[Chronic obstructive pulmonary disease]

Chronic obstructive pulmonary disease (COPD) includes two entities, Chronic Bronchitis (C.B.) and Emphysema (E.), assembled by their common physiopathological feature, a progressive expiratory airflow obstruction. The presence of hyperreactivity is common and partial reversibility may be observed. The coexistence of CB and E. is largely the most prevalent. Cigarette smoking is the main risk factor per se or associated with other urban or occupational air pollutants. Therefore epidemiological COPD rats follow the prevalence of smoking habits in the population. The main goal of the strategy against the disease are preventive decisions and measures, as far as smoking is concerned. FEV1 values lower than 75% of FVC and a decline of FEV1 higher than 30 ml/year indicate a high risk of COPD among smokers. The assessment of FEV1 is important for monitoring and guiding treatment and is valid for grading the severity of COPD. Once the disease is confirmed the therapeutic skills are the following: to reduce the symptoms; to prevent and treat the exacerbations; to attenuate the functional impairment, both short and long term; to achieve better performance in daily activities and quality of life; to avoid and minimise the adverse effects of medication. The increase in life expectancy and the reduction of mortality are tangible goals related to a global and multidisciplinary approach. They mainly depend on smoking cessation, reducing the bronchial obstruction, and correcting chronic hypoxemia.