Gå direkt till huvudinnehållet

Kroniskt obstruktiv lungsjukdom (KOL)

Senast reviderad:
Sakkunnig:
Definition:
KOL är ett heterogent lungtillstånd som kännetecknas av kroniska luftvägssymtom (dyspné, hosta, sputumproduktion och/eller exacerbationer) på grund av inflammatoriska förändringar i luftvägarna (bronkit, bronkiolit) och/eller alveolerna (emfysem) vilket orsakar ihållande, ofta progressiv, luftflödeshinder. 
Förekomst:
KOL är en av de vanligaste orsakerna till morbiditet och mortalitet världen över.
Symtom:
Dyspné, långvarig hosta, ökad slemproduktion och fatigue (främst efter exponering för tobaksrök).
Kliniska fynd:
Fynden beror på hur svår sjukdomen är. Klinisk undersökning är otillräcklig för att ställa diagnosen KOL. Det kan förekomma en betydande lungfunktionsförlust utan att personen har svåra symtom eller att de uppsöker läkare.
Diagnostik:
Om KOL misstänks utifrån riskfaktorer ska luftvägsobstruktionen bekräftas med dynamisk spirometri  efter bronkdilatation. Sjukdomen graderas enligt GOLD 1–4 (svårighetsgrad) och GOLD A, B eller E (symtombörda och exacerbationshistoria).
Behandling:
Individuell behandling baserad på GOLD A, B eller E. Viktiga komponenter i behandlingen är rökfrihet, fysisk träning, influensa-  och pneumokockvaccin , läkemedelsbehandling med inhalation av bronkdilaterande medel och inhalationssteroider (för svårare sjuka) samt tidig och korrekt behandling av exacerbationer.
  1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2021 Report. Available from: http://goldcopd.org goldcopd.org  
  2. Calverley PMA, Walker P. Chronic obstructive pulmonary disease. Lancet 2003; 362: 1053-61. PubMed  
  3. Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med 2000; 343: 269-280. New England Journal of Medicine  
  4. Rabe KF, Hurd S, Anzueto A, et al, for the Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD Executive Summary. Am J Respir Crit Care Med 2007; 176: 532-55. PubMed  
  5. Backman H, Vanfleteren L, Lindberg A, et al. Decreased COPD prevalence in Sweden after decades of decrease in smoking. Respir Res. 2020;21(1):283. PMID:33115506. PubMed  
  6. Sandelowsky H, Weinreich UM, Aarli BB, et al. COPD - do the right thing. BMC Fam Pract. 2021;22(1):244. PMID:34895164. PubMed  
  7. Lamprecht B, Soriano JB, Studnicka M, et al. Determinants of underdiagnosis of COPD in national and international surveys. Chest. 2015;148(4):971-985. PMID:25950276. PubMed  
  8. Lundbäck B, Lindberg A, et Al. Not 15 but 50% of smokers develop COPD?--Report from the Obstructive Lung Disease in Northern Sweden Studies.. Respir Med 2003; Feb;97(2):: 115-22. PMID: 12587960 PubMed  
  9. Chapman KR, Mannino DM, Soriano JB et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J 2006; 27: 188-207. PubMed  
  10. Scanlon PD, Connett JE, Waller LA, Altose MD, Bailey WC, Buist AS. Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease. The Lung Health Study. Am J Respir Crit Care Med 2000; 161: 381-90. PubMed  
  11. Anthonisen NR, Connett JE, Murray RP. Smoking and lung function of lung health study participants after 11 years. Am J Respir Crit Care Med 2002; 166: 675-79. PubMed  
  12. Melbye H, Helgeland J, Karlstad Ø, et al. Is the Disease Burden from COPD in Norway Falling off? A Study of Time Trends in Three Different Data Sources. Int J Chron Obstruct Pulmon Dis. 2020;15:323-334. PMID:32103931. PubMed  
  13. Yin P, Jiang CQ, Cheng KK et al. Passive smoking exposure and risk of COPD among adults in China: the Guangzhou Biobank Cohort Study. Lancet 2007; 370: 751-7. PubMed  
  14. Paulin LM, Diette GB, Blanc PD, et al.. SPIROMICS Research Group. Occupational exposures are associated with worse morbidity in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2015 Mar 1;191(5):557-65. PMID: 25562375 PubMed  
  15. Stern AD, Morgan WJ, Wright AL, Guerra S and Martinez FD. Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study. Lancet 2007; 370: 758-64. PubMed  
  16. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease: ATS statement. Am J Respir Crit Care Med 1995; 152 (5 pt 2) (suppl): S77-120.
