The diagnosis and management of chronic obstructive lung disease

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One of the more commonly misdiagnosed diseases referred to our pulmonary specialty clinic is chronic obstructive pulmonary disease (COPD). COPD is often inaccurately overdiagnosed and used as a catchall category for patients with cough or dyspnea or both. Many times the patients do not have COPD, but more frequently have mild COPD and an additional cardiopulmonary disease that had not been diagnosed, but caused most of the more severe symptoms. To avoid such diagnostic pitfalls it is important to differentiate between the specific types of COPD and their respective mechanisms, namely emphysema, bronchitis, and asthma. A review of the typical and atypical symptoms, physical findings, and laboratory data of a patient with pure COPD and a brief review of current therapy will be discussed.


COPD is one disease or any combination of three separate diseases: pulmonary emphysema, chronic bronchitis, and chronic asthma. Most patients tend to have a combination of these diseases rather than one pure form. For most patients cigarette smoking is the single most important causative factor of both emphysema and chronic bronchitis; it probably plays a minimal role in chronic asthma. Smoking is such an important factor that the validity of a diagnosis of emphysema or chronic bronchitis or both should be questioned when a patient has a history of little or no smoking. However, it is a mistake to think that everyone who smokes heavily has COPD. Of the roughly 50 million people currently smoking in the United States, 45 to 48 million have little . . .



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