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Kroniskt obstruktiv lungsjukdom (KOL)

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Definition:
Tillstånd med hindrat luftflöde/obstruktivitet som inte är möjligt att normalisera med läkemedel som kan minska obstruktivitet. 
Förekomst:
KOL är en av de vanligaste orsakerna till morbiditet och mortalitet världen över.
Symtom:
Man bör misstänka KOL vid långvarig hosta, ökad slemproduktion, dyspné och efter långvarig exponering för riskfaktorer, speciellt 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:
Diagnosen KOL baseras på klinisk bedömning och spirometri  efter bronkdilatation. Diagnosen går inte att ställa enbart på anamnes och kliniska fynd. Sjukdomen graderas enligt GOLD med hjälp av grad av funktionsnedsättning, symtom och exacerbationshistoria.
Behandling:
Individuell behandling baserad på symtom och exacerbationsrisk. Viktiga komponenter i behandlingen är rökfrihet, fysisk träning, influensa-  och pneumokockvaccin , läkemedelsbehandling med inhalation av bronkdilaterande medel och inhalationssteroider 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. 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  
  20. Nationella riktlinjer för vård vid astma och KOL – Stöd för styrning och ledning. www.socialstyrelsen.se  
  21. 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  
  22. 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  
  23. Fabbri LM, Ferrara G. Chronic disease in the elderly - back to the future of internal medicine. Breathe 2006; 3: 41-9. PubMed  
  24. Ställberg B, Janson C, Lindén A, et al. Tillägg av inhalationssteroider vid KOL kan förebygga försämring. Läkartidningen. 2020;117:20051. lakartidningen.se  
  25. Dewar M, Curry RW. Chronic obstructive pulmonary disease: diagnostic considerations. Am Fam Physician 2006; 73: 669-76. PubMed  
  26. 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  
  27. Calverley PM, Burge PS, Spencer S, Anderson JA, Jones PW. Bronchodilator reversibility testing in chronic obstructive pulmonary disease. Thorax 2003; 58: 659-64. PubMed  
  28. 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  
  29. 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  
  30. Socialstyrelsen (2015). Nationella riktlinjer för vård vid astma och kroniskt obstruktiv lungsjukdom (KOL). (Hämtad 2017-04-20) www.socialstyrelsen.se  
  31. Socialstyrelsen. 2020. Nationella riktlinjer för vård vid astma och KOL – Stöd för styrning och ledning. (Hämtad 2021-05-03) www.socialstyrelsen.se  
  32. Läkemedelsverket (2015). Kroniskt obstruktiv lungsjukdom (KOL) – behandlingsrekommendation. medibas.se  
  33. Global Initiative for Chronic Obstructive Lung Disease. GOLD COVID-19 guidance. (Hämtad 2020-06-15). goldcopd.org  
  34. Vogelmeier C, Hederer B, Glaab T, et al. Tiotropium versus salmeterol for the prevention of exacerbations of COPD. N Engl J Med 2011; 364: 1093-1103. New England Journal of Medicine  
  35. 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  
  36. 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  
  37. 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)  
  38. 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  
  39. 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  
  40. 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  
  41. 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  
  42. 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  
  43. 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)  
  44. 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  
  45. 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  
  46. 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)  
  47. 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)  
  48. 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  
  49. 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  
  50. 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  
  51. Larsson K, Lindberg A, Sandelowsky H, et al. Behandling med läkemedel kan reducera mortaliteten vid KOL. Läkartidningen. 2022;119:21155. lakartidningen.se  
  52. 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  
  53. 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  
  54. 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  
  55. 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  
  56. 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)  
  57. Poole P1, Black PN, Cates CJ et al.. Mucolytic agents for chronic brochitis or chronic obstructive pulmonary disease. Cochrane Database Rev 2012; 8: CD001287. pmid:22895919 PubMed  
  58. 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  
  59. Ahmadi Z. Ny kunskap om behandling av kronisk andfåddhet vid svår KOL. Läkartidningen. 2019;116:FS7E. www.lakartidningen.se  
  60. 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  
  61. 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  
  62. 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  
  63. Läkemedelsverket (2016). Granskning bekräftar känd risk för lunginflammation med inhalerade kortikosteroider vid KOL. lakemedelsverket.se  
  64. 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  
  65. 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  
  66. 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  
  67. 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  
  68. 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  
  69. 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  
  70. 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  
  71. 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  
  72. 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  
  73. 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  
  74. 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  
  75. 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  
  76. Wise RA. Changing smoking patterns and mortality from chronic obstructive pulmonary disease. Prev Med 1997;26:418-21. PubMed  
  77. Pauwels RA, Rabe KF. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet 2004; 364: 613-20. PubMed  
  78. 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  
  79. American Lung Association. Trends in chronic bronchitis and emphysema: morbidity and mortality. Accessed online May 18, 2005,
  80. Socialstyrelsens diagnosregister före slutenvård. www.socialstyrelsen.se  
  81. 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  
  82. 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  
  • Kjell Larsson, professor, enheten för lungmedicin (Unit of Lung and Airway Research), IMM, Karolinska institutet
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas