慢性阻塞性肺病(COPD)与慢性支气管炎和肺气肿等同为一种疾病实体。与哮喘不同，COPD的气流限制是相对持久的。对“小气道疾病”的检测不是常规实践的一部分，因为其检测病理变化的准确性是有争议的。肺气肿发病机制的蛋白水解理论强调了中性粒细胞弹性蛋白酶、抗弹性蛋白酶、氧化剂、抗氧化剂的作用，从而潜在的新治疗方法。慢性阻塞性肺病的临床表现为呼吸困难、咳嗽、咳痰，并伴有气流阻塞和肺恶性膨胀。鉴别诊断包括支气管扩张、囊性纤维化、肺动脉高压，但肺纤维化等以影像学浸润鉴别。普通胸部x线摄影不能可靠地诊断生活中的肺气肿，但一种通过CT扫描测量肺密度的新方法可以定位、定量和诊断生活中的肺气肿(通过远端空气空间增大来定义)。与低氧血症、继发性红细胞增多、CO2潴留、肺动脉高压和肺心病的“蓝色腹胀者”相比，具有呼吸困难、恶性膨胀、轻度低氧血症和低二氧化碳分压的“粉红色腹胀者”。禁烟措施是管理的主要目标。我们提出了一种支气管扩张剂方案，将缓释剂口服茶碱与吸入β - 2激动剂、异丙托品和大剂量吸入类固醇结合起来，因为即使是轻微的梗阻改善也能帮助这些患者。 In acute exacerbations with purulent sputum, antimicrobials against Streptococcus pneumoniae and Hemophilus influenzae are used with controlled oxygen therapy aiming to keep the arterial PO2 over 50 mm Hg without the pH falling below 7.25. Influenza prophylaxis is recommended, but pneumococcal vaccination remains debatable. Chronic under-nutrition in "emphysema" implies controlled trials of feeding regimens--but these remain to be assessed. Long-term oxygen therapy is the only treatment known to prolong life in blue bloaters, and oxygen concentrators and transtracheal oxygen delivery are discussed. Pulmonary vasodilators (e.g., beta 2-agonists, hydralazine, nifedipine, angiotensin-converting enzyme [ACE] inhibitors, etc.) have not yet been proved to provide long-term reduction in pulmonary arterial pressure. Blue bloaters have severe nocturnal hypoxemia in rapid eye movement (REM) sleep that is corrected by oxygen or the investigational drug almitrine.(ABSTRACT TRUNCATED AT 400 WORDS)