• Recognize patients at risk for developing COPD.
• Monitor the progression of COPD.
• Add medications to treat COPD in an evidence-based step-wise manner.
• Recognize conditions that can mimic COPD exacerbations.

Terrence Shaneyfelt , MD, MPH
Assistant Professor of Medicine
University of Alabama at Birmingham

The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The boards of nursing in many states, including Alabama, recognize Category 1 continuing medical education courses as acceptable activities for the renewal of license to practice nursing.

Chronic obstructive pulmonary disease is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and characterized by a mixture of small airway disease (obstructive bronchiolitis) and parenchymal destruction (emphysema).

COPD can be classified into 4 stages based on post-bronchodilator FEV1. Spirometry is essential for diagnosis and provides a description of the severity of pathologic changes in COPD.

COPD is the 4th leading cause of death in the United States and is projected to be the 3rd leading cause of death worldwide by 2020. It is estimated that 4-6% of adult white males and 1-3% of adult white females have COPD. These are probably underestimates as COPD is usually not diagnosed until clinically apparent and often advanced.

The economic and social burden of COPD is high. COPD expenditures for health care costs were estimated at $37.2 billion in 2004.

Because of these factors the Global Initiative for Chronic Obstructive Lung Disease has developed a program to improve the knowledge of epidemiology, socioeconomics, public health and health education of COPD (http://goldcopd.com).

The recommendations made in this CME module are based on recommendations of the GOLD Initiative[1] and a joint statement of the American Thoracic Society/European Respiratory Society.[2]

Mr. S is a 56-year-old male who presents to your office for a yearly check-up. He has no complaints today. He is employed as a landscaper. Prior to working as a landscaper he was employed as a painter. He smokes 1 pack of cigarettes per day for the past twenty years. He denies cough or dyspnea. Physical examination reveals no evidence of wheezing or changes in airflow on chest auscultation. You order a screening cholesterol, prostate specific antigen (per patient request), and fecal occult blood testing on three consecutive stool samples.