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Kronisk obstruktiv lungesykdom (kols)

Sist oppdatert: Sist revidert:
Sist revidert av:


Definisjon:
Sykdommen karakteriseres ved kroniske luftveissymptomer og luftstrømsobstruksjon som skyldes sykelige forandringer i luftveiene og/eller alveolene. Forårsakes vanligvis av betydelig eksponering for skadelige partikler eller gasser  
Forekomst: 
Ca. 6% av befolkningen over 40 år i Norge. Øker med økende alder og varighet av eksponering for skadelige partikler og gasser som tobakksrøyk
Symptomer:
Kronisk og progredierende tung pust ved mindre anstrengelser, ev. kronisk hoste og økt slimproduksjon. Utvikles langsomt over mange år. Før diagnosen stilles ses ofte gjentatte bronkitter eller nedre luftveisinfeksjoner
Funn: 
I tidlig fase ingen typiske funn, men etter hvert ofte fremmedlyder over lungene, hørbar og synlig tung pust. Spirometri viser vedvarende luftstrømsobstruksjon
Diagnostikk:
Typiske symptomer og oppfyllelse av kols-kriteriene ved minst to spirometrimålinger i stabil fase. Spirometrimålet som brukes er FEV1/FVC. Det anbefales "lower limit of normal" (LLN) som grenseverdi. Diagnosen inndeles i 4 stadier av luftstrømsobstruksjon (GOLD 1-4) og i 4 symptomdefinerte pasientgrupper (GOLD A-D)
Behandling: 
Røykeavvenning, opptrening og vaksinasjoner. Begrense eksponering for skadelig støv, gass og damp. Bronkodilatorer, ev. i kombinasjon med ICS. Andre betennelsesdempende medisiner (spesialistoppgave). Ev. slimløsende medisiner. Lungerehabilitering. Ved eksaserbasjoner ev. kur med systemiske kortikosteroider, ev. antibiotika. Ved alvorlig kols ev. oksygen- og ventilatorbehandling, unntaksvis spesifikke kirurgiske eller bronkoskopiske intervensjoner
  • Nasjonal behandlingstjeneste for organtransplantasjon, Oslo universitetssykehus HF, nettsted 
  • Nasjonal kompetanse­tjeneste for hjemmerespirator­behandling - NKH - nettsted 
  • Helsedirektoratet. Kols – diagnostisering og behandling . Nasjonal faglig retningslinje. Sist faglig oppdatert 15. februar 2022. Siden besøkt 21.02.2022. 
  • Global Strategy for the Diagnosis, Management, and Prevention of Chronic Ostructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2021 Report. Available from: http://goldcopd.org 
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  • Hasse Melbye, professor i allmennmedisin, Universitetet i Tromsø
  • Peter D. Jost, spesialist i allmennmedisin, redaktør NEL, Trondheim

Tidligere fagmedarbeidere

  • Per Bakke, overlege, professor ved Institutt for indremedisin, Universitetet i Bergen
  • Dag Berild, overlege, Medisinsk klinikk, Aker Sykehus