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Chronic obstructive pulmonary disease (COPD) is an obstructive disease of the lungs and characterized by chronic inflammatory lung damage, leading to progressive limitation of airflow.
To evaluate the validity of the peak expiratory flow rate to detect COPD in adult smokers and determine the prevalence of COPD and the severity of the limitation of airflow in adult smokers attended in primary care.
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COPD is characterized by poorly reversible limitations of airflow and dyspnea [ 5], but it is not limited to the lung.
In multivariate analysis, the combination of CT emphysema and CT air trapping explained 68-83% of the variability in airflow limitation in subjects covering the total range of airflow limitation (p < 0.001).
COPD severity was therefore assessed using the GOLD guideline recommendation that long-acting muscarinic antagonists or inhaled corticosteroids combined with long-acting β2-agonists should be used in patients with severe and very severe airflow limitations (GOLD severity of airflow obstruction grades 3 and 4) and/or frequent exacerbations (groups C and D in the 2011 update) [ 23].
Motegi et al. [ 29] compared three predictive models of COPD exacerbation: the DOSE (dyspnoea, degree of airflow limitation, smoking and exacerbations); BODE (body mass index, degree of airflow limitation, dyspnoea and exacerbations); and ADO (age, dyspnoea, degree of airflow limitation) indices.
COPD is characterized by a persistent airflow limitation that is not fully reversible; thus, the reversibility of airflow limitations in response to a bronchodilator is an important component of COPD.
However, not all smokers exhibit the development of airflow limitation.
Some patients with COPD present with significant reversibility of airflow limitation after receiving bronchodilation therapy.
Survival analysis showed that age, gender, smoking status and reversibility of airflow limitation were independent predictors of adverse respiratory outcome.
These findings suggest that T-lymphocyte abnormalities might be involved in the pathogenesis of airflow limitation in people who smoke.
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