Chronic obstructive pulmonary disease by Calverley, Peter M. A

By Calverley, Peter M. A

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It could be helpful in following the natural history of the emphysema and as an outcome measure for trials of surgical and medical treatment. PULMONARY VASCULAR CHANGES IN COPD The resistance to airflow (cmH2O/L/s) and the compliance (L/cmH2O) of the lung both increase as COPD develops. The combined effect of these two mechanical changes has the units of time and is referred to as the time constant of the lung. When the time constant for lung emptying exceeds that of the chest wall, intrathoracic pressure increases and is transmitted to the pulmonary vasculature and the alveolar gas.

To many health administrators this seems like a paradox as the immediate beneficial effects of smoking cessation are less apparent in COPD than in, for example, ischemic heart disease and maybe even lung cancer. 1 The estimated number of deaths from COPD and HIV infection: 1990–2020. (Based on calculations in ref. 3 These estimates, however, make little sense as they include all ages and therefore underestimate the true prevalence of COPD in older adults. 4/ 100 000 in 1993. In Canada the total number of deaths from COPD almost doubled from 1980 to 1995 and this increase was not merely due to the change from ICD-9 to ICD-10.

Am J Respir Crit Care Med 1998;158:1277–85. 39. Wenzel SE, Szefler SJ, Leung DYM, Sloan SI, Rex MD, Martin RJ. Broncoscopic evaluation of severe asthma: persistent inflammation associated with high dose glucocorticoids. Am J Respir Crit Care Med 1997;156:737–43. 40. Stanescu D, Sanna A, Veriter C, et al. Airways obstruction, chronic expectoration, and rapid decline of FEV1 in smokers are associated with increased levels of sputum neutrophils. Thorax 1996;51:267–71. 41. Maestrelli P, Calcagni PG, Saetta M, et al.

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