| General Illness Information |
Common Name: |
Chronic
Obstructive Pulmonary Disease (COPD) |
|
Medical Term:
|
None Specified. |
| Description: |
Chronic airway obstruction
resulting from chronic bronchitis, emphysema, or a combination of
the two.
Estimated to affect 12-15
million people in North America. Males are more affected
than females. Incidence in females is rising.
It is the fourth common cause
of death |
| Causes: |
Damage to airways occurs
from: Cigarette smoking- most important cause; Air
pollution; Occupational exposure - workers exposed to
noxious gases and dusts; Alpha anti-trypsin deficiency.
Damage to airways occurs as
follows:
Irritants cause inflammation
of the alveoli (tiny air sacs of the lung). If such inflammation
is long standing, permanent damage may result. As a result of the
irritation, white blood cells collect in the inflamed alveoli and
release enzymes called neutrophil elastase that damage connective
tissue in the walls of the alveoli.
Smoking further diminishes the
lungs defenses by impairing the function of the tiny hair-like
cells (cilia) that line the airways and normally carry mucus
toward the mouth and thus expel bacteria and toxic substances from
the lung.
Alpha anti-trypsin is a
protein produced by the body- it’s role is to inhibit the
activity of the enzyme neutrophil elastase and thereby preventing
damage to the alveoli. In a rare hereditary condition, there is
little or no alpha anti-trypsin produced in the body and in these
people emphysema develops by early middle age, especially in
smokers.
|
| Prevention: |
Avoidance of smoking is the
most important measure. Also avoidance of secondary (or passive)
smoke, as it is now considered a risk factor.
Studies are underway to see if
there is a method for early detection of COPD.
|
| Signs
& Symptoms |
 |
No symptoms in early
stages. Earliest symptoms of chronic obstructive pulmonary
disease may appear after as little as 5 to 10 years of
smoking and these are a mild cough and sputum production on
arising. |
|
Chronic cough or
coughing spasms. |
|
Shortness of breath.. |
|
Sputum that is thick and
difficult to cough up. Sputum production varies according to
whether infection is present. |
|
Mild to moderate sputum
production. |
|
Frequent bronchial
infections |
|
Increasing shortness of
breath over several years, eventually severe and disabling
shortness of breath. |
|
Weight loss |
|
| Risk Factors |
|
Smoking. |
|
Exposure to second hand
smoke. |
|
Aging. |
|
Family history of
allergies, respiratory or lung disorders. |
|
| Diagnosis & Treatment |
|
Physical examination - In
early and mild chronic obstructive pulmonary disease, a doctor may not find anything
abnormal on physical examination except for a few wheezes on
auscultation of the chest. At this stage chest x-ray is also
normal. |
|
Pulmonary function
studies - Spirometry
to measure forced expiratory volume in 1 second may
demonstrate airflow obstruction and will help in making the
diagnosis. |
| Laboratory blood studies
- Blood test for alpha anti-trypsin in a young patient
with chronic obstructive pulmonary disease |
|
|
| General
Measures: |
|
Overall goals of
treatment are to relieve symptoms, slow progression of the
disorder and prevent complications.
|
|
Since cigarette smoking
is the most important cause of COPD, the main treatment is
to stop smoking. If smoking is discontinued when the airflow
obstruction is mild to moderate, it will slow the
progression to development of disabling shortness of breath. |
|
Avoid secondary smoke;
avoid other irritants. |
|
Home treatment is
usually adequate, but hospitalization may be required for
infections or worsening of symptoms. |
|
Installing air
conditioning in the home with air filters may be helpful (HEPA
filters are most effective). |
|
Bronchial hygiene may be
improved with postural drainage and chest physical therapy. |
|
Get pneumovax vaccine
every 6 years and influenza vaccine every year. |
|
Supplemental oxygen may
be required as the disease progresses. |
|
Join support group. |
|
Additional information
available from the American Lung Association, 1740 Broadway,
New York, NY 10019. Telephone (212) 586-4872. |
|
| Medications: |
|
Broncholdilators will be
prescribed. A therapeutic trial is necessary and once it is
evaluated, adjustments in dosage are made to minimize side
effects. |
|
Corticosteroid inhalers-
helpful in less than 20% of cases |
|
Antibiotics for
infections- flare-ups of chronic obstructive pulmonary
disease are often due to a bacterial infection, which can be
treated with a 7 to 10 day course of an antibiotic. |
|
Corticosteroids (oral)
may be beneficial for some patients, but use with Caution. |
|
Drugs for anxiety or
depression may be recommended, but must be used with caution
as increased sedation needs to be avoided. |
|
Replacement therapy for
alpha anti-trypsin deficiency. |
|
Oxygen therapy-
long-term oxygen therapy helps prolong the life of people
with severe chronic obstructive pulmonary disease who have
severely low oxygen levels in the blood. Round the clock
therapy would be optimal but even 12 hours of oxygen a day
would be beneficial. Oxygen therapy reduces the excess of
red blood cells caused by low blood oxygen levels, improves
mental function and also improves the heart failure caused
by chronic obstructive pulmonary disease. Oxygen therapy
also helps increase exercise tolerance and reduces shortness
of breath during exercise. |
|
| Activity: |
|
Prolonged inactivity
leads to increased disability. If there is no severe heart
disease, it is important to maintain a regular exercise
program (usually walking, cycling, or swimming).
Occupational therapy,
vocational rehabilitation, and physical therapy may be
recommended |
|
| Diet: |
|
No special diet, but
good nutrition is vital to help maintain your well being.
Drink at least 8 to 10 glasses of fluid each day. |
|
| Possible
Complications : |
|
Frequent infections;
anxiety and/or depression. |
|
Other complications
include pulmonary hypertension, cor pulmonale, secondary
polycythemia, bullous lung disease, and respiratory failure. |
|
| Prognosis |
|
Gradual decline in lung
function. However, treatment can reduce symptoms, help
prevent infections, and permit you to lead a more active,
productive life.
Prognosis depends on the
severity and the age of the patient. Median survival varies
considerably. Younger patients may have a fairly good
prognosis, while older patients have a poorer prognosis,
especially if there are other medical problems. About 30% of
patients with the most severe disease die in 1 year; 95% die
in 10 years.
Patient who reside at an
altitude above 3500 feet have reduced longevity. |
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| Other |
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