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The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine)

COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can...

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Autores principales: Bettoncelli, Germano, Blasi, Francesco, Brusasco, Vito, Centanni, Stefano, Corrado, Antonio, De Benedetto, Fernando, De Michele, Fausto, Di Maria, Giuseppe U, Donner, Claudio F, Falcone, Franco, Mereu, Carlo, Nardini, Stefano, Pasqua, Franco, Polverino, Mario, Rossi, Andrea, Sanguinetti, Claudio M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107539/
https://www.ncbi.nlm.nih.gov/pubmed/25057359
http://dx.doi.org/10.1186/2049-6958-9-25
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author Bettoncelli, Germano
Blasi, Francesco
Brusasco, Vito
Centanni, Stefano
Corrado, Antonio
De Benedetto, Fernando
De Michele, Fausto
Di Maria, Giuseppe U
Donner, Claudio F
Falcone, Franco
Mereu, Carlo
Nardini, Stefano
Pasqua, Franco
Polverino, Mario
Rossi, Andrea
Sanguinetti, Claudio M
author_facet Bettoncelli, Germano
Blasi, Francesco
Brusasco, Vito
Centanni, Stefano
Corrado, Antonio
De Benedetto, Fernando
De Michele, Fausto
Di Maria, Giuseppe U
Donner, Claudio F
Falcone, Franco
Mereu, Carlo
Nardini, Stefano
Pasqua, Franco
Polverino, Mario
Rossi, Andrea
Sanguinetti, Claudio M
author_sort Bettoncelli, Germano
collection PubMed
description COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD "a preventable and treatable disease". The integration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treatment of COPD is represented by inhaled long-acting bronchodilators. In symptomatic patients, with pre-bronchodilator FEV1 < 60% predicted and ≥ 2 exacerbations/year, ICS may be added to LABA. The use of fixed-dose, single-inhaler combination may improve the adherence to treatment. Long term oxygen therapy (LTOT) is indicated in stable patients, at rest while receiving the best possible treatment, and exhibiting a PaO(2) ≤ 55 mmHg (SO(2) < 88%) or PaO(2) values between 56 and 59 mmHg (SO(2) < 89%) associated with pulmonary arterial hypertension, cor pulmonale, or edema of the lower limbs or hematocrit > 55%. Respiratory rehabilitation is addressed to patients with chronic respiratory disease in all stages of severity who report symptoms and limitation of their daily activity. It must be integrated in an individual patient tailored treatment as it improves dyspnea, exercise performance, and quality of life. Acute exacerbation of COPD is a sudden worsening of usual symptoms in a person with COPD, over and beyond normal daily variability that requires treatment modification. The pharmacologic therapy can be applied at home and includes the administration of drugs used during the stable phase by increasing the dose or modifying the route, and adding, whenever required, drugs as antibiotics or systemic corticosteroids. In case of patients who because of COPD severity and/or of exacerbations do not respond promptly to treatment at home hospital admission should be considered. Patients with "severe" or "very severe" COPD who experience exacerbations should be carried out in respiratory unit, based on the severity of acute respiratory failure. An integrated system is required in the community in order to ensure adequate treatments also outside acute care hospital settings and rehabilitation centers. This article is being simultaneously published in Sarcoidosis Vasc Diffuse Lung Dis 2014, 31(Suppl. 1);3-21.
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spelling pubmed-41075392014-07-24 The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine) Bettoncelli, Germano Blasi, Francesco Brusasco, Vito Centanni, Stefano Corrado, Antonio De Benedetto, Fernando De Michele, Fausto Di Maria, Giuseppe U Donner, Claudio F Falcone, Franco Mereu, Carlo Nardini, Stefano Pasqua, Franco Polverino, Mario Rossi, Andrea Sanguinetti, Claudio M Multidiscip Respir Med Position Paper COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD "a preventable and treatable disease". The integration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treatment of COPD is represented by inhaled long-acting bronchodilators. In symptomatic patients, with pre-bronchodilator FEV1 < 60% predicted and ≥ 2 exacerbations/year, ICS may be added to LABA. The use of fixed-dose, single-inhaler combination may improve the adherence to treatment. Long term oxygen therapy (LTOT) is indicated in stable patients, at rest while receiving the best possible treatment, and exhibiting a PaO(2) ≤ 55 mmHg (SO(2) < 88%) or PaO(2) values between 56 and 59 mmHg (SO(2) < 89%) associated with pulmonary arterial hypertension, cor pulmonale, or edema of the lower limbs or hematocrit > 55%. Respiratory rehabilitation is addressed to patients with chronic respiratory disease in all stages of severity who report symptoms and limitation of their daily activity. It must be integrated in an individual patient tailored treatment as it improves dyspnea, exercise performance, and quality of life. Acute exacerbation of COPD is a sudden worsening of usual symptoms in a person with COPD, over and beyond normal daily variability that requires treatment modification. The pharmacologic therapy can be applied at home and includes the administration of drugs used during the stable phase by increasing the dose or modifying the route, and adding, whenever required, drugs as antibiotics or systemic corticosteroids. In case of patients who because of COPD severity and/or of exacerbations do not respond promptly to treatment at home hospital admission should be considered. Patients with "severe" or "very severe" COPD who experience exacerbations should be carried out in respiratory unit, based on the severity of acute respiratory failure. An integrated system is required in the community in order to ensure adequate treatments also outside acute care hospital settings and rehabilitation centers. This article is being simultaneously published in Sarcoidosis Vasc Diffuse Lung Dis 2014, 31(Suppl. 1);3-21. BioMed Central 2014-05-19 /pmc/articles/PMC4107539/ /pubmed/25057359 http://dx.doi.org/10.1186/2049-6958-9-25 Text en Copyright © 2014 Bettoncelli et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Position Paper
Bettoncelli, Germano
Blasi, Francesco
Brusasco, Vito
Centanni, Stefano
Corrado, Antonio
De Benedetto, Fernando
De Michele, Fausto
Di Maria, Giuseppe U
Donner, Claudio F
Falcone, Franco
Mereu, Carlo
Nardini, Stefano
Pasqua, Franco
Polverino, Mario
Rossi, Andrea
Sanguinetti, Claudio M
The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine)
title The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine)
title_full The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine)
title_fullStr The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine)
title_full_unstemmed The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine)
title_short The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine)
title_sort clinical and integrated management of copd. an official document of aimar (interdisciplinary association for research in lung disease), aipo (italian association of hospital pulmonologists), simer (italian society of respiratory medicine), simg (italian society of general medicine)
topic Position Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107539/
https://www.ncbi.nlm.nih.gov/pubmed/25057359
http://dx.doi.org/10.1186/2049-6958-9-25
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