Clinical Review

Chronic Obstructive Pulmonary Disease: Epidemiology, Clinical Presentation, and Evaluation

Journal of Clinical Outcomes Management. 2017 April;24(4)

Author(s):

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From the Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, KY .

Abstract

Objective: To review the classification, epidemiology, clinical presentation, and evaluation of patients with chronic obstructive pulmonary disease (COPD).
Methods: Review of the literature.
Results: While smoking remains the most important risk factor for COPD in much of the developed world, other risk factors, including genetic factors and occupational or environmental exposures, remain important. COPD is the third leading cause of death in the United States. In 2011, 13.7 million adults aged ≥ 25 years were diagnosed with COPD in the United States, and as many as 12 million adults may have COPD that is undiagnosed. In 2010, COPD was responsible for an estimated 10.3 million physician office visits and 1.5 million emergency room visits and was estimated to be the second leading cause of disability-adjusted life years lost among the US population. COPD has primary, secondary, and tertiary prevention strategies. The treatment of COPD has improved in recent years, with new therapies improving patient quality of life.
Conclusion: COPD remains a serious public health problem that is often underdiagnosed, particularly in its early stages.

Key words: Chronic obstructive pulmonary disease; epidemiology; mortality; smoking; evaluation.

Chronic obstructive pulmonary disease (COPD) is characterized by fixed airflow obstruction with breathing-related symptoms, such as chronic cough, exertional dyspnea, expectoration, and wheeze [1]. These symptoms may occur in conjunction with airway hyperresponsiveness and overlap with other chronic diseases such as asthma. Although COPD is a nonspecific term referring to a set of conditions that develop progressively as a result of a number of different disease processes, it most commonly refers to chronic bronchitis and emphysema. These conditions can be present with or without significant physical impairment. Despite being a very common disease and the third leading cause of death in the United States [2], COPD often is a silent and unrecognized disease, particularly in its early phases [3], and may go untreated.

In this article, we review the classification, epidemiology, clinical presentation, and assessment of patients with COPD.

Definition and Classification

Several different definitions have existed for COPD [4–8]. The Global Initiative for Chronic Obstructive Lung Disease (GOLD), an international collaboration of leading experts in COPD launched in the late 90s with a goal to develop evidence-based recommendations for diagnosis and management of COPD [4], currently defines COPD as “a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases” [4].

Airflow limitation is the slowing of expiratory airflow as measured by spirometry, with a persistently low forced expiratory volume in 1 second (FEV ₁) and a low FEV ₁/forced vital capacity (FVC) ratio despite treatment [8]. The GOLD definition for airflow limitation is an FEV ₁/FVC ratio of less than 70% [4]. Some authorities suggest using the lower limit of normal (statistically defined by the lower fifth percentile of a reference population) for FEV ₁