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Tobacco drieth the brain, dimmeth the sight, vitiateth the smell, hurteth the stomach, destroyeth the concoction, disturbeth the humors and spirits, corrupteth the breath, induceth a trembling of the limbs, exsiccateth the windpipe, lungs and liver, annoyeth the milt, scorcheth the heart, and causeth the blood to be adusted.

Tobias Venner (1577–1660), Via recta ad vitam longam

Chronic obstructive pulmonary disease (COPD) is described by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as a ‘common, preventable and treatable disease characterised by non-fully reversible persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients’.1

COPD typically affects middle-aged and older people with the usual age of onset in the fifth and sixth decades. It is the fourth leading cause of death and the third leading burden of disease in Australia, affecting 12.4% of Australians between 45 and 70 years.

Cigarette smoking is undoubtedly the major cause of both chronic bronchitis and emphysema, although only 10–15% of smokers develop the diseases.2

Lifelong passive smoking exposure increases COPD risk by 2.2 to 4.0 times.

FIGURE 83.1 illustrates the influence of smoking on lung function.


Decline of FEV1 with age

Source: Adapted from Fletcher and Peto3

Factors in causation

  • Cigarette smoking (usually 20/day for 20 years or more)4

  • Natural fuel—wood, twigs, crop residue

  • Air pollution (outdoor and indoor)

  • Airway infection

  • Occupation: related to cadmium, silica, dusts

  • Familial factors: genetic predisposition

  • Alpha1-antitrypsin deficiency (emphysema)

  • Bronchial hyper-responsiveness

Diagnosis and management of COPD

The COPDX Plan guidelines5 developed by the Australian Lung Foundation and the Thoracic Society of Australia and New Zealand provide an appropriate framework for diagnosis and management. The key recommendations are: Confirm diagnosis, Optimise function, Prevent deterioration, Develop a self-management plan and manage eXacerbations.

C—Confirm diagnosis and assess severity


Consider the diagnosis of COPD in all smokers and ex-smokers older than 35 years. The diagnosis of COPD rests on the demonstration of airflow obstruction.

The sensitivity of the physical examination for detecting mild to moderate COPD is poor.


The signs vary according to the nature of the disease and the presence of infection. Signs may be completely absent in the early stages of COPD and there may be wheezing only with chronic bronchitis and dyspnoea with chronic airflow limitation.


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