Symptomatic, frail, elderly patients: the urgent need for comprehensive assessment and management

dianagosalvez Diana Gosálvez Prados last modified 2/02/2015 13:06

The working hypotheses for screening and early diagnosis of chronic obstructive pulmonary disease (COPD) have been that: 1) long-term exposure to cigarette smoke or pollutants damages the airways and/or the lungs, and causes airflow obstruction; 2) airflow obstruction occurs primarily in the small airways, is asymptomatic in the early stages of the disease and is progressive in the majority of COPD patients; and 3) forced expiratory volume in 1 s (FEV1) and its ratio with forced vital capacity are necessary in establishing the diagnosis of COPD, and in assessing the excessive decline in lung function, but are of little use, if any, in making the early, pre-symptomatic diagnosis of COPD.

Clini E, Beghe B, Fabbri LM. Symptomatic, frail, elderly patients: the urgent need for comprehensive assessment and management Eur Respir J. 2014 Dec;44(6):1397-400. Available at: http://erj.ersjournals.com/content/44/6/1397.long


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2/02/2015

These working hypotheses have been helpful in stimulating research in the field of structure–function relationships in the lung, and particularly in defining the role of airway and lung inflammation in the development of central and peripheral airway remodelling and emphysema. Research focused on the respiratory system has also brought about the development of physiological and imaging methods to assess peripheral airways and lung parenchyma, and has furthered understanding of the natural history of COPD, particularly the progressive decline in lung function and its modulation by pharmacological intervention.  Thanks to the results of these studies, we now know much more about COPD, about the potential and limitations of screening and early diagnosis based on spirometry, and about interventions in early asymptomatic and newly discovered COPD.


Clini E, Beghe B, Fabbri LM.

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