Intended for healthcare professionals

Student Practical skills

Chronic obstructive pulmonary disease

BMJ 2013; 347 doi: (Published 04 October 2013) Cite this as: BMJ 2013;347:f5043
  1. Nathan Hambly, fellow in respiratory medicine,
  2. Andrew McIvor, professor of medicine
  1. 1McMaster University, Hamilton, ON, Canada

Long term management

Why is chronic obstructive pulmonary disease relevant to medical students?

By the year 2030, chronic obstructive pulmonary disease (COPD) is projected to be the fourth leading cause of mortality worldwide.1 Unlike other leading causes of morbidity, the prevalence and burden of COPD are increasing owing to the ongoing global increase in tobacco use. This is particularly true in low and middle income countries, where 90% of all COPD related deaths occur.2 In the United Kingdom, COPD accounts for nearly 30 000 deaths each year, making it the fifth leading cause of death in the country. Ninety per cent of these deaths occur in those over age 65.34567

Since COPD is a disease primarily related to smoking induced lung injury, management strategies should emphasise smoking cessation therapy before the onset of permanent pathological change. As the disease progresses it is associated with an increased frequency of acute exacerbations that are often caused by infection. During these periods patients become more breathless and develop increased cough or sputum production. People with COPD also experience more widespread effects, called systemic symptoms, such as cachexia, skeletal muscle wasting, and depression.89 COPD is also recognised as an independent risk factor for cardiovascular disease and lung cancer.1011 All medical students will therefore encounter patients with COPD in a variety of clinical scenarios, and since two thirds of cases remain undiagnosed, all clinicians are expected to be able to recognise and supervise the care of such patients appropriately.3 This article focuses on the diagnosis and therapeutic management of stable COPD in an outpatient setting.

COPD under the microscope

On microscopic evaluation, patients with COPD show both the bronchial inflammation, fibrosis, and mucus hypersecretion characteristic of obstructive bronchitis and the destruction of alveoli seen in emphysema. Both are implicated in the physiology of progressive airflow obstruction.12 Great …

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