0
Editorials |

Airway Obstruction in Severe COPD

Archie F. Wilson, MD, PhD, FCCP
Author and Funding Information

Affiliations: Irvine, CA 
 ,  Dr. Wilson is Program Director PUD, School of Medicine, University of California, Irvine.

Correspondence to: Archie F. Wilson, MD, PhD, FCCP, University of California, Irvine Medical Center, Program Director PUD, Bldg 53, Room 1119, 101 City Dr South, Orange, CA 92868-3298; e-mail: afwilson@uci.edu



Chest. 2000;118(4):889-891. doi:10.1378/chest.118.4.889
Text Size: A A A
Published online

Extract

Lung obstruction in emphysema patients is due to the reduction of airway support and the consequent dynamic collapse of airways, particularly during forced exhalation; in emphysema patients, intrinsic airway disease is not present and resistance is entirely expiratory. Severe COPD is a combination of emphysema with varying amounts of chronic bronchitis and bronchospasm. The primary treatment for chronic or recurrent bronchospasm is administration of anti-inflammatory drugs, specifically, inhaled corticosteroids. Attempts to identify significant responses to inhaled steroids in patients with moderate COPD have shown minor improvement in pulmonary function utilizing forced exhalation and in functional measures determined using such assessment tools as questionnaires or distance walked in 6 min. It is usually stated that patients with more severe, end-stage disease will not benefit from receiving inhaled corticosteroids. The possible reasons for such negative opinions about corticosteroids in patients with severe COPD include the following: (1) minimum or the wrong type of airway inflammation; (2) ineffective delivery of inhaled drugs to the sites of inflammation in the airway (eg, small distal airways); and (3) utilization of the wrong evaluation measures. However, (1) airway inflammation clearly plays a role in COPD, since oral corticosteroids are often the sole effective treatment for acute exacerbations of COPD. (2) The delivery of inhaled drugs to airways remains a major issue. The proper use of metered-dose inhalers is not intuitive, and, even with coaching, the coordination of activation with inhalation, the slow speed of inhalation, and end-expiratory breath holding are rarely achieved. Spacers, dry-powder inhalers, and breath-activated devices help with the coordination, but a too-rapid inhalation speed remains a common limitation. (3) The pulmonary function response to agents that increase airway diameter can be accurately assessed with the use of the body plethysmograph, but use of this tool is limited to specialized laboratories. Functional assessments such as the 6-min walking test may be faulty guides to the improvement of airway caliber in patients with COPD, since patients with severe COPD are limited by physical deconditioning and can greatly improve conditioning by pulmonary rehabilitation without change in pulmonary function (by all measures, including body plethysmography).1

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543