COPD: What the anaesthetist should know

Abstract

Chronic obstructive pulmonary disease (COPD) is a chronic, progressive, inflammatory disease affecting the airways and lung parenchyma. It is characterised by persistent airflow obstruction which may be partially reversible, and is caused by exposure of the lung to noxious particles or gases.¹ Although preventable and treatable, once established, the disease course is punctuated by exacerbations. The consequences of COPD result in not just a disease of the respiratory system, but rather a systemic illness which affects multiple organs. COPD is a common disease, yet frequently unrecognised and underdiagnosed. The WHO predicts it will become the 3rd leading cause of death worldwide by 2030.² There has been a trend away from classifying COPD patients as having either emphysema (“pink puffers”) or chronic bronchitis (“blue bloaters”). However, there is now mounting evidence that this may become clinically useful in stratifying patients with regard to prognosis and making treatment decisions. More topically, there is an enhanced appreciation that some patients with COPD manifest with features of coexistent asthma. This entity has been labelled the asthma-COPD overlap syndrome (ACOS).