  17. The Alpha-1-Antitrypsin Deficiency Registry Study Group. Survival and FEV1 decline in individuals with severe deficiency of alpha1-antitrypsin. Am J Respir Crit Care Med 1998; 158: 49-59. PubMed  
  18. Bigna JJ, Kenne AM, Asangbeh SL, Sibetcheu AT. Prevalence of chronic obstructive pulmonary disease in the global population with HIV: a systematic review and meta-analysis. Lancet Glob Health 2018; 6(2): e193-e202. pmid:29254748 PubMed  
  19. Janssen R, Piscaer I, Franssen FME, Wouters EFM. Emphysema: looking beyond alpha-1 antitrypsin deficiency. Expert Rev Respir Med. 2019;13(4):381-397. PMID:30761929. PubMed  
  20. Läkemedelsverket. Kroniskt obstruktiv lungsjukdom (KOL) – behandlings­rekommendation. Publicerad 2023-03-27. www.lakemedelsverket.se  
  21. Haroon S, Jordan R, Takwoingi Y, et al. Diagnostic accuracy of screening tests for COPD: a systematic review and meta-analysis. BMJ Open 2015. pmid:26450427 PubMed  
  22. Nationella riktlinjer för vård vid astma och KOL – Stöd för styrning och ledning. www.socialstyrelsen.se  
  23. Medbo A, Melbye H. Lung function testing in the elderly. Can we still use FEV(1)/FVC <70% as a criterion of COPD? Respir Med 2007; 101: 1097-105. PubMed  
  24. Shahab L, Jarvis MJ, Britton J et al. Prevalence, diagnosis and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sample. Thorax 2006; 61: 1043-7. PubMed  
  25. Fabbri LM, Ferrara G. Chronic disease in the elderly - back to the future of internal medicine. Breathe 2006; 3: 41-9. PubMed  
  26. Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(5 Pt 1):1418-1422. PMID:9603117. PubMed  
  27. Wilkinson TM, Donaldson GC, Hurst JR, Seemungal TA, Wedzicha JA. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169(12):1298-1303. PMID:14990395. PubMed  
  28. Langsetmo L, Platt RW, Ernst P, Bourbeau J. Underreporting exacerbation of chronic obstructive pulmonary disease in a longitudinal cohort. Am J Respir Crit Care Med. 2008;177(4):396-401. PMID:18048806. PubMed  
  29. Ställberg B, Janson C, Lindén A, et al. Tillägg av inhalationssteroider vid KOL kan förebygga försämring. Läkartidningen. 2020;117:20051. lakartidningen.se  
  30. Dewar M, Curry RW. Chronic obstructive pulmonary disease: diagnostic considerations. Am Fam Physician 2006; 73: 669-76. PubMed  
  31. Johannessen A, Omenaas ER, Bakke PS, Gulsvik A. Implications of reversibility testing on prevalence and risk factors for chronic obstructive pulmonary disease: a community study. Thorax 2005; 60: 842-7. PubMed  
  32. Calverley PM, Burge PS, Spencer S, Anderson JA, Jones PW. Bronchodilator reversibility testing in chronic obstructive pulmonary disease. Thorax 2003; 58: 659-64. PubMed  
  33. Mannino DM, Ford ES, Redd SC. Obstructive and restrictive lung disease and markers of inflammation: data from the third national health and nutrition examination. Am J Med 2003; 114: 758-762. PubMed  
  34. Socialstyrelsen. 2020. Nationella riktlinjer för vård vid astma och KOL – Stöd för styrning och ledning. (Hämtad 2021-05-03) www.socialstyrelsen.se  
  35. Muller NL, Coxson H. Chronic obstructive pulmonary disease. 4: imaging the lungs in patients with chronic obstructive pulmonary disease. Thorax 2002; 57: 982-5. PubMed  
  36. Socialstyrelsen (2015). Nationella riktlinjer för vård vid astma och kroniskt obstruktiv lungsjukdom (KOL). (Hämtad 2017-04-20) www.socialstyrelsen.se  
  37. Global Initiative for Chronic Obstructive Lung Disease. GOLD COVID-19 guidance. (Hämtad 2020-06-15). goldcopd.org  
  38. Poole PJ, Chacko E, Wood-Baker RWB, Cates CJ. Influenza vaccine for patients with chronic obstructive pulmonary disease (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software. The Cochrane Library  
  39. Läkemedelsverket (2015). Kroniskt obstruktiv lungsjukdom (KOL) – behandlingsrekommendation. medibas.se  
  40. Walters JA, Tang JN, Poole P, et al. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017 Jan 24;1:CD001390. PMID:28116747. PubMed  
  41. McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015 Feb 23;2:CD003793. Cochrane (DOI)  
  42. Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2006, Issue 4. The Cochrane Library  
