A Copd Primer

In 2012 we received a grant from the Veterans Health Administration Office of Specialty Care entitled, “Patient-Centered Model for the Management of Chronic Obstructive Pulmonary Disease.” The grant’s goals were to enhance the recognition and diagnosis of COPD and implement a Patient-Centered Model for the Management of COPD. As the work on that proposal progressed, we realized that providers did not have an up-to-date, comprehensive, easily read, “how to” manual for the management of COPD despite all the advances in COPD care that have occurred over the past 5 years. Consensus documents such as the VA-DOD Guidelines were abbreviated summaries that were rarely used. From those discussions, the concept for this volume, a COPD Primer, developed. The goal was to develop a practical book that concisely presented COPD to providers with sufficient background and explanation of the physiologic and scientific rationale for various management strategies without becoming an esoteric academic work. We hope that this COPD Primer has achieved that goal and will be a useful, practical text for practitioners and medical trainees alike. The COPD Primer begins with an examination of what COPD is; it is really a syndrome, a constellation of historical features and clinical, physiologic, and radiographic findings. However, those elements come together in many different ways to create multiple different COPD phenotypes that are only now being recognized and used to define specific management strategies. COPD research has progressed beyond the simple classification of “blue bloaters” and “pink puffers.” Next, the epidemiology and economic consequences of COPD are reviewed. Bill Eschenbacher presents an approach to the patient with respiratory symptoms with detailed discussions of pulmonary function testing and how airflow limitation/obstruction is identified by spirometry and the use of lung imaging to identify individuals with COPD. Michael Borchers and Gregory Motz summarize current evidence implicating genetics, proteolytic imbalance, oxidative stress, inflammation, occupational and environmental exposures, and innate and adaptive immune function in the pathogenesis of COPD and the implication of these findings to future treatments. The single most important intervention in the prevention and treatment of COPD is smoking cessation. Shari Altum, Katherine Butler, and Rachel Juran present a practical approach to smoking cessation utilizing motivational interviewing in combination with pharmacologic interventions. Then, they expand upon these concepts to provide practitioners with convenient, realistic suggestions to encourage patient self-management in all aspects of COPD care and overall health. Ahsan Zafar reviews the natural history, recently described COPD phenotypes, and gender differences that clearly illustrate the broad spectrum of disease that comprises the term, COPD. The cover illustration highlights Dr. Zafar’s creative and artistic talents. The extensive nonpulmonary aspects of COPD are reviewed by Ralph Panos in an examination of COPD’s multi-organ manifestations. Next, the effect of COPD on sleep and the overlap syndrome, the concurrence of COPD and obstructive sleep apnea, and its consequences are presented. Jean Elwing examines the effect of COPD on the pulmonary vasculature with a detailed discussion of the evaluation and management of pulmonary hypertension associated with COPD. COPD’s effects on psychosocial functioning and familial interactions are presented by Mary Panos and Ralph Panos. The focus of the Primer then shifts from manifestations to treatment with a discussion of stable COPD management. With the current plethora of devices for delivering respiratory medications, it is difficult for both patients and providers to sustain knowledge of their proper use. Aaron Mulhall presents a practical guide to correct inhaler use that reviews all the current devices. Folarin Sogbetun then reviews the management of outpatient COPD exacerbations and Nishant Gupta discusses the approach to the patient hospitalized with COPD. Because patients with COPD often see multiple subspecialty physicians in addition to their primary care providers, interdisciplinary communication and coordination of care is essential for their management; Sara Krzywkowski-Mohn reviews the interactions between primary and specialty care for the patient with COPD with suggestions for improved communication and care coordination. Finally, advance care planning including palliative care and hospice is reviewed with a discussion of how end stage COPD affects not only the patient but also their family and social network. This COPD Primer incorporates the knowledge that we have learned over the past several years during the development and implementation of a patient-centered model for the management of COPD. It was written with the explicit goal of assisting both the practicing provider and medical trainee in the care of patients with COPD.

Using illustrative case examples, this book thoroughly reviews similarities and differences between asthma, chronic obstructive pulmonary disease (COPD) and the overlap syndrome. It is important to highlight the distinctions because these commonly encountered conditions in respiratory and primary care share many similarities but have important differences often mistaken for each other. This can have serious implications for treatment, particularly as new treatments are targeted at specific phenotypes of the diseases. This practical guide shows how to distinguish between the diseases on a pathological and clinical basis so that appropriate management and treatment may be pursued.

