COPD

COPD is a complex inflammatory disease that involves different inflammatory cell types, like macrophages, neutrophils and CDS T lymphocytes [42, 45, 46]. 

---

Chronic obstructive pulmonary disease (COPD) affects over 5% of the adult population, is the fourth leading cause of death worldwide and is the only major cause of mortality that is increasing worldwide. It is an inflammatory disorder of the lungs, caused mainly, but not exclusively, by cigarette smoking. 15-20% of smokers develop COPD. 

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has defined COPD as a disease state characterized by airflow limitation that is not fully... 

During COPD, the following symptoms occur, usually in the order mucus hypersecretion, ciliary dysfunction, airflow limitation, pulmonary hyperinflation, gas exchange abnormalities, pulmonary hypertension and cor pulmonale. Acute exacerbations appear to be mainly triggered by bacteria, viruses or environmental pollutants. They lead to a worsening of lung functions, wasting and increased mortality their psychosocial impacts include depression and anxiety that may be associated with the will to die. 

COPD is a chronic inflammatory disease that results from prolonged and repeated inhalation of particles and gases, chronic (or latent) infection or an interaction of these factors. In many cases, the inflammation persists even when the exposure (in most cases smoking) is stopped. Prominent among the infiltrating leukocytes are neutrophils, CD8+ lymphocytes (Co-receptor for the T-cell receptor. CD8+ is specific for the class IMHC protein. It is expressed on the surface of cytotoxic T-cells and natural killer cells.) and CD68+ monocytic cells (A lysosomal antigen. All cells that rich in... 

One intensively investigated feature of the inflammatory process in COPD is the release of proteases from neutrophils and monocytic cells that destroy elastin and other components of the interstitial matrix (Table 1). The best studied protease is neutrophil elastase. Independent of its elastolytic activity, neutrophil elastase is a potent secretagogue. More recently matrix metalloproteases (MMP) have received increasing attention, in particular MMP 12 (macrophages elastase). To which extent and how exactly these proteases become activated is not clear at present. 

Oxidative stress has received much attention as a potentially pathogenic factor. It may promote COPD by many factors such as induction of pro-inflammatory genes in many cells including epithelial and endothelial... 

Usually, it takes years of toxin exposure to cause the pathological alterations seen in COPD. In most cases, the disease is already well-progressed when COPD is diagnosed. Reversal of established chronic inflammatory disease is always extremely difficult to achieve and at present healing of COPD is impossible. Smoking cessation is the single most effective and cost-effective... 

Chronic Obstructive Pulmonary Disease. Figure 1 Pharmacotherapy of chronic obstructive pulmonary disease (COPD). 

Inhaled steroids (commonly used are beclomethasone, budesonide, triamcinolone, fluticasone, flunisolide) appear to attenuate the inflammatory response, to reduce bronchial hyperreactivity, to decrease exacerbations and to improve health status they may also reduce the risk of myocar dial infar ction, but they do not modify the longterm decline in lung function. Whether- steroids affect mortality remains unclear. Many patients appear to be resistant to steroids and large, long-term trials have shown only limited effectiveness of inhaled corticosteroid ther apy. Certainly, the benefit from steroids is smaller in COPD than in asthma. Topical side-effects of inhaled steroids are oropharyngeal candidiasis and hoarse voice. At the normal doses systemic side-effects of inhaled steroids have not been firmly established. The current recommendation is that the addition of inhaled gluco-coiticosteroids to bronchodilator treatment is appropriate for patients with severe to veiy sever e COPD. 

The use of antibiotics is not recommended, except for the treatment of infectious exacerbations of COPD and other bacterial infections. Influenza vaccines decrease illness and death in COPD patients. Pneumococcal vaccination is also recommended. 

Up to 30% of COPD patients suffer from anxiety disorder or depression, and should be treated with conventional pharmacotherapy. 