  43. Iepsen UW, Jørgensen KJ, Ringbæk T, et al. . A combination of resistance and endurance training increases leg muscle strength in COPD: An evidence-based recommendation based on systematic review with meta-analyses.. Chron Respir Dis. 2015. pmid:25767138 PubMed  
  44. Cramer H, Haller H, Klose P, et al. The risks and benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil. 2019 Jul 29:269215519860551. PMID: 31353959 PubMed  
  45. Borge CR, Hagen KB, Mengshoel AM, et al. Effects of controlled breathing exercises and respiratory muscle training in people with chronic obstructive pulmonary disease: results from evaluating the quality of evidence in systematic reviews. BMC Pulm Med 2014. pmid:25416306 PubMed  
  46. Rice KL, Dewan N, Bloomfield HE, et al. Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med 2010; 182: 890-6. PubMed  
  47. Bucknall CE, Miller G, Lloyd SM, et al. Glasgow supported self-management trial (GSuST) for patients with moderate to severe COPD: randomised controlled trial. BMJ 2012; 344: e1060. BMJ (DOI)  
  48. Kew KM, Mavergames C, Walters JA. Long-acting beta2-agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013 Oct 15;10. PMID: 24127118. PubMed  
  49. Incorvaia C, Montagni M, Makri E, et al. Striving for optimal bronchodilation: focus on olodaterol. Int J Chron Obstruct Pulmon Dis. 2016 Mar 1;11:439-44.Pmid:27042036. PubMed  
  50. Karner C, Chong J, Poole P. Tiotropium versus placebo for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014 Jul 21;7:CD009285. Cochrane (DOI)  
  51. Cheyne L, Irvin-Sellers MJ, White J, et al. Tiotropium versus ipratropium bromide for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015 Sep 22;9:CD009552. Cochrane (DOI)  
  52. Decramer M, Celli B, Kesten S, et al. Effect of tiotropium on outcomes in patients with moderate chronic obstructive pulmonary disease (UPLIFT): a prespecified subgroup analysis of a randomised controlled trial. Lancet. 2009;374(9696):1171-1178. PMID:19716598. PubMed  
  53. Cohen JS, Miles MC, Donohue JF, et al. Dual therapy strategies for COPD: the scientific rationale for LAMA + LABA. Int J Chron Obstruct Pulmon Dis. 2016 Apr 15;11:785-97. eCollection 2016. Pmid:27143870. PubMed  
  54. Nannini LJ, Poole P, Milan SJ, et al. Combined corticosteroid and long-acting beta(2)-agonist in one inhaler versus inhaled corticosteroids alone for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013 Aug 12;8:CD009071. PMID: 23990350. PubMed  
  55. Larsson K, Lindberg A, Sandelowsky H, et al. Behandling med läkemedel kan reducera mortaliteten vid KOL. Läkartidningen. 2022;119:21155. lakartidningen.se  
  56. Nannini LJ, Poole P, Milan SJ, et al. Combined corticosteroid and long-acting beta₂-agonist in one inhaler versus placebo for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013 Nov 10;11:CD003794. doi: 10.1002/14651858.CD003794.pub4. DOI  
  57. Chong J, Leung B, Poole P. Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2013 Nov 4;11:CD002309. doi: 10.1002/14651858.CD002309.pub4. DOI  
  58. Martinez, FJ, Calverley PMA, Goehring U-M, et al. Effect of roflumilast on exacerbations in patients with severe chronic obstructive pulmonary disease uncontrolled by combination therapy (REACT): a multicentre randomised controlled trial. Lancet. 2015 Mar 7;385(9971):857-66.PMID: 25684586. PubMed  
  59. Rutten FH, Zuithoff NP, Hak E, Grobbee DE, Hoes AW. Beta-blockers may reduce mortality and risk of exacerbations in patients with chronic obstructive pulmonary disease. Arch Intern Med 2010; 170: 880-7. PubMed  
  60. Short PM, Lipworth SIW, Elder DHJ, et al. Effect of β blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study . BMJ 2011; 342: d2549. BMJ (DOI)  
  61. Jolliffe DA, Greenberg L, Hooper RL, et al. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax. 2019 Jan 10. pii: thoraxjnl-2018-212092. doi: 10.1136/thoraxjnl-2018-212092. Pmid: 30630893 PubMed  
  62. Ahmadi Z. Ny kunskap om behandling av kronisk andfåddhet vid svår KOL. Läkartidningen. 2019;116:FS7E. www.lakartidningen.se  
  63. Sciurba FC, Ernst A, Herth FJ, Strange C, Criner GJ, Marquette CH, et al. A randomized study of endobronchial valves for advanced emphysema. The New England journal of medicine. 2010;363(13):1233-44 PubMed  
