Chronic obstructive pulmonary disease airflow limitation

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation that is not fully... 

Hogg JC. Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet 2004 364 709-721. 

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. The most common conditions comprising COPD are chronic bronchitis and emphysema. 

Papi A, Romagnoli M, Baraldo S, Braccioni F, Guzzinati I, Saetta M, Ciaccia A, Fabbri LM. Partial reversibility of airflow limitation and increased exhaled NO and sputum eosinophilia in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2000 162 1773-1777. 

Tiotropium is inhaled from the HandiHaler, a dry-powder, breath-activated inhaler system that delivers particles to the lung over a wide range of airflow limitations in patients with chronic obstructive pulmonary disease (COPD) it can be effectively delivered at inspiratory flow rates as low as 201/minute (2). Pharmacodynamic steady-state studies have shown that most of the bronchodUator activity is achieved with one to two doses within 48 hours, although a carryover effect on forced vital capacity was observed beyond 48 hours (3). 

Hasegawa I, Boiselle PM, Raptopoulos V, Hatabu H (2003) Tracheomalacia incidentally detected on CT pulmonary angiography of patients with suspected pulmonary embolism. AJR Am J Roentgenol 181 1505-1509 Hasegawa M, Nasuhara Y, Onodera Y etal. (2006) Airflow limitation and airway dimensions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 173 1309-1315... 

Attaran, D., Lari, S.M., Towhidi, M., et ah, 2010. Interleukin-6 and airflow limitation in chemical warfare patients with chronic obstructive pulmonary disease. Int. J. Chron. Obstruct. Pulmon. Dis. 5, 335-340. 

Becklake MR (1985) Chronic airflow limitation its relationship to work in dusty occupations. Chest 88 608-617 Becklake MR (1989a) Occupational exposures evidence for a causal association with chronic obstructive pulmonary disease. Am Rev Respir Dis 140 S85-S91 Becklake MR (1989b) Occupational pollution. Chest 96 372S-378S... 

Environmental airborne endotoxins are usually associated with dust particles or aqueous aerosol with a broad size distribution. Endotoxin exposure has been associated with a variety of pulmonary and systemic diseases in homes, office buildings and occupational environments. These diseases or conditions include chronic nose and throat irritation, humidifier fever, organic dust toxic syndrome, grain fever, byssinosis, asthma-like syndrome, exacerbation of asthma, and progressive irreversible airflow obstruction (Heederik et al., 1991 Michel et al., 1996 Muittari et al., 1980 Olenchock, 1990 Rylan-der, 1996 Rylander et al., 1978 Schenker et al., 1998 Schwartz et al., 1994 Schwartz et al., 1995). Recognition of the link between endotoxin exposures and these conditions has led to proposals to establish occupational health exposure limits. The Netherlands Health Council has recently published a criteria document for endotoxin that recommends a health-based occupational exposure limit of 50 EU/m for full shift, personal, inhalable dust sampling (Douwes and Heederik, 1998). 

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