General Illness Information
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- its 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.
- Exposure to second hand smoke;
- 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
- 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.
- 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.
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.
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.
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.