ABSTRACT
Chronic obstructive pulmonary disease (COPD) might be described as 'chronic lung failure.' Like chronic renal failure, it is progressive, irreversible and has more than one aetiology. Many COPD patients have features of both chronic bronchitis and emphysema, differentiated by symptoms, spirometry, and in severe cases, blood and blood-gas analysis. Smoking cessation is the only effective treatment to improve future quality of life and reduce disability and death. A proportion of COPD patients have bronchial hyper-reactivity which is sometimes reversible using bronchodilator inhalers like those used in asthma, but many patients show no such response. In COPD with a reversible element of airway restriction, salbutamol or terbutaline are as effective in relieving dyspnoea as the anticholinergic agents described. In emphysema the problem is progressive destruction of the gas-exchange surfaces of the lungs, and there may be little cough or sputum.
