pCi/L should be fixed.<br><br><A HREF=http://www.epa.gov/radon/iowastudy.html>http://www.epa.gov/radon/iowastudy.html</A>">Iowa Radon Lung Cancer Study | Radon | Indoor Air Quality | Air | US EPA</a></td></tr></table> </div> </span><br/> <span class="fragment"> <div id="external_links_revision_history_fragments"> <table border="0" cellpadding="0" cellspacing="0" hspace="0" vspace="0"><tr><td valign="top" nowrap bgcolor="white"><nobr><img src="images/external_links_revision_history/spacer.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"><img src="images/external_links_revision_history/square2-8x11.gif" align="bottom" width="8" height="11"> </nobr></td><td><a href="http://www.cancer.gov/cancertopics/factsheet/Risk/radon" title="Radon represents a far smaller risk for this <B>disease</B>, but it is the second leading cause of lung cancer in the United States.<br><br><A HREF=http://www.cancer.gov/cancertopics/factsheet/Risk/radon>http://www.cancer.gov/cancertopics/factsheet/Risk/radon</A>">Radon and Cancer: Questions and Answers - National Cancer Institute</a></td></tr></table> </div> </span><br/> </div> <div class="section-delimeter"></div> <div class="section" id="related_topics"> <h1 class="section-title"> <a name="related_topics">Related topics</a> </h1> <span class="core-uptodate">Up to date as of August 19, 2010</span> <ul> <span class="fragment"> <li> <a href="/Asthma">Asthma</a> </li> </span> <span class="fragment"> <li> <a href="/Pneumonia">Pneumonia</a> </li> </span> <span class="fragment"> <li> <a href="/Bronchiectasis">Bronchiectasis</a> </li> </span> <span class="fragment"> <li> <a href="/Bronchitis">Bronchitis</a> </li> </span> <span class="fragment"> <li> <a href="/Rhinitis">Rhinitis</a> </li> </span> <span class="fragment"> <li> <a href="/Silicosis">Silicosis</a> </li> </span> <span class="fragment"> <li> <a href="/Influenza">Influenza</a> </li> </span> <span class="fragment"> <li> <a href="/Pneumothorax">Pneumothorax</a> </li> </span> <span class="fragment"> <li> <a href="/Respiratory_disease">Respiratory disease</a> </li> </span> <span class="fragment"> <li> <a href="/Pulmonary_hypertension">Pulmonary hypertension</a> </li> </span> </ul> </div> <div class="section-delimeter"></div></div> </div> <br/><br/><br/> <script type="text/javascript" language="javascript"><!-- function checkEmail(myForm) { if (/^\w+([\.-]?\w+)*@\w+([\.-]?\w+)*(\.\w{2,3})+$/.test(myForm.str_email.value)){ return (true); } alert("Invalid E-mail Address! 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