The only international clinical textbook for COPD – one of the top 5 causes of death and disability worldwide The only COPD textbook to include the latest national and international guidelines and the newer therapeutic agents in COPD treatment International team of contributors covers all aspects of COPD – from physiology and epidemiology to diagnosis and treatment Everything the busy physician needs to understand, diagnose and treat the COPD patient: Structure and physiology of the respiratory system Clinical considerations and allied conditions Therapy (including current and developing treatments) Diagnostic tests used in daily practice

This book details the benefits of palliative care to improve the lives of patients with serious lung disease and their caregivers. Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness, and is often described as “an extra layer of support” for patients and their caregivers, as patients with malignant and nonmalignant lung disease experience great symptom burden and have advanced care planning needs. This book has three main objectives: Define the role of palliative care in advanced lung disease Incorporate a patient-centered perspective in describing symptom burden and interventions to improve quality of life Provide current initiatives to expand evidence-based practice and improve access to palliative care Written by leading experts in palliative care and respiratory medicine, the chapters seek to answer those objectives by first defining and describing palliative care, advanced lung disease, and inadequate palliative care in this patient population. Patient reported outcomes, quality of life, and interventions to help deal with the psychological toll of serious illness are then detailed, as well as pharmacological and non-pharmacological interventions for symptom management. Detailed information is additionally provided on current research studies and management for several lung diseases, including COPD, ILD, Lung Cancer, Pulmonary Arterial Hypertension, Neuromuscular disease, and pediatric lung disease. The more administrative aspects of palliative care programs are then covered with an example of a specialty palliative care program for advanced lung disease and advice on how to address policy that promotes palliative care. Finally, palliative care's role during a pandemic is thoughtfully considered. This book is an ideal guide for clinicians, nurses, hospital administrators, teachers, students to help them understand and fill unmet care needs that many patients with serious lung disease experience.

Linking basic science to clinical application throughout, Histology and Cell Biology: An Introduction to Pathology, 5th Edition, helps students build a stronger clinical knowledge base in the challenging area of pathologic abnormalities. This award-winning text presents key concepts in an understandable, easy-to-understand manner, with full-color illustrations, diagrams, photomicrographs, and pathology photos fully integrated on every page. Student-friendly features such as highlighted clinical terms, Clinical Conditions boxes, Essential Concepts boxes, concept mapping animations, and more help readers quickly grasp complex information. Features new content on cancer immunotherapy, satellite cells and muscle repair, vasculogenesis and angiogenesis in relation to cancer treatment, and mitochondria replacement therapies. Presents new material on ciliogenesis, microtubule assembly and disassembly, chromatin structure and condensation, and X chromosome inactivation, which directly impact therapy for ciliopathies, infertility, cancer, and Alzheimer’s disease. Provides thoroughly updated information on gestational trophoblastic diseases, molecular aspects of breast cancer, and basic immunology, including new illustrations on the structure of the T-cell receptor, CD4+ cells subtypes and functions, and the structure of the human spleen. Uses a new, light green background throughout the text to identify essential concepts of histology – a feature requested by both students and instructors to quickly locate which concepts are most important for beginning learners or when time is limited. These essential concepts are followed by more detailed information on cell biology and pathology. Contains new Primers in most chapters that provide a practical, self-contained integration of histology, cell biology, and pathology – perfect for clarifying the relationship between basic and clinical sciences. Identifies clinical terms throughout the text and lists all clinical boxes in the table of contents for quick reference. Helps students understand the links between chapter concepts with concept mapping animations on Student ConsultTM – an outstanding supplement to in-class instruction.

In this issue of Emergency Medicine Clinics, guest editors Drs. Haney Mallemat and Terren Trott bring their considerable expertise to the topic of Respiratory and Airway Emergencies. Respiratory emergencies may range from “shortness of breath,” or dyspnea, to complete respiratory arrest, or apnea, in which the patient is no longer breathing. In this issue, top experts in the field address topics such as pulmonary hypertension; COPD and asthma; pulmonary embolism; special procedures; procedures for the challenging airway; physiologically difficult intubation; and more. Contains 13 relevant, practice-oriented topics including intubating special populations; ARDS; basic modes of ventilation; advanced modes of ventilation (APRV); infectious pulmonary disease; and more. Provides in-depth clinical reviews on respiratory and airway emergencies, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.