Airflow obstruction, chronic can present with many of the same symptoms as chronic obstructive pulmonary disease; however, there are some differences. Patients can present either with chronic cough (70%), or chronic dyspnea (30%). There is a greater tendency to report symptoms of both chronic airflow obstruction, chronic and asthma if a family member has had the disease. In patients with chronic airflow obstruction, the average severity is more in the dyspnea category. The typical age range of those with airflow obstruction (chronic) is 55-65 years. In patients with chronic dyspnea, the average age range is less, 35-45 years old.
Although airway epithelium may be damaged in asthma, chronic airway obstruction is more probably caused by underlying disease in the airways, sinuses, and/or lungs. These changes in the airways predispose to chronic airway obstruction as part and/or contributor to asthma.
About 1.2 percent of the U.S. population has airflow obstruction, chronic. The prevalence of airflow obstruction, chronic is expected to decrease as rates of smoking declines, as a percentage of the U.S. population. The percentage prevalence of obstructive respiratory conditions in the United States has been decreasing since 1982.
Unfortunately, airway obstruction is difficult to reliably control. If airflow obstruction can be reduced (for example, by using a bronchodilator) then it can improve the quality of life but does not necessarily eliminate any symptom scores.
Airflow obstruction is often treated with long-acting beta-agonists and salbutamol. Other common treatments include nonsteroidal anti-inflammatory drugs like ibuprofen and oral steroids such as prednisolone. Airway pressure management, such as CPAP and bilevel positive airway pressure (BiPAP), is a well-established adjunct treatment for chronic airflow obstruction.
There are several signs and symptoms of airflow obstruction, chronic but they differ in different places in the body: in the lung parenchyma, in the pleura, and in the upper and lower airways. In lung parenchyma signs include hyperinflation, pleural effusion and pulmonary hypertension, while in the pleura signs include chest pain and exertion intolerance. In airways signs include shortness of breath, cough, and dysphonia. There is also a high prevalence of airflow obstruction in rheumatological disorders which is related to inflammation. [Health Services Guidelines of the Faculty of Community Medicine] The signs of chronic obstructive pulmonary disease (COPD) are well known throughout the world.
There are differences in the characteristics, demographics, and lung function results between the different groups. However, these differences seem to have little impact on the final results of any trial. If patients with airflow obstruction, chronic were all enrolled in a study, it is unlikely that they would benefit, and there would be a potential cost to both the trial and the patients. The same is true for trials that enroll patients from other geographical areas. As such, the choice of patients for clinical trials should consider the benefits relative to cost and benefit to the patient rather than the country or geographical background of the patients.
There are currently a number of clinical trials (https://clinicaltrials.gov/ct/show/NCT04390639) underway in the United States and Canada that focus on various aspects of treatment for lung diseases, such as CF and cystic fibrosis where the majority of patients are children. These trials offer a glimpse of the potential of treating lung disease with gene therapy or stem cell therapy. It may therefore be a good time to consider how we would respond to any future COVID-19 infection in terms of treatment from these clinical trials.
In our opinion, there are no single answers to the questions about the optimal and most cost-effective treatment for patients with chronic airflow obstruction. The main questions relate to 1) the timing of treatment initiation, 2) which treatment will work best in most patients and 3) how well treatment works in preventing hospitalization due to exacerbation of chronic airway obstruction and subsequent death or illness. The answer to the last question will require a prospective study.
In patients with airflow limitation and in those with an occupational diagnosis of airflow limitation, a FEV(1) less than 70% of the expected is associated with a substantially increased odds for subsequent COPD-related events.
In general, we found that there were no severe safety concerns with using corticosteroids in the treatment of chronic obstructive pulmonary disease. Corticosteroids are generally well tolerated and are safe in the short or long term, except in people with coexisting corticosteroid-sensitive conditions such as rheumatoid arthritis.
A successful treatment strategy needs to address the treatment of both the obstructive and the autoimmune causes of SSc, as well as the improvement of underlying diseases.