Approximately 2% of all COPD patients suffer from homozygous al-AT deficiency. Intravenous infusion of replacement protein twice weekly in patients with established al-AT deficiency is approved in the US but not in Europe. The effectiveness of this extremely expensive treatment is not yet known. 

TLR4 EAE, Atherosclerosis, Sepsis, Asthma, COPD, RSV bronchitis, Arthritis... 

COPD, chronic obstructive pulmonary disease EAE, experimental autoimmune encephalomyelitis RSV, respiratory syncytial virus SLE, systemic lupus erythematosus. 

Zanamivir is used cautiously with pregnancy (Category C), lactation, asthma, COPD, or other underlying respiratory diseases. No significant drug interactions have been reported with the use of zanamivir. 

ZANAMIVIR There is a risk for bronchospasm in patients with asthma or COPD. A fast-acting bron-chodilator should be on hand in case bronchospasm occurs. Zanamivir use should be discontinued and the primary health care provider notified promptly if respiratory symptoms worsen. 

Other disorders of the lower respiratory tract include emphysema (lung disorder in which the terminal bronchioles or alveoli become enlarged and plugged with mucus) and chronic bronchitis (chronic inflammation and possibly infection of die bronchi). Chronic obstructive pulmonary disease (COPD) is die name given collectively to emphysema and chronic bronchitis because die obstruction to die airflow is present most of the time. Asdima diat is persistent and present for most of die time may also be referred to as COPD. 

A broncho dilator is a drug used to relieve bron-chospasm associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema These conditions are progressive disorders characterized by a decrease in die inspiratory and expiratory capacity of die lung. Collectively, tiiey are often referred to as COPD. The patient with COPD experiences dyspnea (difficulty breatiiing) with physical exertion, has difficulty inhaling and exhaling, and may exhibit a chronic cough. 

The two major types of bronchodilators are the sym-padiomimetics and die xantiiine derivatives. The anticholinergic drug ipratropium bromide (Atrovent) is used for bronchospasm associated witii COPD, chronic bronchitis, and emphysema. Ipratropium is included in die Summary Drug Table Bronchodilators. Chapter 25... 

Ms. Smith, age 68 years, returned to the clinic for a follow-up visit after receiving a diagnosis of COPD. She is taking theophylline daily and using a metered-dose inhaler 4 times a day. Determine what assessments would be most important for you to make at this time. 

Kool M. Lambrecht BN Dendritic cells in asthma and COPD opportunities for drug development Curr Opin Immunol 2007 19 701-710. 

In addition to the NOD mouse, Entelos has models for several human metabolic diseases (diabetes, obesity, and metabolic syndrome), inflammatory diseases (rheumatoid arthritis), and respiratory diseases (asthma and COPD). 

Corticosteroids have been evaluated in several types of cerebral injury, including cerebral infarction. Corticosteroids reduce vasogenic edema, such as that associated with neoplasms, but not cytotoxic edema, the type associated with ischemic stroke. A large meta-analysis found no benefit to the use of corticosteroids in ischemic stroke (or intracerebral hemorrhage), and their use is not recommended, except to treat concomitant conditions that mandate it (e.g., COPD flare). 

Con A Concanavalin A COPD Chronic obstructive pulmonary disease COS Fibroblast-like kidney cell line established from simian cells CoVF Cobra venom CP Creatine phosphate Cp Caeruloplasmin c.p.m. Counts per minute CPJ Cartilage/pannus junction Cr The chemical symbol fir chromium CR Complement receptor CRl, CR2 CR4 Complement receptor types 1, 2 and 4 CR3-a Complement receptor type 3-[Pg.281]

Mustain WE, Kepler K, Prakash J. 2007. CoPd, oxygen reduction electrocatalysts for polymer electrolyte membrane and direct methanol fuel cells. Electrochim Acta 52 2102-2108. Nagy Z, You H. 2002. Applications of surface X-ray scattering to electrochemistry problems. Electrochim Acta 47 3037-3055. 

---