  64. Vestbo J, Edwards LD, Scanlon PD, et al. Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med 2011; 365: 1184-92. New England Journal of Medicine  
  65. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilatior on the rate of decline of FEV 1 : the lung health study. JAMA 1994; 272: 1497-1505. Journal of the American Medical Association  
  66. Läkemedelsverket (2016). Granskning bekräftar känd risk för lunginflammation med inhalerade kortikosteroider vid KOL. lakemedelsverket.se  
  67. Ernst P, Gonzalez AV, Braasard P, Suissa S. corticosteroid use in chronic obstructive pulmonary disease and the risk of hospitalization for pneumonia. Am J Respir Crit Care Med 2007; 176: 162-6. PubMed  
  68. Janson C1, Larsson K, Lisspers KH, Ställberg B, et al.. Pneumonia and pneumonia related mortality in patients with COPD treated with fixed combinations of inhaled corticosteroid and long acting β2 agonist: observational matched cohort study (PATHOS).. BMJ 2013; mAY: 346ff. pmid:23719639 PubMed  
  69. Kylhammar D, Rådegran G. The principal pathways involved in the in vivo modulation of hypoxic pulmonary vasoconstriction, pulmonary arterial remodelling and pulmonary hypertension. Acta Physiol (Oxf). 2017 Apr;219(4):728-756. PMID: 27381367 PubMed  
  70. Wrobel JP, Thompson BR, Williams TJ. Mechanisms of pulmonary hypertension in chronic obstructive pulmonary disease: a pathophysiological review. J Heart Lung Transplant. 2012 Jun;31(6):557-64. PMID: 22502811. PubMed  
  71. Ho TW, Tsai YJ, Ruan SY, et al. In-hospital and one-year mortality and their predictors in patients hospitalized for first-ever chronic obstructive pulmonary disease exacerbations: a nationwide population-based study. PLoS One. 2014;9(12):e114866. PMID:25490399. PubMed  
  72. Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012;67(11):957-963. PMID:22684094. PubMed  
  73. Rothnie KJ, Müllerová H, Smeeth L, Quint JK. Natural History of Chronic Obstructive Pulmonary Disease Exacerbations in a General Practice-based Population with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018;198(4):464-471. PMID:29474094. PubMed  
  74. Larsson K, Janson C, Lisspers K, et al. The Impact of Exacerbation Frequency on Clinical and Economic Outcomes in Swedish COPD Patients: The ARCTIC Study. Int J Chron Obstruct Pulmon Dis. 2021;16:701-713. PMID:33776429. PubMed  
  75. Chu CM, Chan VL, Lin AWN, et al.. Readmission rates and life threatening events in COPD survivors treated with non-invasive ventilation for acute hypercapnic respiratory failure. Thorax 2004; 59: :1020-1025 . doi:10.1136/thx.2004.024307 DOI  
  76. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004; 350: 1005-12. New England Journal of Medicine  
  77. Puhan MA, Garcia-Aymerich J, Frey M, et al. Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index. Lancet 2009; 374: 704-11. PubMed  
  78. Sin DD, Wu LL, Man SFP. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest 2005; 127: 1952-9. PubMed  
  79. Wise RA. Changing smoking patterns and mortality from chronic obstructive pulmonary disease. Prev Med 1997;26:418-21. PubMed  
  80. Pauwels RA, Rabe KF. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet 2004; 364: 613-20. PubMed  
  81. Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Chronic obstructive pulmonary disease surveillance-United States, 1971-2000. Respir Care 2002; 47: 1184-99. PubMed  
  82. American Lung Association. Trends in chronic bronchitis and emphysema: morbidity and mortality. Accessed online May 18, 2005,
  83. Socialstyrelsens diagnosregister före slutenvård. www.socialstyrelsen.se  
  84. Sulku J, Janson C, Melhus H, et al. Changes in critical inhaler technique errors in inhaled COPD treatment - A one-year follow-up study in Sweden. Respir Med. 2022;197:106849. PMID:35483167. PubMed  
  85. Sveriges regioner i samverkan. Nationellt system för kunskapsstyrning Hälso och sjukvård. Personcentrerat och sammanhållet vårdförlopp, Kroniskt obstruktiv lungsjukdom (KOL). 2020-09-25 (Hämtad 2021-06-11). nationelltklinisktkunskapsstod.se  
  • Hanna Sandelowsky, specialist i allmänmedicin, Med dr, Karolinska Institutet, Stockholm