Chronic Obstructive Pulmonary Diseases Conundrums

  • Heba Ismail
  • Andrew Chan
  • Samuel Louie


Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. Clinicians and researchers have only recently recognized the disease heterogeneity and systemic consequences from tobacco smoking in aging COPD patients. Diagnosis and management of COPD and its acute exacerbations that begin to occur regularly after FEV1 has declined to less than 40–60% of predicted is a conundrum encountered frequently in clinical practice. Perhaps the most important challenge is the need to diagnose COPD in earlier stages, beginning in the fifth decade of life, at least a decade before the ­familiar albeit terminal phenotypes of chronic bronchitis (“blue bloater”) and emphysema (“pink puffer”) emerge. Persisting poor exercise tolerance despite the use of bronchodilators and inhaled corticosteroids should alert the clinician to the presence of co-morbidities associated with COPD, especially those that resemble acute exacerbation. COPD can often present as conundrums, singularly or severally in a patient. Thus enhancing the knowledge, skills and professional performance of an integrated COPD health care team to provide comprehensive COPD management may improve patient outcomes via early treatment and/or prevention of ­serious complications secondary to COPD.


COPD Obstructive sleep apnea Pulmonary hypertension Disproportionate pulmonary hypertension Pulmonary embolism Chronic cough Chronic bronchitis DLco Asthma–COPD overlap syndrome 


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineUC Davis Health System, University of California Davis, Veterans Affairs Northern California Health Care SystemSacramentoUSA
  2. 2.Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineUC Davis Health System, University of California, Veterans Affairs Northern California Health Care SystemSacramentoUSA
  3. 3.Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineUniversity of California, Davis Health SystemSacramentoUSA

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