By Calverley, Peter M. A
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Additional resources for Chronic obstructive pulmonary disease, Edition: 2nd ed
Both the increase in small airway resistance and the loss of lung elastic recoil caused by emphysema contribute to the decline in FEV1 and FEV1/FVC ratio, whereas the reduction in lung surface area/volume ratio and total surface area of the lung contribute to the reduction in diffusing capacity. The behavior of the pulmonary circulation is inﬂuenced by the changes in lung mechanics that occur in patients with COPD. e. the product of resistance and compliance) of the lung and when the time constant of the lung exceeds that of the chest wall intrathoracic pressure begins to rise.
The fate of the chronic bronchitic: a report of the 10 year follow up in the Canadian Department of Veterans Affairs co-ordinated study on chronic bronchitis. Am Rev Respir Dis 1973;108:1043–65. 90. Kanner RE, Anthonisen NR, Connett JE, et al. Lower respiratory illnesses promote FEV1 decline in current smokers but not ex smokers with mild COPD. Am J Respir Crit Care Med 2001;164:358–64. 91. Burge PS, Calverley PMA, Jones PW, Spencer S, Anderson JA, Maslen TK. Randomised, double blind, placebo controlled study of ﬂuticasone proportionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial.
The lung function impairment which deﬁnes COPD is generally believed to be the result of changes which take place over decades. The most important and also best investigated deviation from the normal course of changes in lung function is the accelerated decline of FEV1, in the middle-aged or elderly smoker. 4 Theoretical model of risk factors in COPD showing effect of risk factors during pregnancy (a), during growth of lung function (b), during plateau phase (c) and during phase of decline (d).